March 31, 2021 Hazardous Waste Management for Veterinary Practices In 2019, Americans spent $95.7 billion on pet care – 30% of that total was for veterinary care and services. In 2018, a New York Times article reported that pet owners “spend $9,000 to more than $13,000 for medical treatments over their pets’ lifetimes.” Animals are living longer because they benefit from better nutrition and better healthcare, but a longer lifespan makes them more susceptible to age-related diseases like heart disease, diabetes, arthritis, and cancer. As a result, many veterinarians are called upon to provide more advanced care. Some treatments may produce regulated medical waste and/or hazardous wastes that could expose the staff to environmentally harmful and hazardous substances. Veterinary practices need to understand how to safely administer treatments and make waste determinations to compliantly segregate and package/store hazardous wastes in order to comply with OSHA and DOT safety standards. Hazardous Wastes in Veterinary Practices Hazardous waste is waste that is dangerous or potentially harmful to our health or the environment. It may be in the form of liquids, solids, gases, sludges, discarded commercial products, like pharmaceuticals, or the by-products of a healthcare process such as gram staining. Can you answer “yes” to these four questions about hazardous waste? Determination: Do you know if the wastes you generate are hazardous according to the Environmental Protection Agency’s RCRA regulations or state definitions? Storage: Do your storage containers comply with EPA, DOT, and state storage and volume limits – including utilizing the proper DOT-authorized containers for on-site storage and transportation? Transportation: Are you using a regulatory-compliant transportation method to ship the hazardous wastes to a treatment facility? Treatment: Have you implemented a cradle-to-grave tracking system that allows you to track and verify the receipt and treatment of the hazardous wastes generated at your site as required by state and federal regulations? If the answer to any of the questions is “no,” your practice could incur regulatory penalties and/or monetary fines for non-compliance. Sharps Compliance can help you correctly identify wastes, train employees, and provide regulatory-compliant storage, transportation, tracking, and disposal solutions. Pharmaceutical Waste in Veterinary Clinics Proper disposal of medications used in veterinary practices can be confusing. Common pharmaceutical wastes unique to the veterinary industry include: Autogenous vaccines Modified live vaccines Controlled substances used in euthanasia Drugs used for infusing chemotherapeutics and expired inventory medications can fall under several different types of drug classifications with regard to disposal. This waste involves expired pharmaceuticals in original containers and non-controlled pharmaceuticals (spilled liquids, dropped pills, drugs remaining in syringes after treatment, etc. and not in original containers). Many of the medicines are classified as hazardous waste pharmaceuticals (HWP). The American Veterinary Medical Association (AVMA) urges its members to follow all regulations and guidelines for pharmaceutical waste and train employees on its proper segregation and disposal procedures. The AVMA also explicitly endorses incineration as “the best method of drug disposal.” Sharps Compliances can help you manage your HWP waste as well as your non-regulated pharmaceutical waste through a variety of programs, along with DEA-controlled substances used in veterinary medicine. Other Types of Hazardous Wastes Common in Veterinary Clinics Waste Gram Stain and Differential Stains: The HW from this process generates ignitable solvent-based waste. Waste Formaldehyde/Formalin: Used solutions are not RCRA HW, but the management is regulated in many states. Formalin contains a biocide and can damage water treatment systems. Waste Fixer Solution: X-ray fixer solutions may be toxic for silver, an EPA characteristic HW. Veterinarians and Federal Regulations (OSHA, DOT, etc.) Many veterinarians don’t realize that they’re subject to regulations promulgated by many federal and state agencies. The most common agencies include the Environmental Protection Agency (EPA) and the US Department of Transportation (DOT) in the proper management of hazardous wastes. The compliant management of discarded pharmaceuticals or wastes from analytical processes can be cumbersome and confusing. This is because, contrary to all the training of healthcare professionals, there is not routine training or instruction in environmental regulations. Let Sharps Compliance Help All employees of veterinary clinics should have training in hazardous waste management, so they understand waste categories, proper use of personal protective equipment, OSHA safety standards, and other aspects of hazardous waste storage and handling. All our customers have access to ComplianceTrac. This online tool is available 24/7. It puts employee training, safety plans, and storage of all required OSHA documents in one location for easy access. With ComplianceTrac, you and your staff can easily manage: Employee Training: Employees can access OSHA-required training in BBP, HazMat, Fire Safety, Workplace Violence, and more. SDS Management: View, print, store, and organize SDS (MSDS) from a searchable database of over 1 million SDS. Safety Plans: Fill-in-the-blank customization of OSHA-required Safety Plans Up-to-date access: ComplianceTrac replaces outdated hard copy manuals with up-to-date resources available 24/7, all archived online for ten years. Sharps Compliance is a leading supplier of hazardous waste disposal solutions for veterinary hospitals of all sizes. We work with small standalone practices, specialty animal hospitals, and multi-state veterinary practices. Contact us to learn more. Read More
