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Reusing Disposables... In The Garden!

Q: I have a situation that has occurred at my surgery center. One of my nurses has taken a disposable item used in shoulder surgery and found another use for the item. This was not approved for her to do. She has been washing the items in Klenzyme before taking them out of the building. She then has used them in her yard to stake plants and mark her property line.

Did you ever hear of any similar situation wherein a crafty, inventious-minded nurse would take a biocontaminated disposable item that she thought a shame to waste and has found another use for it?

We do have a policy that references theft from the facility, but it is usually assumed that the item would be of some value. In this case it is theft of an item that we usually dispose of and are responsible to see that it is handled appropriately from a public health standpoint.

A: Klenzyme is a liquid, enzyme-based presoak for medical appliances and instruments, as such soaking the shoulder surgery disposable in it did not render the "yard stakes" free of bloodborne pathogen contamination at the time they left your facility (a high level disinfectant would be required to kill BBP contaminants). Although other employees were hopefully not exposed, I would still consider your employee to have violated OSHA regulations by transporting biohazardous waste outside of a properly labeled container and also EPA regulations by disposing of biohazardous waste without a permit.

Certainly if you have in your employee's job description (as all facilities should) the requirement to comply with OSHA, HIPAA and other applicable regulations you could use this clause, as opposed to the theft of a non-valuable item, for disciplinary action.

Your employee could have contracted a BBP when transporting this equipment to her home. If your employee was infected this way, you could likely fight the claim regarding workman's comp. Here's an example, albeit from another industry.

From a public health (liability) standpoint, UV light effects cellular function by altering the structure of the nuclear material (DNA). The end result is sterilization. My guess is that any actual HIV, HBV, or HCV on the "stakes" has likely died as a result of time and sunlight, but I do not believe any research has been done in outdoor conditions, taking into account the wavelengths of UV in natural sunlight. Hospital based research on nosocomial infections claims that HIV and HBV can live on a dry surface for at least 7 days.

In this study, following exposure to UV light in a class II biological safety cabinet, cell-free and cell-associated HIV suspended in culture medium was inactivated within 5 to 20 minutes.

Also UV light is used as a virucide when preparing Factor VIII for hemophiliacs: "For example, when UVC [short wavelength ultraviolet light] is combined with solvenudetergent treatment, the overall clearance of enveloped viruses like HBV and HCV is likely to increase above 10^10, and the clearance of HIV is likely to exceed 10^11."

If you would want to retrieve the shoulder surgery equipment from the employee's yard and dispose of it you may, but I would think at this point (based upon time and UV) it is no longer infectious. I would still advise your employee not to eat anything that was staked with the equipment. Disciplinary action will be an internal call.

Do you have a situation that has left you scratching you head, thinking: "employees do the darndest things"? If so, tell us about it here!

Posted by Quality America on March 30, 2007 | Comments (0)


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