Waste disposal, vaccination, and exposure protocols

Protocols for disposal of biological and chemical materials

The Medical Waste Tracking Act established standards for governmental regulation of medical waste; however, the law expired in 1991. States were then given responsibility for regulating medical waste disposal. As a result, requirements vary by state, ranging from minimal regulation to very strict oversight.

Healthcare facilities must follow state-specific regulations for the handling, storage, transport, and disposal of biomedical waste.

Examples of regulations covering the disposal of hazardous materials include the following:

• Biomedical waste should be collected in containers that are leakproof and strong enough to prevent breakage during handling.
• Containers must be labeled with the biohazard symbol.
• Workers who handle biomedical waste should follow standard precautions.
• Biological waste containers and boxes should not be held in the healthcare facility for longer than 30 days.
• Sharps, including lancets, scalpel blades, needles, and syringe/needle combinations, must be placed in red, hard plastic sharps containers after use.
• Sharps containers should be closed when they are three-fourths full.
• Chemical disposal containers should be labeled with the chemical name and other pertinent information.
• Chemical containers must be adequately sealed to prevent breakage or leakage.
• Each healthcare facility must contract with a biomedical waste disposal service whose employees are trained to collect and transport biomedical waste for proper treatment and disposal.

Sidenote

Sharps safety

Never force items into an overfilled sharps container. Replace containers before they become full to reduce the risk of injury.

The cost of biomedical waste disposal is typically based on the weight of the contaminated materials collected, including filled sharps containers, biohazard bags, and waste boxes.

Hepatitis B vaccination

HBV vaccination must be available free of charge to all employees at risk for occupational exposure to bloodborne pathogens within 10 working days of starting employment.

The vaccine is administered by intramuscular injection and consists of either a two-dose or three-dose series, depending on the vaccine product used. Booster doses are not currently recommended. However, if future recommendations change, boosters must be provided at no cost to eligible employees.

More than 90% of healthy adults develop protective antibodies after completing the hepatitis B vaccine series.

After completing the hepatitis B vaccination series, healthcare workers with a high risk of exposure should have a hepatitis B antibody titer drawn to determine whether immunity has developed. Antibody testing should be performed 1 to 2 months after the final dose.

If the employee does not respond to the initial vaccine series, a second vaccination series may be recommended. If antibodies still do not develop after revaccination, no further vaccination is typically administered.

Employees have the right to decline hepatitis B immunization, but they must sign a declination form that is maintained in their employee record.

Before signing the declination form, the employee must receive education regarding:

• Hepatitis B and hepatitis B vaccination
• Vaccine safety
• Route of administration
• Benefits of vaccination

Employees must also be informed that the vaccine is available free of charge. If an employee later changes their mind, the vaccine must still be provided at no cost.

Post-exposure follow-up

If an employee is exposed through an accidental needlestick, human bite, exposure to broken skin, or a splash to the eyes or other mucous membranes, specific procedures must be followed immediately.

Immediate response

The following steps should be taken after exposure to contaminated materials:

• Immediately wash or flush the exposed area.
• Report the exposure incident to a supervisor as soon as possible.
• Obtain a confidential medical evaluation immediately.

Prompt reporting and evaluation are critical because some post-exposure treatments are most effective when started as soon as possible.

The healthcare provider evaluating the exposed employee must receive written details regarding:

• The route of exposure
• Circumstances surrounding the incident
• Information about the source individual, if known

Documentation requirements

All documentation related to the exposure must:

• Remain confidential
• Not be disclosed without the employee’s written permission
• Be maintained for the duration of employment plus 30 years

An incident report must be completed documenting:

• The details of the exposure
• The route or type of exposure
• The identity of the source individual, if known

The source individual is the person, living or deceased, whose blood or potentially infectious material caused the occupational exposure.

Source individual testing

The source individual is screened for:

• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Human immunodeficiency virus (HIV)

Depending on state law, consent may or may not be required before testing. If consent is required but not obtained, the employer must document that consent was requested but not granted.

If testing is performed, OSHA requires that the exposed employee be informed of the source individual’s test results.

Employee testing and follow-up

The exposed employee may be tested for:

• HBV
• HCV
• HIV

Testing helps determine whether the employee already had one of these infections before the exposure incident.

If the employee declines testing but blood is drawn, the specimen must be stored for 90 days in case the employee later decides to have testing performed.

If the employee has not previously received hepatitis B vaccination, the vaccine series must be offered.

The employee must also:

• Receive a copy of the healthcare provider’s written opinion within 15 days of completing the evaluation.
• Receive counseling regarding the risks of infection and disease transmission to family members, patients, and others.

Sidenote

Healthcare students

Healthcare students are also at risk for occupational exposure and should follow the same OSHA safety practices used by healthcare professionals.

A complete, unabridged copy of OSHA’s Bloodborne Pathogens Standard may be obtained from the OSHA website.

Infection prevention assessment tools

The CDC has developed assessment checklists that ambulatory care facilities can use to evaluate infection-prevention practices.

These checklists help facilities determine whether they:

• Follow recommended infection-control procedures
• Have appropriate policies and procedures in place
• Maintain adequate supplies for infection prevention
• Support employee compliance with safety standards

If deficiencies are identified during an infection-prevention assessment, the facility should take corrective action related to staff training, procedures, equipment, or supplies.

Regular evaluation of infection-prevention practices helps protect patients, visitors, and healthcare personnel while supporting compliance with OSHA and CDC recommendations.