July 7, 2021 New Medication Disposal Regulations Can Help Long-Term Care Communities Lower Costs With many long-term care (LTC) communities already struggling with staff shortages, rising salaries, declining resident census, and other challenges, new government regulations can seem like just one more burden. However, changes to federal medication disposal regulations can actually help assisted living facilities, skilled nursing facilities, memory care facilities, and other providers realize significant savings. If your facility would like to save money on medication disposal, including hazardous waste pharmaceuticals (HWP) and labor costs, review our recent white paper: Cost-Saving Solutions for Compliant Medication Disposal in Long-Term Care Communities We explain how key provisions of the following laws and regulations apply to LTCs: Secure and Responsible Drug Disposal Act of 2010 2014 Disposal of Controlled Substances, Final Rule Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine (EPA Pharma Management Rule) You’ll learn how LTCs can lower costs by using on-site medication collection or mailback options for unused pharmaceuticals, including HWPs. Many facilities may realize significant cost savings. For example: Labor costs: LTCs utilizing on-site pharmaceutical collection receptacles could save as much as $10,000 annually, per community, in salary expenses for the time it takes two RNs to prepare medications for disposal via a multi-step process, as opposed to the simple solution of placing medication wastes into a collection receptacle. Disposal costs: Communities utilizing drug disposal receptacles or mailback packages could potentially realize a savings of nearly $12,000 annually, per community, by consolidating all their medication disposal options into a single solution. Would your facility like to reduce costs without cutting staff or patient services? Download our white paper to learn how Sharps Compliance can help you manage your pharmaceutical waste disposal. Read More
June 9, 2021 Common Hazardous Waste Streams in Healthcare Many healthcare providers that are in the same healthcare sector generate similar hazardous waste streams. For instance, long-term care facilities typically all have hazardous waste pharmaceuticals, and healthcare laboratories will generate flammable solvents, considered hazardous waste. Let’s look at some of the more common hazardous waste streams generated by healthcare facilities. High BTU Liquid Solvent Wastes High BTU liquids are a general description that can consist of numerous chemical constituents. “BTU” stands for “British Thermal Unit,” a unit of heat defined as the amount of energy needed to raise the temperature of water. Thus, these solvent waste streams have latent energy – as heat value – for the management of the waste through a combustion process. They are 100% liquid with no sludge or smaller inner containers in the DOT shipping container. A high BTU liquid solution is a good energy source (>6,000 BTU/lb) when burned and has a low amount of water. Much of the time, these are flammable liquids – look for signage! Below are some examples of high BTU liquids that are often generated by dermatologists, veterinarians, and clinical labs: Gram stain solution Xylene Toluene Alcohols, including methanol, ethanol, and isopropanol Oxygenated solvents, including acetone, methyl ethyl ketone, and ethyl acetate Hexane and other aliphatic solvents Hazardous Waste Pharmaceuticals Hazardous waste pharmaceuticals (HWPs) are medications that meet the EPA definition of “hazardous waste” and have an associated RCRA hazardous waste code. HWPs make up about 8% to 10% of all medications. Examples: warfarin, mitomycin C, lindane, nicotine, daunomycin, dandruff shampoo, insulin, vaccines, alcohol-based creams, gels, and ointments Generators: pharmacies, skilled nursing, long-term care facilities, rehab facilities Medical Aerosols/Inhalers Meter-dose inhalers are pressurized canisters that are managed as aerosols. In some cases, the propellant liquid within the canister is also flammable and carries a RCRA code. Generators: long-term care facilities, allergists, doctors’ offices Used X-ray Fixer/Developer Solution Fixer and developer solutions are part of a two-product system in the development of X-ray film. In their unused state, they do not carry a RCRA code. The x-ray fixer is typically a weak acid solution. During the fixing process, light-sensitive silver-halide crystals present on radiographic films are released as silver-thiosulfate. The resultant waste fixer solution has absorbed the silver and is then considered a hazardous waste due to the toxicity of the silver content. Generators: dentists, doctors’ offices, urgent care More Common Wastes There are two more types of waste that most healthcare providers have: Just about everyone has universal waste! Light bulbs, batteries, and mercury-containing devices are all universal wastes that can be safely recycled using convenient mailback systems. Expired and unused chemical products still in manufacturer packaging may be expired or no longer needed, posing an unnecessary potential hazard to the facility. Lab packs are the best way to manage these types of chemical products. Many medical waste generators also produce hazardous waste. Sharps Compliance offers many solutions to keep you in compliance! Read More
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