February 27, 2019 Veterinarians, Pet Medications, and the Opioid Crisis Last updated on April 13, 2021 Ninety-five percent of pet owners say they consider pets a part of the family, but there’s a darker side to some of those families. Sadly, as in so many human families, drug addiction is breaking the bonds of affection and trust. Veterinarians have reported cases where opioid addiction is leading pet owners to steal their pets’ medications or even injure their pets in an effort to get pain meds prescribed. As a result, many veterinarians unexpectedly find themselves involved in a human epidemic – the opioid crisis. According to the CDC, 46 people die every day from prescription opioid overdoses, and pet medications play a role. Abusers Look to Pet Medications as an “Easier” Source for Drugs In 2017, Blue Cross Blue Shield analyzed the claims of over 30 million people and found that diagnoses of opioid-use disorder had increased by almost 500% in just 7 years. The study also found that prescription strength and duration affected the chance of opioid-use disorder. As evidence mounted that over-prescribing opioids was contributing to increasing rates of addiction and death, many states imposed restrictions on physicians and pharmacists. When that happened, it became more difficult to get and fill opioid prescriptions for humans. That made pet medications an attractive alternative for some abusers. In 2018, an editorial in the American Journal of Public Health cited a survey of Colorado veterinarians and urged the profession to accept that they “have a dog in the fight” against opioid abuse. “Key findings include the following: 13% of surveyed veterinarians were aware that an animal owner had intentionally made an animal ill, injured an animal, or made an animal seem ill or injured to obtain opioid medications; 44% were aware of opioid abuse or misuse by either a client or a veterinary practice staff member; and 12% were aware of veterinary staff opioid abuse and diversion.” One of the more shocking aspects of pet medication abuse is how far people will go to obtain the medications. A woman in Kentucky cut her golden retriever with a razor and took him to the same vet three times for pain meds. The doctor became suspicious because the cuts “looked like clean cuts instead of the jaggedness that you might see in most animal injuries,” and the woman asked for a medication by name. An Ohio man taught his dog to cough on cue in an effort to obtain hydrocodone prescriptions. A Connecticut man was charged with animal cruelty, illegally obtaining drugs, and “doctor shopping” after he took two injured dogs to multiple vets to obtain pain pills for himself. The problem has become so prevalent that government agencies and professional organizations are working to educate veterinarians about the dangers to their patients and the community. FDA Warnings and State Regulations In 2018, the Food and Drug Administration (FDA) warned veterinarians about possible misuse of pet medications and offered information resource links and advice to doctors who “stock and administer opioids.” Follow all state regulations. Use alternatives when possible. Educate pet owners on proper storage and disposal. Know what to do in case of overdose. Have a safety plan and learn the signs of opioid abuse. In response to the epidemic, many states have implemented reporting and prescription control regulations for opioids prescribed to humans. Increasingly, the FDA noted, states are regulating veterinarians as well. “According to the American Veterinary Medical Association, fifteen states and the District of Columbia currently have regulations requiring veterinarians to report when they dispense opioids and other controlled substances to patients: Alaska, Arkansas, California, Connecticut, Illinois, Indiana, Michigan, New Hampshire, New York, North Dakota, Oklahoma, South Carolina, Vermont, Washington state, and West Virginia. Thirty-four states, however, exempt veterinarians from Prescription Drug Monitoring Programs. Not only are states changing reporting requirements, some are also setting limits on the number of pills that can be prescribed at one time and some are even limiting the duration of a patient’s treatment with opioids. States such as Colorado and Maine require veterinarians to look at a pet owner’s past medication history before dispensing opioids or writing an opioid prescription.” The requirement to check a pet owner’s medication history is a source of controversy among veterinarians. There’s a cost concern, but many doctors also cite