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Spring 2001 Circulate to: ____ Safety
____ Infection Control ____ Plant Operations ____
Other Safe Needle Devices In 2000, state and federal legislation was passed requiring hospitals to use safe needle devices. These devices come in a variety of styles. Some are essentially old-fashioned syringes with retractable needles. Imagine the scene…. An injection is given and a second later, the needle retracts into the barrel of the syringe, leaving a blunt tip plastic syringe. There are other safe needle devices as well associated with other 'sharp' devices health workers use such as intravenous catheters, dialysis catheters and blood drawing devices. For years, hospitals have been complying with the OSHA bloodborne pathogen rule and other regulations that require the segregation of sharps. Hospitals and health facilities have installed needle collection boxes, referred to as “sharps containers” in areas where sharps are used. Regardless of the type of sharps container your facility uses, keep using them for the new safe needle devices. Just because there isn't an obvious 'sharp' object at the end of a syringe with the new devices, it does not alleviate the need for segregation and disposal of these devices as sharps. The sharp is still present, only now it is housed in the barrel of the syringe. With handling, the needle may protrude. Protecting workers and reducing exposure to bloodborne pathogens all along the chain, from hospital housekeepers to waste treatment processing staff to landfill workers, is the intended purpose of containment of sharps devices in sharps containers. For more information, visit www.needlestick.org. Bad Medicine Did you know that some pharmaceuticals are actually hazardous wastes? For an informative read about hazardous pharmaceuticals visit this Web site: www.hfmmagazine.com/asp/ArticleDisplay.asp?PubID=5&ArticleID=13508. You and your hospital pharmacist may be surprised to learn that drugs such as warfarin, epinephrine > 0.3% concentrations, nicotine and nitroglycerin are listed as hazardous wastes. Other wastes that are listed as hazardous wastes for toxicity include lindane, mitomycin C, diethylstilbesterol, selenium sulfide and cyclophosphamide. DOT Hazardous Materials
Registration Program As of July 1, 2000, registration is required for persons that offer or transport any shipment of hazardous materials that requires placarding. This rule applies to hospitals that generate hazardous waste and have it transported off site. Under the federal hazardous material transportation law (49 U.S.C. 5101 et. seq.), offerers and transporters of hazardous materials, including hazardous waste, are required to file a registration statement with the U.S. Department of Transportation and to pay an annual fee. This program began in 1992 and is administered by the Associate Administrator for Hazardous Materials, Safety, Research and Special Programs Administration (RPSA). The registration regulations are found at 49 CFR 107.601 - 107.620. The fee provides funds for grants distributed to states and Indian tribes for hazardous materials emergency response planning and training through the Hazardous Materials Emergency Preparedness Grants Program. For use in FY 2000, 50 states, the District of Columbia, five territories and the eight Indian tribes received grant awards totaling $8.5 million. These grants support planning and training of emergency personnel to respond to incidents involving hazardous materials. Since 1993, the grants have been used to train, in part, approximately 120,000 emergency responders each year. In addition, $750,000 in grants have been made to the international Association of Fire Fighters to support their hazardous materials instructor train-the-trainer program. The fees are also used to publish the Emergency Response Guidebook. Your fee is helping communities prepare for a spill accident or other hazardous materials emergency that may occur. For more information on the program call 617/494-2545 to obtain a form and instructions or call for Automated Fax-on-Demand service for brochure and form (request document 700) 800/467-4922. For registration information and answers call 202/366-4109. For general hazardous materials information call 800/467-4922. Helpful Information on Ohio EPA Web Site Did you know you are just a few clicks away from useful and interesting information on health care pollution prevention, waste management and mercury management? Do you know where to find lists of vendors to assist in managing those more challenging wastes created at your facility? Visit the Ohio EPA Web site at www.epa.state.oh.us/opp/hospital.html to learn more. Also visit the U.S. EPA Web site at www.h2e-online.org/index.asp. Hazardous Waste and Compliance with RCRA: The Resource
