Wondering how your Wisconsin healthcare facility can avoid hazardous disposal violations and sail through a surprise inspection by the WI DNR?

This Wisconsin Department of Natural Resources presentation highlights six areas to concentrate on to ensure a compliant hazardous waste management program. If you’re counting, we’re adding a seventh one in the list below, as the August 21, 2019 Sewer Ban is just around the corner.

To clarify, the WI DNR lists healthcare facilities as: hospitals, clinics, community-based residential facilities, residential care apartment complexes with centrally managed medications, in-patient hospice care and nursing homes with five or more beds.

The WI DNR defines hazardous waste as material being discarded (solid waste), which has any of these characteristic properties:

  • Ignitable (D001) – alcohol, solvents
  • Corrosive (D002)  – acids
  • Reactive (D003) – reacts violently with water, explosive
  • Toxic (D004 – D043) – regulatory levels (lead, mercury, silver)

Acute hazardous wastes are highly toxic in the environment. This includes things like U-listed wastes (nitroglycerin), and P-listed wastes, like warfarin and nicotine.

Now let’s get to the meat of the matter.

Most Common Hazardous Waste Disposal Violations

According to the WI DNR, the most common compliance violations and issues they see in Wisconsin healthcare facilities’ hazardous waste disposal process include:

  1. Incorrect Waste Determinations
  2. Inaccurate information on Land Disposal Restriction Notifications
  3. Insufficient Manifests recording cradle-to-grave hazardous waste disposal process
  4. Missing March 1 deadline for the WI DNR’s Annual Hazardous Waste Report
  5. Improper Hazardous Container Management
  6. Inadequate Training Documentation for Employees Handling Hazardous Waste

And, effective August 21, 2019, add:

  • Illegally Pouring Hazardous Waste Pharmaceuticals Down the Drain

Here’s a deeper dive into each:

Waste Determinations

It’s crucial to evaluate and properly characterize each hazardous waste stream for proper disposal. WI DNR publication WA1259, Table of Common Healthcare Wastes, is good to have on hand when sorting. Another guide, WI DNR’s Publication WA1152, Waste Determinations and Record Keeping, can also help when evaluating, characterizing and documenting each waste.

For pharmaceutical wastes, work with your pharmacist to get an updated formulary list to determine hazardous from non-hazardous. Commingling of hazardous and non-hazardous waste pharmaceuticals in the same container is acceptable. You must dispose of it as hazardous waste pharmaceuticals.

Beyond hazardous waste pharmaceuticals, you’ll need to keep in mind other hazardous waste streams. Spent hazardous materials from a lab (formalin), maintenance area (corrosive cleaning chemicals) and power plant (used oil and boiler chemicals) count too.

Keep track of universal waste. This includes hazardous lead items from protective x-ray clothing (aprons, shields, gloves). And, it includes shielding or wallboard from former X-ray rooms, or x-ray film foil wrapping.

If your facility has a dental clinic, keep track and properly dispose of wastes that contain silver. These include items like silver tipped catheters, X-ray film, plates and negatives. Dental amalgam should be sent to special mercury recycling center.

In Wisconsin, chemotherapy waste needs to be thermally destroyed. Be sure to document this for trace and bulk chemo destruction.

Land Disposal Restriction Notifications

From the moment hazardous waste is generated onward, it is subject to land disposal restrictions. If a hazardous waste generator produces more than 220 pounds of hazardous materials or 2.2 pounds of acute hazardous waste in a calendar month, it must identify the type and nature of the waste on a Land Disposal Restriction (LDR) Notification. And, it also must determine the course of applicable treatment before land disposal.

LDR Notifications must be kept on file for three years, per NR 668.07 Wis. Adm. Code. Being able to quickly retrieve them is important. The inspector will likely want to review them to see that all of the information is correct on them.

