Q: Can you please go over the appropriate process on handling non-chemo drugs (for example, Colchicine in tablet form and if needed, compounding into a suspension for vent patients).
All non-chermotherapy drugs must be evaluated to determine if they meet any of the definitions of a hazardous waste, and if so, must be managed as such. For non-hazardous drug waste, the best management practice is to segregate them, usually in white containers with a blue top, and have them incinerated at either a regulated medical waste or waste-to-energy incinerator.
Q: We have had a problem with hazardous drug breakage as received from distributor. Are distributors covered by the requirements or special rules, and are there standards for their packaging of hazardous drugs for delivery?
Distributors certainly are governed by the hazardous waste regulations, but I am unaware of any specific rules that require special handling. The best practice is to secure chemotherapy drugs in marked zip-lock bags, include additional packing materials, and segregate into a specially market chemotherapy tote. I would suggest contacting the distributor and if that does not achieve results, consider changing distributors or taking it to your IDN or GPO.
Q: Since we know that overwraps/boxes/packaging of drugs can be contaminated, how should that waste be disposed of?
All packaging associated with chemotherapy drugs should be managed as trace chemotherapy waste, usually in a yellow container, and incinerated at a regulated medical waste incinerator.
Q: Do you have any RCRA vendors you would recommend?
A number of hazardous waste brokers are available regionally. There are several companies that operate RCRA incinerators, including Heritage, Clean Harbors, Ross, and Veolia.
Are Barium Sulfate products considered Hazardous Waste in California or other regulatory agencies: RCRA, NIOSH, EPA?
Some barium sulfate products fail the toxicity characteristic leaching procedure and are a hazardous waste in all states. If you have not run such a test or do not have access to the results from the manufacturer, it is safest to manage barium sulfate as a hazardous waste.
If we use a CSTD (PhaSeal) when compounding hazardous drugs and there is exposure to the gown may the gown be dispose of as regular medical waste?
All items involved with chemotherapy preparation should be managed as trace chemotherapy waste and incinerated, not as red bag waste, which is often autoclaved.
1. Originally my impression was that based on USP 797 guidelines, inj chemo drugs only had be stored separately from the regulary stocked items, preferably in a negative pressure room.
Based on this hazardous drug presentation will we need to also consider separating all hazardous drugs discussed in this slide presentation.....that would almost necessitate another room to be able to store these additional items?
Please differentiate between OSHA hazardous drugs and EPA hazardous wastes. Hazardous drugs under OSHA are most often chemotherapy agents, unless hormones are being compounded also.