Conservation and Recovery Act Looking for a cost-effective way to learn more about hazardous waste regulations? Visit the EPA's Web site listed below to gain access to a series of 33 different self study modules that can get you up to speed in a flash. www.epa.gov/epaoswer/hotline/rmods.htm Hospitals have many obligations and responsibilities under hazardous waste regulations. Hospitals are not exempt from compliance. This RCRA Web site includes RCRA modules on various aspects of the regulations including enforcement, storage, waste generator status, mixed wastes and more. In case you are wondering whether or not you need to learn about RCRA, try taking the little quiz below for a quick check on your knowledge base. 1. My hospital does not generate hazardous chemical waste. TRUE FALSE 2. Our hospital's waste generator status has been determined and it is: CESQG SQG LQG TSDF UNSURE 3. Our facility has an EPA ID number. TRUE FALSE 4. Our facility disposes of alcohol, formaldehyde, xylene and other lab chemicals down the drain. TRUE FALSE 5. D00, F00, P00 are:______________________. Answers & Explanations 1. FALSE. Every hospital generates hazardous waste. It's a fact of life in hospital settings. Whether it’s solvents in the lab, hazardous pharmaceuticals, silver and lead from radiology, or formaldehyde from dialysis. 2. If you circled unsure, give yourself 0 points. Be sure and visit the module on waste generator status to determine your facility's waste generator status. CESQG means conditionally exempt small quantity generator. SQG means small quantity generator, LQG means large quantity generator and TSDF means treatment storage and disposal facility. Rules govern each of these categories. 3. Most hospitals generate quantities of hazardous wastes and are required to have an EPA ID number. If you aren't sure if your facility has one, give yourself 0 points unless you can produce a certified letter from your local wastewater treatment authority specifying permission to discharge specific quantities of listed hazardous wastes. Check with individuals responsible for handling hazardous wastes. If that is you and you are still not sure, contact the Ohio EPA and request the EPA publication "Notification of Regulated Waste Activity" EPA form 8700-12. 4. If you answered True to this, give yourself 0 points. You might want to review and reconsider your facility's current practices. Alcohol, formaldehyde and xylene are listed wastes for their characteristics of either ignitability or toxicity and should be managed as hazardous wastes. Unless your organization can produce written documentation from the local water treatment authority giving permission to discharge specific amounts and types of listed hazardous wastes down the drain, it is advisable to discontinue this practice. 5. If you left this answer blank, give yourself 0 points. The D00, F00 and P00 codes are part of the numeric coding system for hazardous wastes. F00 is the number heading for hazardous wastes from non-specific sources. P00 is the number heading for hazardous wastes from discarded chemicals, spills and container residues. D00 is the number heading for hazardous wastes that are toxic. Patient Confidentiality Has Implications for Paper
Recycling and Waste Paper Programs Patient privacy concerns at both the state and federal levels have placed greater attention on paper recycling and waste paper management at hospitals. The Ohio Supreme Court ruled in 1999 that “an independent tort exists for the unauthorized, unprivileged disclosure to a third party of nonpublic medical information that a physician or hospital has learned within a physician-patient relationship” (Biddle v. Warren General Hospital). This decision appears to make a hospital financially responsible for mismanagement of paper waste containing patient information. At the federal level, the Health Insurance Portability and Accountability Act of 1996 requires a patient privacy rule. The final rule prohibits the disclosure of patient information to others without patient consent, notice, or contracts with business associates such as waste haulers. While the Bush administration is expected to reduce its scope, it still is possible that the revised rule will impact the manner in which hospitals recycle or dispose of paper containing patient information. Hospitals should consider treating as confidential all waste with patient information. Medical records and certain financial documents are obvious candidates, but so too are lab slips, message notes with patient names and diagnosis information, care plans, special menus, and billing information. Things to check:
If you are just beginning to address this issue and are unsure of whether or not to hire a company to manage confidential document disposal or to do it yourself, here are some considerations to think about:
Mercury Factoid Some scientists say if all mercury pollution ended today, it would be 50 years before fish would be safe to eat. Bioterrorism Training Available The Ohio Department of Health has developed a two-hour presentation on the subject of hospital readiness for bioterrorism. Included is reporting and contact guidelines, detection of outbreaks, infection control practices, decontamination issues, laboratory support, and public communication. Participants receive a free manual that otherwise retails for $75. For information, contact Chris Mesner at ODH, 614/995-5901. Governor’s Award for Excellence in Energy Efficiency Gov. Bob Taft has announced that entries are being accepted for the 2001 Governor's Award for Excellence in Energy Efficiency. Created in 1994, the Governor's Excellence in Energy Efficiency Award was established as an initiative in the Ohio Energy Strategy Report. The award honors individuals, businesses and organizations that improve energy efficiency, the environment and Ohio's economic competitiveness. "This winter's high energy bills have demonstrated that Ohio, like the rest of the nation, must continue to develop new methods of energy," Taft said. "The Governor's Award for Excellence in Energy Efficiency salutes individuals and companies who are providing a vital service by pursuing resourceful, cost-efficient ways to limit energy consumption." Projects eligible for the Governor's Award include:
Last year's award winners included: City of Lakewood; HI Tech Metal Group; Neighborhood Housing Services of Toledo; Ohio Bureau of Worker's Compensation; Stark Metropolitan Housing Authority; and the University of Cincinnati. The Ohio Department of Development's Office of Energy Efficiency coordinates the Governor's Award for Excellence in Energy Efficiency. All project entries must be postmarked by June 15, 2001. The winners will be honored at a ceremony this fall. Cancer Factoid Ohio ranks 13th in the country in cancer deaths according to the Ohio Cancer Surveillance System. An article in the July 13, 2000 issue of the New England Journal of Medicine concluded that “the environment has the principal role in causing sporadic cancer,” and that “inherited genetic factors make a minor contribution to susceptibility to most types of neoplasms.” May 14-17 Free Mercury Seminars The five metropolitan hospital associations and OHA are sponsoring two-hour workshops at which the Ohio EPA’s Mercury Challenge resource guide and campaign will be unveiled and discussed. In addition to EPA staff, Glenn McRae of CGH Environmental Strategies, Inc. will make a presentation involving:
The free workshops are scheduled on the following dates and corresponding cities: May 14 (3-5 p.m.) Akron Regional Hospital Association May 15 (9-11 a.m.) The Center for Health Affairs, Cleveland May 15 (3-5 p.m.) Fisher-Titus Medical Center, Norwalk May 16 (9-11 a.m.) Hospital Council of NW Ohio, Toledo May 17 (9-11 a.m.) Greater Dayton Area Hospital Association May 17 (3-5 p.m.) Greater Cincinnati Health Council You can register for the free workshops by calling the metropolitan hospital association that is hosting the meeting, or by contacting Stacey Walton (staceyw@ohanet.org) at OHA. The shorter version of the two hour workshop will be presented at OHA’s Summit on June 19 in Columbus. However, there will is a registration fee of $50 for the Summit, and a fee for the luncheon at which the Mercury Challenge presentation will be made. Pollution Prevention, Mercury & EPA Sessions at OHA’s
June Summit OHA is holding its annual state hospital convention on June 18-19 in Columbus, and June 19 will feature three interesting environmental programs and a luncheon. Dale Farmer, an OEPA staff person who responds to mercury spills, will discuss the difficulty of mercury spill cleanup and show slides or video of the clean-up problems presented by mercury. Those who have heard Dale speak on this subject can attest to the interesting and practical nature of his remarks, plus remarkable audio-visual. Pollution prevention strategies will be the topic for panel discussion on the same day. Peg Baird from Fisher-Titus Medical Center, Daryl Seckman from East Liverpool City Hospital and Lewis Hutchison from Forum Health. A third session will feature Charles