Hazardous Waste Manifests

Unless exempted, large quantity and small quantity generators (those who produce more than 220 lbs of hazardous waste or 2.2 lbs of acute hazardous waste per month) must use a paper or electronic manifest when shipping their hazardous waste. This Guide for Hazardous Waste Generators outlines more about this topic.

Retrieving these manifests from the past three years is key. They must document the cradle to grave destruction of your hazardous waste. Plus, they must also include proper waste codes, volumes, as well as the name of the transporter and receiving facility for the waste. Signatures must document each step of the way on a paper or electronic manifest.

Annual Hazardous Waste Reporting

By March 1, Wisconsin healthcare facilities must complete a hazardous waste annual report if they meet any of these three qualifications in any one month during the previous year. If they had:

  • 220 pounds of hazardous waste,
  • 2.2 pounds of acutely toxic waste, or
  • 220 pounds of acute hazardous waste as part of a spill cleanup.

Large Quantity Generators (more than 2,200 pounds of hazardous waste in any one month, or 2.2 pounds of acutely hazardous waste) must also submit a waste management plan in odd numbered years.

Container management

Here are a few questions inspectors might address regarding your hazardous containers.

Are:

  • Your containers in a secure area and labeled hazardous waste?
  • You tracking how much you are generating?
  • The lids securely closed on the containers?
  • Arrival dates on container labels?
  • You doing weekly inspections of the satellite accumulation area to ensure your containers are in good working condition and the covers are closed?

It’s always smart to have your hazardous containers near the point of generation. But, move them when they full. Remember, you have only three days to move them to main accumulation areas.

Very Small Quantity Generators (less than 220 pounds of hazardous waste a month) don’t have a time limit to when they need to dispose of their hazardous waste. As a best practice, we suggest to dispose of it at least once per year.

Small Quantity Generators have 180 days to remove their full hazardous waste containers. Large generators have only 90 days to remove their full containers from the main accumulation storage area.

Finally, make sure your staff knows which type of container is appropriate for each type of hazardous waste. Having a medical waste map that outlines what waste goes in each container could demonstrate to the inspector that your facility is on top of it. MERI offers a template of a medical waste map to our customers which offers a guideline as to which waste goes where.

Training and Emergency Response

It is not only vital to provide training for employees managing hazardous waste, but also to have a record of when and where the training took place. All facility personnel must understand the emergency evacuation portion of the contingency plan.

In addition, an agreement must be made with an emergency response contractor who understands ahead of time the types of hazardous wastes they could be handling if a spill were to take place. 

To sum up, would you be able to find the number of who to call should a hazardous spill occur on the premise? Could the folks who are cleaning up quickly be given information about what they are dealing with?

Sewer Ban Begins August 21, 2019

We’ve covered six common violations the DNR may site you for. Yet, one that will likely be addressed in the near future is what gets flushed down your facility’s drain. Medical facilities should have a letter from their Public Owned Treatment Works (POTW). It should explain what is currently being disposed of via the sink or toilet. Remember, take into account the new Sewer Ban before flushing.

The August 21, 2019 EPA sewer ban will affect healthcare facilities nationwide. Read our recent blog to learn more. Hazardous pharmaceutical waste cannot be disposed of down the sink or toilet. The following five DEA controlled substances are hazardous waste. They must not be flushed down the drain. They must be made non-recoverable. Or, a DEA Registrant needs to handle them.

  • Chloral/ Chloral Hydrate
  • Fentanyl Sublingual Spray
  • Phenobarbital
  • Testosterone gels/solutions
  • Valium injectable/gel

It Pays to Be in Compliance

Simply put, the consequences of not being in compliance are steep. Penalties can run up to tens of thousands of dollars, depending on the type and seriousness of the violation. Be sure to avoid this by educating yourself, and your staff!

As always, MERI is here for you. We often help our customers pull together key information they need to have at their fingertips. It is helpful to have on should an inspector come calling.

Give us a call at 608-257-7652 if you have any questions, or email us at info@meriinc.com

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