Management of infectious waste by US hospitals

Article Abstract:

The fear of acquired immunodeficiency syndrome (AIDS) has been sparked by recent events, such as syringes floating onto beaches and children playing with discarded tubes of blood found in dumpsters. In 1976 Congress directed the Environmental Protection Agency (EPA) to regulate the management of infectious waste, but the EPA only prepared a guidance manual. In 1988 the EPA was required by the Medical Waste Tracking Act to regulate certain infectious waste and to develop a tracking system. States had also begun to put their own regulations into effect; 88 percent of states in 1988 acted to regulate infectious waste, compared to 57 percent in 1986. Twenty percent of US hospitals were randomly surveyed concerning their infectious waste disposal practices; 46 percent responded. Eighty-two percent of these hospitals discard blood, microbiological materials, sharps (needles and scalpels), pathology, and contaminated animal carcass waste in accordance with the recommendations for the Centers for Disease Control (CDC). The compliance rate with the EPA is 75 percent. No hospital identified an infection problem in the last five years involving infectious waste disposal, except for needle-stick injuries. A major problem in handling the disposal of infectious waste is the lack of consensus in a definition. Since there are no tests to determine if infectious waste contains pathogens with sufficient virulence and quantity to cause illness, waste is usually defined as infectious when it is suspected of containing potentially harmful organisms. Options for on-site waste treatment are diminishing and the costs, especially when using the EPA definition, are a considerable burden for hospitals which receive little incentive or penalty regarding compliance.

Hospitals

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Infectious medical wastes

Article Abstract:

Several recent incidents involving the improper handling of medical waste prompted the American Medical Association (AMA) to pass Resolution 53 in 1987, in support of pending federal legislation concerning the disposal of infectious medical waste. The AMA's Council on Scientific Affairs subsequently reviewed hospital management of infectious waste and state and federal regulations. Acknowledging that irresponsible disposal of waste pollutes the environment and endangers the food supply, the Council urges immediate action. In consultation with the Environmental Protection Agency (EPA) the American Hospital Association and the Centers for Disease Control (CDC) infectious medical waste is defined as cultures and stocks of infectious agents and associated biological materials, human blood and blood products, pathological waste, and contaminated sharps (needles and scalpel blades). The EPA also includes: animal carcasses, body parts, bedding, and waste from patients who were in isolation. The Council concludes that existing or pending state regulations, in conjunction with the CDC and EPA guidelines, should ensure the safe disposal of infectious hospital waste. Congress has since ordered the EPA to develop a tracking system for waste from Connecticut, New Jersey, New York and the states bordering the Great Lakes. This report should be accepted in place of Resolution 53.

Reports, American Medical Association. Council on Scientific Affairs

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Transparent polyurethane film as an intravenous catheter dressing: a meta-analysis of the infection risks

Article Abstract:

Patients with a central or peripheral intravenous (IV) catheter may have a higher risk of infection when the catheter is held in place with transparent polyurethane film dressing rather than gauze dressing. Of 14 studies in the medical literature that examined the risk of infection associated with the use of transparent dressing with IV catheters, seven used central venous catheters and seven used peripheral venous catheters. Analysis of the studies that used central venous catheters found that a significantly higher risk of catheter tip infection and bacterial infections of the blood and tissues was associated with the use of a transparent dressing, but not with the use of a gauze dressing. Analysis of the studies that used peripheral catheters found that a higher risk of catheter-tip infection was associated with the use of a transparent dressing, compared to a gauze dressing. But the risk of phlebitis, infiltration of bacteria into the tissues, or skin infections did not increase when a transparent dressing was used with a peripheral catheter.

Health aspects, Infection, Equipment and supplies, Risk factors, Intravenous catheterization, Polyurethanes, Medical plastics, Polyurethanes in medicine

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