March 17, 2021 DOT Hazard Classes Explained The DOT separates hazardous materials into nine different categories or “hazard classes.” They are defined by specific hazardous properties and have distinct regulatory requirements for packaging, markings, and labels. Keep reading for a general summary of those properties. Hazard Class 1 – Explosives The explosives hazard class is divided into six categories based on the kind of explosive hazard: Mass explosion Projection Fire Level of sensitivity Explosives that most people are familiar with include dynamite, gun powder, and fireworks. Hazard Class 2 – Gases Gases have three divisions: Flammable gases (2.1) burn readily in air and are in a gaseous state at 68°F (e.g., propane and spray paints). Non-flammable gases (2.2) may include liquified gases or cryogenic liquids (e.g., helium and asthma inhalers). Poisonous gases (2.3) are toxic or presumed toxic to humans (e.g., carbon monoxide). Hazard Class 3 – Flammable Liquids Flammable liquids have a “flash point” of 140°F or less. A flash point is the temperature when an ignition source near the liquid can ignite the vapors. Examples of flammable liquids include the following: Gasoline Acetone Ethanol Xylene Many paints and common solvents Hazard Class 4 – Flammable Solids These are the three divisions of flammable solids along with a common example for each: Flammable solid (4.1) (e.g., match sticks), Spontaneously combustible material (4.2) (e.g., oily rags) Dangerous when wet (4.3) (e.g., magnesium fire starter) Hazard Class 5 – Oxidizing Substance & Organic Peroxide Oxidizers (5.1) may contribute to the combustion of other materials. Concentrated hydrogen peroxide and silver nitrate are both examples of oxidizers. Organic peroxides (5.2) contain both an oxidizer and an organic fuel. They are thermally unstable and can release dangerous amounts of heat and energy. They are sometimes used to initiate polymerization of epoxy resins. Hazard Class 6 – Toxic & Infectious Substances Toxic or poisonous material (6.1) can be solids or liquids known or presumed to be toxic to humans. Classification is based on oral, dermal, and inhalation exposure. In high doses, some medications are toxic, such as coumadin. Division 6.2 Infectious Substances are materials that are known or reasonably expected to contain a pathogen. Hazard Class 7 – Radioactive Uranium and plutonium are not the only radioactive materials. Exit signs, smoke detectors, and x-ray equipment are a few common sources of radioactive material in our day-to-day lives. Hazard Class 8 – Corrosive Materials Acids (low pH) and bases (high pH) are corrosive materials that can eat away at skin and steel. Sources for corrosive material include battery acid and degreasers. Hazard Class 9 – Miscellaneous Hazardous Material Class 9 materials pose a hazard during transportation, so they are regulated when shipped, but they do not meet the definition of the previously listed hazard classes. Formalin sample containers and liquids fall under the class 9 category. Remember that small and large quantity generators of hazardous wastes must notify the EPA of their generation activities and receive an EPA identification number. Some states have stricter regulations. If you need help identifying your hazardous waste, contact Sharps Compliance. We offer comprehensive solutions for the management of regulated medical waste, hazardous waste, and unused medications. Read More
October 7, 2020 Why You Need to Train Employees on Proper Disposal of Medical Waste Every medical office is under pressure to increase productivity and control costs. However, you can never be too busy to make sure your staff is trained on the proper handling and disposal of medical waste. Regulated medical waste (RMW) handling and disposal mistakes can lead to workplace injuries, increase disposal costs with improper segregation, and potentially lead to fines for improper handling, disposal, and worker injury. At Sharps Compliance, we offer online tools to help train employees and keep the workplace safe and OSHA compliant. OSHA is the agency tasked with governing proper handling of RMW by healthcare workers. Workplace Injuries Cost More Than You Realize The healthcare and social assistance sector has one of the highest rates of workplace-related injuries – 582,800 were reported in 2017. Injuries are expensive and carry several hidden costs, such as medical, salary, or legal expenses. Calculating the total cost of a work-related injury is more complex than a single worker’s compensation claim. For example, suppose a team member receives a needlestick injury from a used sharp discarded in the regular trash. The injured staffer must immediately stop and clean the wound. The supervisor must investigate how the sharp got in the trash and attempt to identify the patient it came from. Depending on the patient’s medical history, the staffer may need to begin prophylaxis treatment, which could include immunizations, anti-viral drugs, and multiple medical visits. You may even have to pay overtime to other employees in order to cover for the injured staffer while receiving treatment. The costs add up quickly. Injuries may also affect employee productivity and morale. In some cases, your employee may even have legal standing to file a civil lawsuit. In addition to the direct employee effects, a pattern of workplace accidents or violations could attract the attention of regulators. Remember that OSHA only cites/fines employers for violations – even if the accident/injury happened because an employee wasn’t following proper procedures. Proper training, along with a commitment to safety and compliance, is essential. Waste Segregation: A Safety & Financial Issue It can cost ten times as much to dispose of regulated medical waste (RMW) than to dispose of regular trash. Fortunately, only a small percentage of healthcare-related waste falls into the RMW category. According to the World Health Organization, “up to 85%of waste generated by health care-related activities is general, non-[bio]hazardous waste” and doesn’t pose a health, safety, or environmental threat. Your staff must understand the difference between general waste, RMW, and non-biohazardous medical waste. When RMW is mixed in with regular trash, it poses a health and safety threat. RMW can potentially spread contagions like Ebola, Hepatitis, and HIV. Likewise, loose sharps placed into the trash or RMW container can injure healthcare workers, custodial staff, landfill workers, and recycling facility workers. The vast majority of healthcare workers understand the dangers, and, even go as far as adopting a “better-safe-than-sorry” attitude and place general, non-hazardous trash into red bags along with the materials required to be disposed of as RMW That means your facility is paying RMW prices to dispose of regular garbage – greatly exaggerating the expenses for RMW disposal. It is not a good situation at all. Learn more about proper medical waste classification in our three-part series, “What’s Going into That Red Bag?” ComplianceTrac: Get Help with Training & Compliance Sharps Compliance customers have access to