Waterman III, an attorney with Bricker and Eckler, LLP. He will review current EPA regulatory and
enforcement issues. Also at the Summit will be a luncheon featuring Ellen Miller as a speaker. Ellen is with the OEPA Office of Pollution Prevention, and she will review the Mercury Challenge program. This will be a good time to network with your colleagues. More information about OHA’s Summit will be mailed by May. Mercury in the News The Cleveland Plain Dealer reported March 24th that theft of a jar of mercury exposed 90 students to the hazardous element and led to evacuation of a family from their home. The incident began when a Lorain County student stole a jar of mercury from the storage room of a vocational school in Oberlin. The boy and classmates played with the mercury on the school bus, and then took it home where he contaminated his family’s house. Air monitoring in the home found an unsafe level and the family was evacuated indefinitely. Lorain officials also found two bottles of mercury shared by the first student with others on the bus. Officials visited the homes of the 47 students and bus driver, and the classroom from which the mercury was stolen was isolated. The Plain Dealer also reported a mercury spill in a Geauga school, when students dropped a foot-long mercury thermometer. The Township Fire Chief reported the spill was contained. In related news, conservation groups such as the National Wildlife Federation announced in late March their opposition to efforts by the electric utility industry to stop the U.S. EPA from setting low mercury emissions. The electric industry argues the agency failed to adequately quantify human health risk posed by mercury emissions, or to provide a public comment period before finalizing the standard. The Centers for Disease Control and Prevention separately released a report in March showing at least 10% of women of childbearing age ingest mercury at rates above the EPA’s safe level. CDC estimated 390,000 children are born annually at risk for neurological effects due to mercury exposure. Pollution Prevention Seminars on June 5 & 6 In addition to mercury workshops in May and general environmental programs at the OHA convention in mid-June, the Ohio EPA and OHA are offering half-day pollution prevention seminars on June 5 and 6. The June 5 seminar will be held in the Akron area, and the June 6 seminar will be held in Northwest Ohio. Locations will be announced later. These morning seminars will feature the unveiling of an Ohio EPA “pollution prevention” resource guide intended to help hospitals reduce waste stream volume and otherwise prevent pollution. Hollie Shaner of CGH Environmental Strategies, Inc. will use examples drawn from her hospital background and consulting experience with the American Hospital Association and in other states; the examples will assist hospitals in identifying waste stream opportunities, including those that are good for the financial bottom-line. OHA Environmental Policy Committee The mission of OHA’s Environmental Policy Committee (EPC) is to make recommendations to OHA staff and governing board regarding environmental and occupational safety matters. For example, the EPC’s recent agenda included discussion of Ohio’s infectious waste law, OSHA’s bloodborne pathogen standard and a proposal by a national campaign to collect chronic disease diagnoses. The EPC members include: §
Peg Baird, Fisher Titus Medical Center (Chair) § Mary Beth Barrentine, Miami Valley Hospital § Jo Ann Boggs §
Naomi Caldwell, Community Hospital of Springfield §
John Capron, Cleveland Clinic Foundation § Robert E. Columber, Marion General Hospital §
Carol Elder, Mt. Carmel Health System §
Michael Grodi, University Hospital, Inc. §
Ron Himes, Promedica Health Systems §
Lewis Hutchison, Forum Health §
Terri LoPresti, Community Hospital of Springfield §
Howard Perry, St. Luke's Hospital § Brian Saul, Grant/Riverside Methodist Hospitals §
Richard Schuffert, MedCentral Health System §
Rich Stephenson, Children’s Hospital Medical Center §
David Taylor, The Ohio State University Med Center If you are interested in attending or being a member of the EPC, contact Stacey Walton at OHA. |
