Bioharzard Removal Within a Perioperative

Bioharzard Removal within a Perioperative Procedure

What is Medical (Bioharzard)Waste?

According to the Environmental Protection Agency Medical Waste is defined as waste generated at health care facilities such as hospitals, physicians offices, etc. The Medical Waste Tracking Act of 1988 defines medical waste that is generated in the diagnosis, treatment or immunizations of human beings or animals. The Act includes several broad categories. These categories are:

(1) Blood-Soaked Bandages

(2) Culture Dishes and other glassware

(3) Discarded Surgical Instruments

(4) Discarded Surgical Gloves

(5) Discarded Needles

(6) Swabs used to inoculate cultures

(7) Removed Body Organs

(8) Discarded Lancets

How is Medical Waste Handled?

Operating Room Nurses, specifically the Perioperative Nurse is responsible for handling the medical waste. Perioperative Nurses are charged with adequately handling the medical waste in conjunction with the standards initiated by the Environmental Protection Agency. The Perioperative Nurse has several medical waste initiatives they can initiate. These initiatives include arranging for the meticulous segregation of potentially infectious and noninfectious waste; the correct disposal of chemicals, tissues and hazardous materials and engage in recycling of medical waste. The Perioperative Nurse can initiate supply conservation and management practices by opening only the supplies that are needed; medical supply management processes to ensure that only those materials required for operations are used and engage in a practice of proactive maintenance-anticipate problems and create solutions (the Nightingale Institute, 2011).

Literature Review

In 1992, Medical Waste was at the forefront of nursing research when medical waste began to wash up on the shores of New Jersey. In Anderson's article "Medical Waste Management: Implications for Plastic Surgery Offices and Surgicenters," Anderson detailed a study that was instrumental in developing standards for monitoring and managing the storage and disposal of medical waste (Anderson, 1992). Individuals were worried that medical waste washing up on the shoreline of New Jersey posed substantial risks of conveying diseases (Anderson, 1992). The appearance of such waste lead to the public thinking contracting diseases such as HIV or Hepatitis C (Anderson, 1992). In 1994, the government passed the Medical Waste Tracking Act. This created a two-year tracking study that documented the flow of medical waste (Anderson, 1992). The study lead to the Association for Operating Room Nurses (AORN) to develop industry standards that examined the procedures used to monitor medical waste (Anderson, 1992). The Anderson article set the stage for further research in the area of environmental impact of medical waste.

Melamed (2003) in her article "Environmental Accountability in Perioperative Settings," stated that Perioperative nurses have a higher degree of responsibility in monitoring the impact of medical waste on the overall environment (Melamed, 2003). Melamed states that global environmental problems are connected to patient issues-one could argue this is the overall theme of the article. Toxicity of medical waste, according to Melamed, has increased exponentially over the past ten years (Melamed, 2003). Perioperative Nurses must create innovative methods to segregate those toxic waste materials and prevent them from contaminating the patient's environment (Melamed, 2003). This theme of medical waste impacting the environment was extended to include a global view in Owens, 2003 article "Challenges of International Disaster Relief." Owens argues that surgical care is the most important service to provide to victims of disaster (Owens, 2003). A specialized response team created by the National Disaster Medical Treatment division of the Federal Emergency Management Agency is charged with the sole duty of providing surgical services to victims of disaster (Owens, 2003). This can include and is not limited to the construction of portable surgical units (Owens, 2003). The construction of such mobile operating rooms creates an entirely new set of medical waste and environmental issues (Owens, 2003). Effective management of medical materials in this environment is critical to ensuring that patients do not suffer from toxic exposure (Owens, 2003). Perioperative nurses can incorporate the various Operating Room procedures to minimize the risk of patient harm. A discussion regarding the literature detailing medical waste and perioperative nursing is not complete without a discussion involving the clinical impact of medical waste.

In Volko's 2002 article "Contact with Hospital Syringes containing bodily fluids; Implications for Medical Waste management regulation," detailed the results of a study wherein the use of syringes was examined in their conjunction with medical waste. The objective of the study was to determine the amount and body fluids of these syringes (Volko, 2002). Syringe use was surveyed at a tertiary care center or a period not exceeding seven (7) days. Syringe use was categorized into four different components. These components included: (1) Contained Blood at the time of use; (2) Contained other bodily fluids; (3) Used exclusively for drug dilution and application and (4) Intramuscular; Subcutaneous and Intradermal IV's (Volko, 2002).

As a result of the study, approximately 17% contained blood during use; 4.8% had other bodily fluids within; 73% were used exclusively for drug dilution and .5% were used during injections (Volko, 2002). The study concludes there is an urgent need for a review of the management of medical waste. Updating the process and standards will improve the management of medical waste and reduce the probability of environmental damage (Volko, 2002). The Volko study serves to express what has been a looming theme in perioperative research in relation to medical waste.

Ultimately, Nurses and other hospital staff are at the mercy of the Hospital Administrator in terms of budget allocation. Incorporating enhanced standards for the maintenance of medical waste requires increases in training, possibly staff and improvements in the facilities that store and collect the medical waste. This requires the hospital to expend resources, in times when resources are stretched thin this necessity may fall by the way-side as other more pressing matters are attended to by the Hospital Boards.