ComplianceTrac, an online training management system, including OSHA-required, DOT, HIPAA, and Medicare training. The online training videos are available 24/7, so employees can train at their convenience. The modules typically allow employees to train in less than an hour, where they receive a certificate of completion at the end of the training. Examples of training modules include: Bloodborne pathogens Fire Safety GHS hazard communications (HazCom) HIPAA Ergonomics Medicare Fraud, Waste, and Abuses For those healthcare facilities that have direct pickup of their RMW, they are required to have DOT training, which is provided in ComplianceTrac. ComplianceTrac also serves as a document repository, providing customizable OSHA-required safety plans, which you can disseminate among staff. The searchable SDS (MSDS) database allows you to create site-specific electronic SDS manuals along with the required corresponding Chemical Inventory with SDS sheets dating back to 1990. Lastly, there is the audit tool, where your facility can perform regular workplace audits, view reports, assign corrective actions to individuals or departments, and set due dates for completion. Sharps Compliance has a comprehensive array of online resources, in addition to our disposal products, to help ensure your staff are trained and equipped with everything they need to properly manage your facility’s regulated medical waste needs. Read More
September 22, 2020 Disposal of Controlled and Non-Controlled Medications in Long-Term Care Communities Last updated on June 14, 2021 This is an update of the article originally published on October 9, 2014. Regulations change frequently. That’s why Sharps Compliance monitors updates and communicates any changes to its customers. On September 9, 2014, the Drug Enforcement Agency published the Disposal of Controlled Substances Final Rule, which went into effect on October 9, 2014. This new rule allowed registered collectors to place DEA-compliant drug collection receptacles in long-term care facilities (LTCFs) for the collection and disposal of ultimate-user controlled substances (Schedules II-V). “Best Practices” for Medication Disposal Have Changed Many people aren’t aware that EPA guidelines and state/local environmental regulations strongly discourage many common medication disposal methods, including: Flushing medications: In addition to the EPA’s new rule, the sewering of hazardous waste pharmaceuticals is explicitly forbidden. The DEA also states that the flushing of controlled substances does not meet their non-retrievable standard for disposal. A 2013 EPA study estimated over 46 million Americans could be potentially exposed to up to 4.4 daily doses of an active pharmaceutical ingredient from their wastewater treatment plants. Other studies have shown changes in aquatic life such as gender changes in fish, due to pharmaceuticals in the water. Mixing medications with kitty litter or coffee grounds: The purpose of mixing medications with kitty litter or coffee grounds is to mask the medications, but eventually, the mixture ends up in a landfill where the pharmaceuticals can cycle back into the water. Additionally, the process is time-consuming and often messy — not the best use of a community’s best resource: nurses. Like flushing, this form of disposal likely does not meet the DEA’s non-retrievable standard of disposal. To learn more about how landfilling of medications harms both people and the environment alike, read our article on this topic. Chemical Solutions May Increase Disposal Costs Chemical solutions that break down the compounds on-site are relatively new options. These solutions are messy, release a foul odor, require nurses to remove, or “pop,” pills one at a time from blister packs or other packaging. Additionally, these methods of destruction do not meet the DEA’s non-retrievable standard, given the medication does not fully dissolve or takes days to dissolve. Anyone who has ever struggled to remove a single pill from a blister pack knows that this can be a difficult and time-consuming task. In fact, this type of disposal solution can cost a community upwards of $10,000 annually in nursing salary alone.1,2 Figure 1: After seven days, medications treated with a chemical solution were emptied into a plastic bag. The pills were removed from the plastic bag and rinsed off, but the pills were still not liquefied. Nurses must also take time to completely block out Personal Health Information on the packaging to comply with HIPAA before placing that packaging into the trash — overall, consuming even more valuable staff hours and increasing potential facility liability. Lastly, if chemical solutions are used for the disposal of hazardous waste, controlled, and non-controlled medications, then they must be disposed of by a hazardous waste provider, given the presence of hazardous waste pharmaceuticals and the unknown resulting conglomeration of waste. It causes the customer to “double pay” for disposal: once to purchase the pouch and then a second time to dispose of it by a hazardous waste provider. Sharps Compliance Offers Safe Medication Disposal Options for LTCFs Long-term care facilities can now utilize a DEA compliant drug collection receptacle or provide mailback solutions to residents for safe disposal of their medications, including controlled and non-controlled medications. Sharps Compliance has been at the forefront of safe mailback and on-site pharmaceutical collection options. We can help LTCFs safely dispose of unused/unwanted medications and stay compliant with the DEA. LTCFs have two options for the disposal of comingled controlled and non-controlled substances: collection receptacles or mailback envelopes/boxes. We offer both a collection receptacle program (MedSafe™) and a mailback solution (TakeAway Medication Return System™). As the DEA has stated, “the DEA has considered the diversion risks and determined that the installation and maintenance of collection receptacles by authorized hospitals/clinics and retail pharmacies is the most secure and responsible means by which registrants may collect and dispose of LTCF residents’ pharmaceutical controlled substances.” Collection Receptacles for Medication Disposal As outlined in § 1317.60 of the Disposal of Controlled Substances