“Helping Hospitals Manage Waste” Hospital Waste Volume 9, Issue 4 Hospital Waste Management Winter 2007 Inside this issue: Stericycle Returning Radioactive Stericycle Returning Radioac- Medical Waste Containers tive Medical Waste Containers 1 tericycle, Washington’s largest gamma scintillator probe. Medical waste S medical waste treatment ven- tubs pause for 3 to 5 seconds on the con- EPA De-Lists Epinephrine 3 dor, has been checking incoming medi- veyor belt for the system to detect radioac- Have All Your EOC Informa- cal waste tubs at their Morton, WA fa- tivity. If a tub trips the detection alarm on tion at Your Fingertips 3 cility and increasingly discovering “hot” the conveyor belt system, an additional tubs. These discoveries typically cost scan is performed with the handheld device Homeland Security Establishes hospitals $1,000 per radioactive tub (not to confirm the reading. a National Strategy for Public counting transport costs) and have been The Washington Department of Health 3 Health and Medical Prepared- getting a lot of attention in hospitals. doesn't regard patient waste of any kind as ness This has always been an issue since being legally radioactive, even if it is radio- Stericycle has always had a policy of active. Patient waste is exempt from Wash- not accepting radioactive materials, but ington state radioactive material manage- has recently become problematic due to ment regulations. However, Stericycle equipment changes at Stericycle that doesn't have a radioactive materials license increase the detection sensitivity for and cannot accept any radioactive tubs for Our firm… radioactive materials. The current prob- treatment. DOH has no influence over ospital Waste Man- lem began in March 2007 when a Wash- Stericycle’s zero-tolerance policy towards agement is commit- H ington research facility accidentally sent radioactivity in the tubs that it treats. Both ted to assisting healthcare fa- a medical waste tub to Stericycle's treat- Stericycle and DOH consider the medical cilities in complying with haz- 125 ardous material management ment plant that contained I - really waste generator as the default responsible and waste disposal regulations hot and plenty of it. It tripped Stericy- party. As a direct consequence, hospitals and better managing their cle's tub conveyor line gamma energy are receiving more telephone calls from wastes. Our clients are hospi- detector, which takes a fair degree of Stericycle with the irritating news that a tub tals, clinics, and medical labs. radioactivity to activate. Since then must be retrieved because it is radioactive. Our services include con- Stericycle has been much more aggres- It is important to note that the U.S. De- ducting dangerous, solid, ra- sive about checking tubs with a hand- partment of Transportation regards regu- dioactive, and regulated medi- held low-energy iodine probe, which is lated medical waste as not otherwise speci- cal waste audits; risk assess- more sensitive than their tub conveyor fied (n.o.s.), 6.2, UN 3291, PG II material. ment; hazmat audits; develop- ing waste management plans line detector when physically held It continues to retain this designation even for Joint Commission compli- closer to the tub surface. after it is found to be radioactive, so don’t ance; hazmat emergency re- Stericycle uses two radiation detec- send your assistant down to Stericycle in sponse training; and annual tion systems: a conveyor belt system his/her private vehicle to pick up the tub! dangerous waste and Pollution and a portable system. The belt system If you receive a call from Stericycle Prevention reporting. uses a Ludlum Model 177 as rate meter about a hot tub, you should contact the Our e-mail address is: and a Model 44-2 Sodium Iodide Washington Dept. of Health and immedi- [email protected]. For gamma scintillator probe. The portable ately request a Special Permit to retrieve past Hospital Waste issues, system uses a Ludlum 14C rate meter the radioactive tub. This Special Permit check our website at http:// and another Model 44-2 Sodium Iodide (Continued on page 2: Radioactive Tubs) www.hospitalwastemgmt.com. PAGE 2 HOSPITAL WASTE VOLUME 9, ISSUE 4 (Radioactive Tubs: continued from page 1) vesting about $1,000 or so in their own will relieve the transporting party of Ludlum low-energy radiation detectors Hospital Waste most U.S. Department of Transporta- (Ludlum Measurements, Inc., Sweet- tion regulations pertaining to the ra- water, TX; http://www.ludlums. com/) “Helping Hospitals dioactivity content in the tub. The and training staff to survey all their Manage Waste” DOH Permit transfers oversight au- medical waste tubs before going Publisher: thority to Washington DOH for the out. Because Washington DOH doesn't Alan B. Jones, Ph.D. unknown radioactivity and serves as regard this waste as legally radioactive Hospital Waste Management