the ethical issues involved with checking the medical history of a non-patient. Dr. Amanda Bison, legislative chair of the Maine Veterinary Medical Association explained: “We are not allowed to treat humans and therefore should not have anything to do with their medical information.” How Veterinary Practices Can Respond to Opioid Abuse While state veterinary associations and state regulators work to develop effective laws and regulations, individual veterinary practices should be proactive. Control access inside the clinic. Drugs must be inaccessible to non-authorized personnel. Employees may steal them to sell or use themselves. Vet clinics have also been targeted by burglars looking for drugs. Be alert to signs of staff drug abuse. Warning signs include mood swings, mental confusion, frequent mistakes, and absenteeism. Learn to recognize client warning signs. These include asking for a particular drug by name, requesting early refills, and avoiding bringing the animal in for a physical exam. Review AVMA resources. The AVMA offers charts, white papers, and printable educational materials to help doctors understand reporting requirements, educate their staff, and prevent drug diversion. It’s also important to educate staff and patients about safe medication disposal options. Many people don’t understand the dangers of improper disposal of medical and pharmaceutical wastes. Drugs stored at home or thrown out in household garbage may be retrieved and misused. Medications flushed down the drain or dumped in landfills can also cause both physical and environmental harm. Sharps Compliance offers DEA-compliant, safe drug disposal solutions for clinics and end-users. These offer immediate disposal of unwanted/unused medications and eliminate the need to wait for a community Drug Take Back Day event. TakeAway Medication Recovery Systems are designed for clinics and ultimate users. They meet the DEA rules for controlled substance disposal by ultimate users. MedSafe Medication Disposal System kiosks can be found in many retail pharmacies and other health care facilities. The North Dakota Board of Pharmacy partnered with Sharps in 2017 to place MedSafe kiosks in retail pharmacies throughout the state. Learn more about Sharps Compliance’s affordable, DEA-compliant medication disposal solutions. Read More
February 21, 2018 Safely Dispose of Pet Needles, Syringes, and Medications Last updated on January 24, 2019 Americans love their pets! So, in honor of National Spay/Neuter Awareness Month and World Spay Day (February 27), we’re spending the month highlighting a specific segment of medical waste generators – veterinary hospitals and pet owners. Our pets are living longer, so pet owners need to be knowledgeable about safety issues around home medical care for diseases related to obesity and aging – specifically safe disposal of syringes and unused medications. The American Pet Products Association’s 2017/2018 annual survey of pet ownership found that approximately 47 million households in the U.S. have at least one cat and 60 million households have at least one dog. As the United States population ages, our pets are aging right along with us and are subject to many of the same diseases of aging – and often the same treatments. Many pet owners now give regular in-home injections to their pets and must deal with how to safely dispose of the syringes. Aging Pets Are More Susceptible to Chronic Diseases & Health Problems Part of the average lifespan increase of our pets is due to advances in veterinary medicine, but also because families are willing to spend more money for better care. Average medical costs for dogs can reach $700 annually – and go higher if the animal is injured or suffers from chronic diseases. A triple-digit increase in overweight and obese pets has been seen in the last decade, resulting in higher medical costs for pet owners. Obesity is a risk factor for many health problems, including heart disease, kidney disease, and diabetes mellitus. According to a Banfield Pet Hospital 2016 report, “Canine diabetes has increased by 79.7 percent since 2006, while in felines, the prevalence of diabetes has increased 18.1 percent over the same time frame.” Diabetes is a serious illness, and if diet and exercise adjustments aren’t effective, many pet owners must inject their pets with insulin at home. According to the American Kennel Club: “Most diabetic dogs will require daily shots of insulin under the skin, something that the owner will have to learn to do. Although it’s understandable to be apprehensive about doing this, it’s not as hard as it might sound. It can become a quick and easy daily routine that isn’t traumatic at all for either dog or owner.” Disposal of Pet Syringes in the Home Proper disposal of syringes used to treat feline or canine diabetes, allergies, and other conditions in the home is not only recommended by regulatory agencies but is crucial to protecting the community. If syringes are placed into the regular trash and someone is stuck with the needle, no one knows whether the syringe came from a diabetic pet or a human with an infectious disease, such as hepatitis or HIV/AIDS. Safe disposal methods, available from veterinarians or online, can be