Regulations, a collection receptacle is a substantially constructed container with a permanent outer container and a removable inner liner. Collection receptacles must be securely fastened to a permanent structure, and the outer container shall include a small opening that allows contents to be added to the inner liner but does not allow removal of the inner liner’s contents. LTCFs can utilize a collection receptacle for medication disposal, provided that an authorized collector manages the program. A collector is a DEA registrant that has been approved to administer drug collection programs at an LTCF. The collector for the community is the managing pharmacy that provides medication for the residents (retail, closed-door, or hospital/clinic with an on-site pharmacy). While the collection receptacle is physically located within the community, the authorized collector will manage the program. Program management includes inserting inner liners into the collection receptacle, removing and sealing inner liners for disposal, and documenting a step log of the procedures. Note: No LTCF can operate a collection receptacle program without an authorized collector managing the program. The removable inner liners, once sealed by the authorized collector, can be stored on-site at the community for up to three business days per the DEA regulations. The inner liners are returned via common carrier to a registered treatment facility for proper destruction. With the goal of diversion as a main concern of the DEA, all steps outlined above are conducted by two people — either two employees from the authorized collector pharmacy or one employee from the authorized collector pharmacy and a second supervisory-level employee from the LTCF. Mailback Medication Disposal For LTCFs where residents manage their own medications, specially-designed mailbacks can be used for disposing of controlled substances. The resident places their medication into the mailback, seals it, and gives it to USPS for direct return shipping to the registered collector for destruction. Our 10- and 20-Gallon TakeAway Environmental Return Systems™ are optimal mailback solutions for communities where residents are managing the disposal of their own non-controlled, non-hazardous medications. To learn more about the 2014 Disposal of Controlled Substances Final Rule and options for a collection receptacle or mailback program for your communities, please contact Sharps Compliance at 800.772.5657 or visit our MedSafe website. Additionally, Sharps Compliance continues to offer both medical and hazardous waste management services. For more information on medication disposal in LTCFs, read our other articles: This white paper was co-written by Sharps Compliance and Senior Housing News: “Medication Disposal in Senior Living: Understanding New Regulations.” Our white paper, “Requirements for Long-Term Care Facilities Under the EPA’s Pharmaceutical Rule,” describes in detail how the new EPA rule affects LTCFs. In this video interview, Sharps Compliance’s Director of Regulatory Compliance discusses new EPA regulations and their implications for LTCFs. 1 Working hours per year = 2087 based on Policy, Data, Oversight. Fact Sheet: Computing Hourly Rates of Pay Using the 2,087-Hour Divisor. The U.S. Office of Personnel Management. 2 Salary estimates based on Salary Guide: Nurses 2018 & 2020 Salary Survey Results: An Elite Healthcare Resource Guide. (2018, 2020). Elite Healthcare. Read More
June 17, 2020 Who is Maintaining Your Medical Waste? Last updated on May 7, 2021 This is an update of the article originally published on August 6, 2014. Regulations change frequently. That’s why Sharps Compliance monitors updates and communicates any changes to its customers. “I don’t have time to close up and label the medical waste box – so the medical waste transport driver does it.” This statement is often uttered by busy employees responsible for managing their facility’s medical waste. However, the US Department of Transportation (DOT) and other regulatory bodies place the onus of responsibility for preparing and packaging medical waste on the generator of the waste, not the transporter. The DOT and individual states regulate transport and labeling of waste managed by a pickup service. Since the facility that generates this waste is responsible for the proper packaging, the DOT requires anyone who “prepares medical waste for transport” to be trained in the proper procedure. Training must be documented and repeated every three years. In addition, states can require training as well. When mailing medical waste, instructions are included with each mailback system, which can be used for training on proper packaging. DOT does not regulate mailback packages and therefore, does not require the training mandated by DOT. However, since the person packaging the waste is still responsible for properly doing so, it is important to train the employee using the mailback instructions. When signing the manifest tracking form that must follow the waste from “cradle to grave,” the person signing the form declares that the contents have been classified, packaged, marked, and labeled according to applicable government regulations. This is true for both pickup service and mailback. That person declares that the shipment does not include hazardous materials, such as mercury or hazardous drugs. For this reason, only employees of the generator can close or and package the transport or shipping box and sign the manifest tracking form. If your organization is using a pickup service, follow the driver’s instructions, which typically include the following: Build out the box, making sure the box bottom is taped well, and all closure and/or locking mechanisms are engaged and taped closed. Place liner in the box. Close sharps containers and tie up red bags before placing into lined box or container. Securely tie closed liner around containers/bags. Close the box flaps and secure with packing tape or secure the lid and closures. Place label(s) as required by state regulations, including the label provided by the medical waste company. Sign manifest tracking form (keep generator copy). Provide box/container to pickup driver. Access proof of treatment. If you are using a mailback system, written instructions are included with each system. Instructions include the following: Retain plastic-lined mailback box to ship container(s) back for treatment. Close sharps containers and tie up red bags prior to placing into lined box/container. Absorbent is already included in liner and/or each sharps container. Securely seal liner around filled container(s) using provided twist or zip tie. Close the numbered box flaps and place provided tape over closure tab(s). Write the facility return address on the top of the box. No additional labeling is required. Complete and sign manifest tracking form (keep generator copy). Provide to mail carrier. Access proof of treatment. Don’t get caught out of compliance! Our ComplianceTrac tool helps offices build plans and policies to address these issues. Read More
