Proper disposal of chemotherapy waste is extremely important to protect healthcare workers, patients, and the environment from exposure to hazardous drugs. Even trace amounts of chemotherapy drugs can be dangerous if not contained and disposed of correctly. In this article, we will examine the best types of containers to use for disposing of trace chemotherapy waste.
Overview of Chemotherapy Waste
Chemotherapy drugs, also known as hazardous drugs or antineoplastic agents, are used to treat cancer and other illnesses. They work by killing cells that divide rapidly, which includes cancer cells as well as some healthy cells. Chemotherapy drugs are highly toxic and can cause serious health effects if people are exposed.
Healthcare facilities that administer intravenous (IV) chemotherapy generate a significant amount of related waste. This includes:
- Trace chemotherapy waste – small amounts of leftover drugs, contaminated personal protective equipment (PPE), disposable materials that come into contact with hazardous drugs, and other related items.
- Bulk chemotherapy waste – larger volumes of contaminated liquids, empty drug vials, IV tubing, and other waste.
Both trace and bulk chemotherapy waste must be carefully contained and disposed of to avoid contamination. This article focuses specifically on trace chemotherapy waste disposal.
Hazards of Improper Disposal
Improperly contained or disposed trace chemotherapy waste poses significant risks including:
- Environmental contamination – Chemotherapy drugs can leach into the water supply and soil if poured down drains or into landfills.
- Worker exposure – Healthcare workers who handle waste without adequate protection can absorb chemicals through their skin or inhale traces, increasing their risk for adverse health effects.
- Patient exposure – Patients and family members may be exposed if trace amounts of drugs contaminate surfaces, medical equipment, or patient care areas.
- Public health risks – Improper landfill disposal can expose waste management workers. Drugs may also leach into groundwater if not properly contained.
To prevent these risks, special disposal processes must be followed.
Regulations for Chemotherapy Waste Disposal
A variety of regulations at the federal, state, and local levels dictate the proper handling and disposal of hazardous chemotherapy waste in healthcare settings.
Federal Regulations
- OSHA’s Bloodborne Pathogens Standard requires employers to have a written exposure control plan that includes handling and disposing of regulated waste like chemotherapy.
- EPA classifies discarded commercial chemical products like chemotherapy drugs as hazardous waste under the Resource Conservation and Recovery Act (RCRA).
- DOT establishes transportation requirements for hazardous materials including chemotherapy waste.
State Regulations
Most states adopt their own hazardous waste regulations that align with and often expand upon federal rules. States may have specific chemotherapy waste requirements including:
- Licensing for healthcare facilities that generate hazardous chemotherapy waste.
- Training requirements for workers who handle waste.
- Storage limits for accumulated hazardous waste.
- Recordkeeping and reporting rules.
- Strict disposal standards.
Local Regulations
Local municipalities and waste management authorities often have their own hazardous waste programs with rules that healthcare facilities must follow. Many prohibit or restrict chemotherapy waste disposal in landfills or sewer systems.
Best Containers for Trace Chemotherapy Waste Disposal
To comply with regulations and best practices, trace chemotherapy waste should be accumulated and stored in designated containers before final disposal. The best containers are:
1. Sealable Plastic Bags
- Double-lined and leakproof
- Meet ASTM D1709 standard for tear and puncture resistance
- Often red or orange to signify hazardous content
- 1-3 gallon size optimal
- Thicker 3-5 mil plastic preferred
Sealable plastic bags provide secure containment and are easy to tie off when full to prevent spills. Bags should be placed inside a second leakproof protective bag before handling and storage.
2. Rigid Plastic or Metal Containers
- Impermeable plastic or stainless steel
- Tight-sealing, leakproof lids
- Handles for safe transport
- Locking capability preferred
- Well-labeled with chemotherapy hazards
Rigid containers offer sturdy, long-term storage with less risk of rupture compared to bags. They are ideal for facilities that accumulate larger volumes before hauling away.
3. Chemotherapy Disposal Boxes
- Cardboard box lined with leakproof plastic or a portable stand-alone container
- Conforms to DOT shipping regulations
- Designed specifically for chemo waste with absorbents, segregated inner bags, and a tight lid
- Available in sizes ranging from 2 gallons to 55 gallons
- Pre-labeled with hazards and compliance information
Specialized chemotherapy disposal boxes provide the benefits of rigid containers in an easy to use package that contains spills. Their design allows safe transport of full boxes to treatment facilities.
Key Steps to Safely Accumulate and Store Trace Chemotherapy Waste
Healthcare workers who generate trace chemotherapy waste should follow specific procedures to safely accumulate and store the containers before final disposal. Key steps include:
- Segregate – Separate trace chemo waste from other trash immediately at the point of generation. Do not mix with regular waste.
- Contain – Place items inside sealable plastic bags first. Double-bagging is recommended. Bags can then go into rigid containers or chemo boxes.
- Label – Identify all containers with words like “Chemo”, “Chemotherapy Waste”, “Hazardous Waste”, or with universal biohazard symbols.
- Transport – Use carts or secondary containment during transportation to prevent spills.
- Store – Keep closed chemotherapy waste containers in a designated, secure area with restricted access.
- Inspect – Check storage areas regularly for leaking or deteriorating containers.
- Manage – Follow facility policy and regulations for maximum storage time before disposal.
Adhering to safe handling and storage processes reduces risks to staff, patients, and the public from improper management of trace chemotherapy waste.
Types of Acceptable Final Disposal Methods
After packaging in designated containers, trace chemotherapy waste must be properly disposed of by acceptable methods that are protective of human health and the environment. The main disposal methods are:
Incineration
- High temperature burning in a controlled incinerator
- Most widely used and preferred disposal method
- Destroys chemotherapy compounds and converts to non-hazardous emissions
- Special permit and emissions controls required
Hazardous Waste Landfill
- Specially engineered landfills designed to safely contain hazardous wastes
- Only available in some regions
- Must follow Land Disposal Restrictions for certain chemo drugs
Medical Waste or Municipal Incinerator
- Alternative in some areas lacking hazardous waste incinerators
- May face regulatory restrictions on chemotherapy amounts
- Ash residues still require hazardous waste landfill disposal
Return to Supplier
- Full or partially unused vials may be returned under some state laws
- Follow manufacturer and regulatory requirements
Whichever method is used, proper permits and manifests are required to track chemotherapy waste from its generator to final disposal.
Table Comparing Disposal Methods for Trace Chemotherapy Waste
| Method | Disposal Process | Considerations |
|---|---|---|
| Incineration | Burning at high heat to destroy chemotherapy agents and sterilize waste. |
|
| Hazardous Waste Landfill | Burial in a specially designed landfill. |
|
| Medical or Municipal Incinerator | Burning in incinerator without hazardous waste permit. |
|
| Return to Supplier | Sending unused vials back to manufacturer. |
|
Conclusion
Properly containing and disposing of trace chemotherapy waste is critical for protecting healthcare personnel and the public from hazardous exposure. Plastic bags, rigid containers, and chemo boxes are all appropriate for packaging trace waste to be sent for final disposal by incineration, hazardous waste landfill, or another regulated method. Strict procedures must be developed and followed for segregating, storing, transporting, and managing chemotherapy waste within healthcare facilities. With careful attention to safe handling and disposal practices, the risks associated with hazardous chemotherapy agents can be minimized.