used to properly contain, package, and mail the syringes for proper disposal right from the home – an excellent way to solve a serious dilemma. Individual states provide guidance for home injectors, and the FDA advises: “Pet owners who use needles to give medicine to their pets should follow the same sharps disposal guidelines used for humans.” Disposal of Unused Pet Medications in the Home In addition to injectable pet medications, many more pets take oral pharmaceuticals. When it comes to protecting the environment, humans, and pets, disposal of medication down the drain or into the trash is not a safe practice. There are several safer disposal options available to pet owners for not only their pets’ but also their own unused medications. Contact us to learn more about how using our disposal systems for the home can help protect pets, pet owners, and communities, as well as how our medical waste management systems can reduce liability in veterinary practices. Read More
February 14, 2018 Veterinarians Protect Staff, Patients, & Communities with Proper Medical Waste Disposal Practices Last updated on January 24, 2019 In honor of National Spay/Neuter Awareness Month and World Spay Day (February 27), we’re highlighting a specific segment of medical waste generators – veterinary hospitals and clinics. Many veterinary practices are small businesses that play large roles in their communities by keeping pets healthy, supporting animal rescue organizations, and helping stop the spread of rabies and other diseases. Because pet owners most often visit veterinary offices for preventative care – vaccinations, spay/neuter surgeries, etc. – it’s easy to forget that they are often small hospitals that can generate many of the same types of medical waste as human hospitals and medical offices. Indeed, for most companion animals, a veterinary hospital offers primary care, surgical care, emergency care, dental care, and end-of-life care. So, it’s no surprise that veterinarians must understand how to safely package and dispose of many types of regulated medical waste. AVMA Offers Biohazardous Waste Disposal Guidelines/Education for Veterinary Practices The American Veterinary Medical Association (AVMA) has a number of policies regarding waste disposal. In addition to these general statements of policy, the AVMA also maintains a members-only area of the organization’s website, which includes tips on medical waste handling. However, the AVMA warns against using the information as a comprehensive guide and recommends going directly to federal and state regulatory agencies, which are often the best sources for compliance. That’s excellent advice. If a clinic or hospital is unsure of the regulations, it’s important to ask for guidance from regulators and experienced medical waste disposal companies. Confusion can lead to mistakes, which are not only costly but also present a risk to hospital employees, the community, and the hospital’s reputation. Veterinary Clinics that Violate Medical Waste Disposal Regulations Can Face Fines & Regulatory Action Some veterinarians may have been slow to realize that disposal regulations applied to their clinics and hospitals, not just the ones for humans. Several high-profile events, however, quickly raised awareness. In 2009, Arizona Department of Environmental Quality (ADEQ) cited a veterinary hospital for improper disposal of used needles and syringes. The initially levied $96,000 fine was “the equivalent of what ADEQ estimated the biohazardous waste collection would have cost him over the last decade.” In 2011, the parties negotiated a $65,000 settlement that combined a cash fine with donated services to the local Humane Society. The practice owner also contracted with a medical waste disposal company for regular pickups. Also in 2009, a veterinary practice in Rhode Island faced a possible $25,000 fine to cover the cost of repackaging “a 30-yard waste load that was rejected at the landfill because it contained used needles, pipettes filled with blood and a few blood samples in vials.” As with the Arizona case, the problem was lack of awareness about disposal regulations and regulated medical waste classification: “They thought it was unreasonable to consider it medical waste because it didn’t contain any pathogens,” says Mark Dennen, principal environmental scientist as the Rhode Island Department of Environmental Management (RIDEM), of the unnamed veterinary clinic at fault. “But there’s no way of knowing, looking at a needle to tell if it’s contaminated with a zoonotic disease or, for humans, HIV. We treat all sharps as contaminated because there’s no way you can get to the level of knowing anything is totally safe.” At the time of these incidents, there was often a lack of educational resources for veterinarians. The Rhode Island clinic escaped any fines and penalties because of that, state officials noted: “Most of them are very small businesses. We hate to see that happen. In this case, it seemed it was just them not realizing what was regulated,” Dennen says. “We’d really rather see them be compliant than hit them with such a severe cost.” Pet Hospitals Also May Be Improperly Disposing of Inventory Medications that Expire or Go Unused Proper