May 6, 2020 Opioid Painkillers After Oral Surgery May Put Teens at Risk for Later Opioid Abuse Most parents worry about their teens getting access to drugs at school or in social settings – not at the dentist. However, the American Dental Association and private insurers have expressed concerns about the widespread practice of prescribing opioid painkillers to teens after oral surgeries. The patients who filled those opioid prescriptions were nearly three times as likely to use opioids in the year after the prescription. Teens Are at Risk for Substance Abuse During the past decade, opioid addiction rates exploded across the country and created an ongoing public health crisis. Centers for Disease Control (CDC) statistics show the rate of drug overdose was four times higher in 2018 compared to 1999. In 2018, almost 70% of drug overdose deaths involved an opioid. Public health professionals have become concerned about the intersection between legitimate opioid prescriptions for teens and later opioid use and addiction. The American Academy of Pediatrics Journal addressed the issue of teen opioid use in 2015: “Legitimate opioid use before high school graduation is independently associated with a 33% increase in the risk of future opioid misuse after high school. This association is concentrated among individuals who have little to no history of drug use and, as well, strong disapproval of illegal drug use at baseline.” During adolescence, teen brains are still developing. That makes them particularly susceptible to a drug’s effect on the reward pathways in the brain. Parents and prescribers need to be alert to common risk factors for teen substance abuse. Wisdom Teeth Extraction Can Lead to Opioid Misuse Insurers and dental professionals are looking closely at “best practice” pain management strategies for children and teens. A2015 study of private insurance patients age 16-25 found 13% of participants had received at least one opioid prescription, and dentists wrote 30% of them. Within the next year, 5.8% of those patients were diagnosed with opioid abuse. In 2019, Delta Dental reported: Compared to their peers around the world, teens in the United States are much more likely to be prescribed opioids after wisdom tooth extraction. Many American teens leave their dentist’s office with a prescription for hydrocodone, also known as Vicodin or Norco. Almost all of this drug’s supply worldwide — 99% — is prescribed and used in the U.S. United Healthcare (UHC) launched an initiative to “limit teens’ exposure and inform dentists, patients, and parents about opioid medications.” The company’s public education efforts include radio and TV public service announcements and a public toolkit. The toolkit includes a downloadable dental opioid flyer and checklist and other educational materials. UHC implemented a new in-network pharmacy policy that “limits all first-time opioid prescriptions for people age 19 and under to no more than three days and fewer than 50 morphine milligram equivalents per day, as recommended by the Centers for Disease Control and Prevention (CDC).” The company also created an outreach program to dentists who have a pattern of “prescribing opioids outside of CDC guidelines.” Questions to Ask the Dentist about Pain Relief The National Institute on Drug Abuse for Teens has a list of suggested questions to discuss with your dentist before filling a prescription for opioids: Ask if there’s an option other than prescription opioids to treat your pain. Some non-opioid medicines might offer the best balance between benefits and risks. Tell the dentist about any substance use disorders or addiction in your family. This will help the dentist decide if opioids are safe for you. Talk about your medical history and any medications you’re taking. It might not be safe to take opioids with some other medicines. The vast majority of medical professionals are happy to discuss options with patients. They realize that patient education about opioids helps prevent misuse and encourages safe disposal of unused/unwanted opioid prescriptions. Always Safely Store and Dispose of Opioids Two=thirds of teens who report misusing prescription pain medications got them from friends, acquaintances, or family members. Many people have extra: a 2017 meta-analysis found up to 92% of people don’t finish their prescription painkillers, and fewer than 10% safely dispose of the leftovers. Three-quarters of patients fail to keep opioids in a locked cabinet. Safe disposal of unused/unwanted medication is just as important as safe storage. Consider the community and environmental effects before flushing medication or throwing it away with household trash. This infographic highlights the dangers of improper disposal of medication and pharmaceutical wastes. Households and professionals alike share a responsibility to protect America’s teens from indiscriminate access to opioid painkillers. Ensuring residual medications are properly disposed means those same medications no longer pose a threat to our vulnerable youth. As part of their patient education efforts, we encourage dentists to discuss safe disposal options for unused/unwanted opioid medications. For example: Provide information about nearby MedSafe medication collection receptacles in nearby pharmacies or other public locations. Offer the patient a TakeAway Medication Recovery System envelope along with the prescription. Provide the dates of semi-annual Prescription Drug Takeback Day events – if the local community participates. In addition to offering safe, convenient pharmaceutical disposal solutions to generators and ultimate users, Sharps Compliance also helps dental offices comply with other waste disposal regulations regarding dental carpules, amalgam recycling, and more. Read More