the authority to transport the radioac- there are no specific management re- 17629 N.E. 138th Street tive medical waste tub if the trans- quirements when you hold such waste Redmond, WA 98052-1226 porter should be stopped and ques- to decay to background. You must store tioned by Washington State Patrol. it somewhere in any fashion that is se- Hospital Waste is published Some Stericycle clients have been cure from untrained staff and the gen- quarterly for hospital, clinical, and medi- charged by Stericycle with radioactive eral public until the radioactivity isn't cal laboratory waste managers. medical waste tubs that contain iso- detectable by Stericycle. After the de- Hospital Waste Management is topes that don’t even appear on the cayed regulated medical waste is sent to committed to serving the Healthcare Industry by assisting hospitals in manag- facility’s radioactive use license. In- Stericycle, you must close out the Spe- ing their waste. Hospital Waste cluded in this group are facilities that cial Permit that you obtained from aims to broadcast information about don’t have a radioactive materials li- Washington DOH to transport the tub waste regulations and waste manage- cense. This frustrating situation can by contacting Washington DOH. ment initiatives and to provide helpful develop because patients may un- If you do use a Ludlum 44-2 to hints and general waste information to dergo radiation procedures in one monitor your medical waste tubs, note healthcare waste managers. medical office, then arrive on your that Stericycle has set their monitors for If this newsletter has reached you in facility’s doorstep for a surgical pro- a background count of 900—1000 cpm error, please notify the Editor by phone, cedure. The procedure creates medi- and to alarm at 1200 cpm. fax, or e-mail. If you wish to be placed cal waste contaminated with the ra- It is possible to identify a radioac- on our quarterly mailing list, please con- tact the Editor. For past issues and an dioactive isotope from the first, off- tive isotope either using a multi-channel index of articles, check our website at site procedure. The patient is under no analyzer (which can cost $5,000 to http://www.hospitalwastemgmt.com. legal obligation to tell the surgeon and $6,000 or more) or by monitoring the This newsletter is may not be aware that their bodies half-life decay of the offending waste. copyrighted by Alan still contain the radioactive materials. The most commonly-found isotope in B. Jones. Reprints are The administering physician must medical waste tubs is technetium encouraged with ac- only counsel the patient to warn an- (99mTc), which has a half-life of 6-hours knowledgement to other physician if the total effective and typically decays to background Alan B. Jones, Ph.D. dose equivalent (TEDE) to anyone within two days. The next most com- Please send any letters else is likely to exceed 100 millirem. monly-found isotope is probably iodi- or comments to: This is only likely when a patient is ne131 (131I), which has a half-life of 8.06 Alan B. Jones, Editor undergoing therapeutic treatments. days and can take about 2 months or Hospital Waste Almost all diagnostic procedures in- more to decay to background. Finally, 17629 N.E. 138th Street volving radioactivity would not result another commonly-found longer-lived Redmond, WA 98052-1226 in someone receiving a 100 millirem isotope is thallium201 (201Tl), which has Ph: (425) 883-0405 Fax: (425) 895-0067 dose from the patient. a 73-hour half-life and decays to back- E-mail: [email protected] Incredible as it may seem, your ground in approximately 3-4 weeks. http://www.hospitalwastemgmt.com facility’s surgeons may be creating Technetium 99m is seldom a lingering radioactive medical waste and not problem because by the time the waste Our Editorial Policy even know they’re doing so. Unfortu- transport truck gets to Stericycle’s Mor- While every effort was made during the development of this newsletter to insure nately, your facility has little, if any, ton plant, the isotope has decayed to accuracy, we make no warranties or cer- recourse. You must retrieve the tub background. tifications. We encourage you to contact and hold it until it is decayed to back- The problem of returned medical the references listed in the articles or ground because the hospital is invaria- waste tubs is likely to get worse as Alan B. Jones for further information bly the default responsible party. Stericycle continues to discover “hot” about any topic mentioned in this news- To prevent this situation from tubs. letter. occurring some hospitals are now in- VOLUME 9, ISSUE 4 HOSPITAL WASTE PAGE 3 U.S. EPA De-Lists Medical the locations of all fire extinguish- Have All of Your ers in your facility, by floor? All Epinephrine Salt Solutions EOC Information At such information can be visible - but - with a mouse click.