disposal of medications used in veterinary practices can also be very confusing. Drugs used for infusing chemotherapeutics, for example and expired inventory medications can fall under several different types of drug classifications with regard to disposal. They may be considered hazardous waste pharmaceuticals (HWP), controlled substances, or drugs that are neither. Reaching out to a full-service medical waste disposal provider can help find the best and most compliant solutions for these waste streams. Veterinary Clinics & Hospitals Must Juggle a Patchwork of Regulations & Enforcement Agencies No veterinary medical clinic would ever intentionally put staff, patients, or the community at risk by improperly handling or disposing of regulated waste. Compliance, however, isn’t always easy. Multiple federal agencies, state regulators, and local governments offer regulations and guidance on regulated medical waste disposal. Most state medical waste regulations cover all generators doing business in that state. However, there are states in which counties and even cities take on that enforcement responsibility. California is the most populous state in the country and has the largest number of employed veterinarians – over 6,000. California law allows county and municipal governments (Local Enforcement Agencies – LEAs) to enforce the California Medical Waste Management Act. At present, 32 counties and two cities have oversight authority, while the remaining 25 counties and one city rely on the California Department of Public Health. This map shows the patchwork of enforcement entities in the state. Veterinary clinics and hospitals with locations in multiple California counties, must deal with individual LEAs when registering as a generator and complying with regulations and inspections. An even further challenge falls on organizations with hospitals across the country that must comply with specific regulations unique to each state. A qualified medical waste disposal company can help any size veterinary organization comply with medical waste storage, disposal, tracking, and other regulations. At Sharps Compliance, our medical waste management experts can develop compliance programs for a single clinic or chains with hospitals across the country. When it comes to documentation of proper disposal, SharpsTracer prevents scrambling to find lost manifests during an inspection or audit. SharpsTracer allows customers to track and verify the receipt and treatment of returned materials as required by state and federal regulations, while eliminating the need for paper-based manifest tracking. Contact us to learn more about how our medical waste management systems can help protect not only veterinary practices but also pets, pet owners, and our communities. Read More
January 30, 2015 Managing Pet Diabetes Last updated on January 16, 2019 So the vet just diagnosed your pet with diabetes mellitus, which means that your pet isn’t producing enough insulin which is required for the body to efficiently use sugars, fats, and proteins. Diabetes mellitus is most often diagnosed in older dogs, primarily female dogs and older cats, most often male cats. Younger animals can also be afflicted. Can diabetes in animals be managed? For most animals, diabetes is managed long term by the injection of insulin once or twice a day by the owner or caretaker. While some diabetic cats can be treated with oral medications instead of injections, oral medications are rarely effective in dogs. According to the College of Veterinary Medicine at Washington State University, there are three general types of insulin used in dogs and cats: short- acting insulin (regular or crystalline) is used in sick diabetic animals until they are eating again NPH and Lente are intermediate- acting insulins Ultralente and PZI are long- acting insulins Once the type of insulin is decided, the vet will show the caretaker how to give the pet his/her injection. Most likely, the vet will review how to handle the insulin itself, paying attention to temperature, expiration date, etc. The vet will demonstrate how to use a syringe, how to draw up the insulin in the correct amount as well as how to properly administer the injection. After the injection is given, what should be done with the used needle and syringe? While this part of the conversation between the vet and the caretaker can be very brief or not even discussed, it’s important that the needle and syringe – often referred to as the “sharps” – be placed into a compliant sharps container. The sharps container is designed to hold used sharps in a safe manner until the container is full and ready to be disposed of. Accidental needlesticks occur frequently in the home because needles are left in common areas, such as the trash, countertops, or even the floor, and people – and their pets – inadvertently get stuck. Once the sharps container is full, contact the vet to determine if he/she can take them or can offer a more viable solution. Several states have passed legislation making it illegal to throw sharps into household trash so be sure to work with the vet to determine the safest method of disposal that meets all state requirements. Source: Pet Health Topics. (n.d.) Read More