March 18, 2020 The Do’s and Don’ts of Medical Waste Packaging Last updated on March 20, 2020 This is an update of the article originally published on June 1, 2016. Regulations change frequently. That’s why Sharps Compliance monitors updates and communicates any changes to its customers. Just when you thought that your waste was packaged properly, you learn that your state has laws that differ from federal regulations. Did you know that states have the authority to add additional rules to many federal regulations? It’s important to follow local, state, and federal requirements when packaging and labeling your waste. Here are a few simple steps that you can follow to lessen the potential environmental, safety, and financial risks associated with improper packaging of your medical waste. As a “generator,” the person producing the waste, you are accountable for the proper classification, segregation, packaging, and sealing for transportation of your waste and subject to fines and penalties for any defaults. So, what are the best options for learning proper packaging of medical waste in your state? First, you must identify which wastes are classified as regulated medical waste. Each state has a specific definition, very similar to OSHA’s definition included in the Bloodborne Pathogens Standard. According to OSHA, regulated medical waste includes: Sharps Liquid or semi-liquid blood or other potentially infectious materials (OPIM1 ) Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling Pathological and microbiological wastes containing blood or OPIM Next, you must properly package your waste for transport, according to the Federal Department of Transportation (DOT), as well as any specific state or local regulations. For example, some states require identification on the box if waste must be incinerated. Others may require generator identification on red bags and sharps containers. Others have time limits for the storage of your waste. Feel free to discuss these requirements with your service provider or check your specific state requirements here. Sharps Compliance customers gain access to our Regulatory Hub, which goes into even more detail about state regulations. After setting up your transport box, place the provided red-bag liner inside the transport box, which is now ready for you to contain your full, sealed sharps containers and individually tied red bags. Loose sharps and free liquids are never allowed in the transport box. If you have large volumes of liquid waste to dispose of, please contact Sharps Compliance Customer Service at 800.772.5657 for the best disposal options. As a reminder, please note that the following items should not be placed in the medical waste transport box: Items contaminated with urine, feces, sputum, tears, sweat, nasal excretions – unless those items are affixed with protected health information Regular trash All of these items can be placed into the regular trash. If you place them in a medical waste transport box, then you are paying up to 10 times the amount to dispose of this waste as you would if placed them into the regular trash where they belong. The items below MUST NOT be placed into the medical waste transport box. Contact Sharps Compliance at 800.772.5657 for the proper disposal systems for these materials. Hazardous and chemical waste Loose sharps Compressed gas cylinders Radiographic and amalgam waste Medication Free liquids Once the transport box is full or otherwise ready to be sealed2 , the red-bag liner must be closed by gathering and twisting the neck into a single knot or by using a twist tie. Next, fold the box flaps closed (they must lay flat on top of the box), and tape closed, making sure that the red bag is not visible. Keep in mind that if the box is damaged or not packaged correctly, then the driver will not be able to pick up the box at that time, and you will have to schedule a new pickup once the box has been packaged and sealed properly. Apply the supplied barcode label to the exterior of the box on the indicated location and have the appropriate person sign the tracking form. The person who signs the tracking form should be knowledgeable about what is contained in the box and that it has been properly packaged and sealed. Keep your copy for the state-required length of time. All Sharps Compliance customers can access their proof of destruction and run needed reports at https://www.sharpsinc.com/sharps-tracer. Click here to download our Medical Waste Packaging poster. [1] OPIM (Other Potentially Infectious Materials): (a) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (b) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (c) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. [2] States differ regarding storage times for different waste streams. For a list of each state’s storage time limitations, call 800.772.5657 or check with your state’s environmental department website. Read More
January 22, 2020 Cost-Effective Medication Disposal in Long-Term Care This is an update of the article originally published on November 3, 2015. Regulations change frequently. That’s why Sharps Compliance monitors updates and communicates any changes to its customers. Nurses practicing in senior care have very busy work schedules. From caring for residents to distributing medications and updating records, their days can become overwhelming. One of the most important tasks is the disposal of unused medication. When a resident’s medication is permanently discontinued, per the 2014 Drug Enforcement Agency’s (DEA) Disposal of Controlled Substances Final Rule, it must be properly disposed of within three business days. Prior to the 2014 DEA regulation updates, the most common ways to dispose of a resident’s medication was either flushing medications down the sink or toilet (sewering) or placing them into a drug disposal pouch and placing it into the trash. However, these options are costly, inefficient, and unsafe for the environment. Reducing costs is key to the success of any business. So, paying Clinical Directors, Directors of Nursing, and nurses up to $50/hour to pop pills out of blister packs to flush them down sinks or toilets or place them into disposal pouches is certainly not the best use of their time, skill set, and salary expense. This practice can cost a community upwards of $14,000 annually in nursing salary alone. Additionally, the ability to streamline disposal options for multiple medication waste streams can reduce the expense of managing multiple disposal solutions by over $2,700 annually. This action reduces disposal solutions from four or five solutions down to only two. Secondly, sewering drugs or placing them into disposal pouches are an inefficient use of the highest-paid staff’s time and efforts. Nursing Directors, Clinical Directors, and nurses in the long-term care setting are spending, on average, 4 hours a week removing pills from their packaging in order to prepare them for disposal, which takes significant time away from direct resident care. Also, after disposing of the pills, the staff is still responsible for disposing of the medication packaging in a HIPAA compliant manner to protect the resident’s protected health information, further contributing to time away from residents in need. Lastly, neither sewering nor disposal pouches are environmentally friendly disposal options. In August 2019, the EPA Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine made it illegal to sewer hazardous waste pharmaceuticals in all 50 states due to the environmental hazards. Plus, there have been several studies published on the fact that medications are showing up in our water streams and that water treatment facilities are not equipped to remove pharmaceuticals as part of their treatment processes. Furthermore, though used drug disposal pouches are designed to be placed directly into the trash, many states have outlawed businesses from landfilling such waste since there is no way to verify the sludge contents within the pouch, which has implications for leachate and its impact on the environment. So, businesses not only pay for the pouches themselves but then must pay a second time to dispose of the pouches as regulated or hazardous waste, which is extremely costly. Fortunately, thanks to the promulgation of both the DEA and EPA rules, there are more efficient, environmentally safe, and cost-effective methods to dispose of controlled, non-controlled, and hazardous waste pharmaceuticals (HWPs) upon adoption of the new EPA rule by each state. The first is the use of a DEA-compliant drug collection receptacle like our MedSafe. With MedSafe, there is no need for your highest-paid employees to spend their time popping pills for disposal. Rather, you simply dispose of the blister pack or pill bottle full of controlled, non-controlled, or HWPs (once the state has adopted the new EPA rule) into the securely locked collection receptacle, which provides the extra benefit of reducing the possibility of diversion. Once the inner liner is full, it is sent directly to our treatment facility via prepaid postage by common carrier. Upon receipt, all liners are incinerated, meeting the DEA and EPA disposal standards. Plus, since all contents are incinerated, the resident’s protected health information is destroyed in a HIPAA compliant manner. Like MedSafe, the DEA also allows for individuals to utilize mail-back envelopes, like our TakeAway Medication Recovery System Envelopes, in their home to dispose of their unwanted medications, controlled and non-controlled, via USPS. An individual simply takes the nondescript envelope, fills it with their unwanted medication bottles and blister packs, seals the envelope, and places it in the mailbox or gives it to the mail carrier. With the prepaid postage, the envelope is sent directly to our treatment facility, where it is incinerated – again, meeting the DEA and EPA destruction standards as well as HIPAA. By using MedSafe or TakeAway Medication Recovery System Envelopes, communities will not only remain compliant with DEA, EPA, and HIPAA, but they also save long-term care communities money, potentially as much as $17,000 annually, with the reduction in the various expenses related to medication disposal. Additionally, these easy, efficient, and time-saving methods of disposal will give nursing staff their valuable time back to care for residents rather than spending their time popping pills out of blister packs. Contact us today at 800.772.5657 to learn more about how we can help your community save money on medication disposal. Read More
December 18, 2019 INFOGRAPHIC: What to Do if You Find a Discarded Syringe or Sharp Jump to the infographic. Safe handling and disposal of used needles and sharps help prevent injuries caused by accidental needlesticks. Unfortunately, many people don’t properly dispose of their used syringes and sharps. As a result, other people are injured by used syringes that were carelessly discarded in garbage cans, dropped in parks and playgrounds, or left behind in other public places. It’s scary to realize that there’s a chance that you or your child might find one! Do you know what to do? You Found a Used Needle. Now What? Anybody who finds a discarded syringe should assume it’s contaminated with a bloodborne disease or unknown type of drug. The safest course of action is to call the authorities and report it. For example, you might alert park police, lifeguards, security personnel, a store manager, etc. depending on where the needle is located. You can also call your local health department or law enforcement agency to report it. If you choose to remove it yourself, be extremely careful! Children should be taught never to touch a used syringe but always report it to an adult. The Spokane Regional Health District recommends these safe syringe removal steps for adults: Do not try to recap the syringe. Find a rigid, thick-walled, sealable plastic container big enough to contain the syringe. Use protective gloves if possible. Bring the container to the syringe. (Walking with an uncapped syringe increases exposure risk.) Place the container on the ground next to the syringe. Pick up the syringe in the middle of the barrel, never by the needle. Place the syringe in the container, sharp in first, and let it drop. (Never try to hold the container as you place the syringe inside. You could accidentally stick yourself.) Secure the lid on the container and affix with tape. Remove your gloves and thoroughly wash your hands with soap and water. Seek medical attention immediately if you receive an accidental stick or cut from the used sharp. If there are multiple syringes piled up, never try to separate them by hand. Always use tongs to lay them out separately prior to placing them, individually, into a safe container. Remember that protective gloves and tongs can reduce manual dexterity and make it more difficult to hold the syringe securely in place. The Sharps Compliance infographic below shows the different types of sharps and offers some brief “do’s and don’ts” for safe sharps disposal. Never Place Used Syringes in Garbage Cans or Recycling Bins You’re only transferring the risk to someone else, usually a sanitation or recycling worker. For example, a recycling center in Broward County, FL reported a spate of worker injuries due to accidental needlesticks: Hypodermic needles have stabbed five employees this year at the Waste Management Recycling Brevard plant — sending them to the emergency room for blood-borne pathogen treatments. Since New Year’s Day, workers have filled six 30-gallon “biohazard” cardboard boxes with thousands of dirty needles that Space Coast residents improperly tossed into curbside recycling carts. Many municipalities do not permit contained sharps in the regular trash. Contact your local authorities before you place any sharps in your trash. Medication Self-Injection Is on the Rise Safe disposal of used syringes is a growing public safety issue, mainly because the rate of self-injection is on the rise in this country. Although many people think of illegal drug use when they see the phrase “self-injection,” many people with cancer, migraines, or chronic conditions like diabetes, rheumatoid arthritis, and multiple sclerosis self-inject their medications. Nearly 45% of all Americans suffer from at least one chronic disease, and the numbers are expected to rise as the population ages. When self-injection is a prescribed treatment, most medical professionals and pharmacists counsel patients on safe disposal methods approved by regulators. Sharps Compliance offers FDA-cleared Sharps Recovery Systems: Mailback sharps containment and disposal systems for home disposal, Travel-size transport tubes for safe disposal away from home, and Sharps container and disposal systems installed in public restrooms. The use of these is increasing as employers and local governments become more aware of the public health and liability issues raised by improper disposal. Illicit drug use (Schedule I drugs) is also on the rise. The Centers for Disease Control call heroin use “an epidemic” in the United States. In contrast to those who self-inject and immediately dispose of their syringes, lancets, etc., many IV drug abusers regularly reuse needles. Needle exchange programs help curb this trend, but safe disposal is rarely a priority. Local laws regarding the possession of “drug paraphernalia” can act as disincentives to safe disposal. Abusers often share needles with others, which increases the risk of contracting/spreading bloodborne diseases like HIV and hepatitis. That’s why accidental needlesticks and cuts are so traumatic for the victims and expensive to treat. For example, after a classmate poked an Arizona child with a syringe, the injured child’s mother described the prophylaxis treatment, multiple tests, and the cost: Amanda said her daughter is now taking antiviral medication for hepatitis and HIV as a precaution. […] Meantime, she said her out-of-pocket medical costs are mounting. The HIV medication alone cost $1,400 and her daughter will require regular blood tests for six months, she said. Improperly discarded syringes affect the health and safety of our communities. Contact us to learn more about how using our medical waste disposal systems can protect you, your family, and your community from accidental injury. Want to embed “INFOGRAPHIC: What to Do if You Find a Discarded Syringe or Sharp” on your site? Copy and paste the code below. <p style="text-align: center;"><img style="width: 100%; height: auto;"src="https://blog.sharpsinc.com/wp-content/uploads/2019/10/SCI-Discarded-Syringe-2019-Infographic.jpg"> What to Do if You Find a Discarded Syringe or Sharp - An Infographic by <a href="https://www.sharpsinc.com">Sharps Compliance</a></p> Read More
November 20, 2019 New Video Puts the Spotlight on Medication Disposal in Long-Term Care Facilities Last updated on April 13, 2021 The EPA’s new rule regarding pharmaceutical waste disposal means that many long-term care (LTC) facilities will have to change their current practices and train employees on the new regulations. In an interview with McKnight’s Long Term Care News, Sharps Compliance’s Director of Regulatory Compliance, Wanda Lingner, explains how the new EPA rule will affect senior living facilities. “Long-term care currently has a myriad of different disposal options. Flushing used to be the way that LTCs could easily dispose of unused medications, but that no longer is allowable per the EPA’s new rule. Now the question is: how do they manage the different types of pharmaceutical waste in the most compliant manner?” How indeed? Lingner answers common questions and concerns that LTC facilities have about compliance under the new rule and how the changes will affect their operations. What are the different methods for medication disposal in long-term care facilities? How does MedSafe save long-term care communities money and staff time? How does the EPA’s new pharmaceutical rule affect medication disposal in long-term care? Watch the interview to learn how it can help your facility streamline medication disposal while making the process safer for residents, the community, and the environment. Get more detailed information about the EPA’s new pharmaceutical rule in these articles: Better options for safe medication disposal in senior living facilities Read our white paper on the EPA’s new hazardous waste pharmaceutical rule EPA’s new pharmaceutical rule: reasons and origins EPA’s new pharmaceutical rule takes effect 8/12/2019 Read More
