AFAMS

EO 001.05 Hazmat Handling(Dari)

01/09/2013

Modified Presentation from Chennai Government Hospital For Thoracic

Medicine

AFAMS

Learning Objectives

• Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority

• Learn ways to minimize waste• Know the criteria for safe

management of sharps

• Insert Dari

Modified Presentation from Chennai Government Hospital For Thoracic

Medicine

Insert Dari

AFAMS

Overview EO 001.05(Dari)

• Biohazardous materials– Handling– Storage– Disposal

• Hospital Grade Gases– Handling– Storage

• Lesson Review• Scenarios (not graded)

AFAMS

Insert Dari

AFAMS

Part I: Health Care Waste Overview

Modified Presentation from Chennai Government Hospital For Thoracic

Medicine

Insert Dari

AFAMS

Definitions of Waste

Health care waste• All types of waste from all health

care activities

Hazardous health care waste• Waste that presents a health hazard

of some kind• Note: Most health care waste is no

more hazardous than household waste

• Insert Dari

AFAMS

Types of Hazards to Consider

• Flammable

• Toxic - mutagenic, cytotoxic, teratogenic, etc

• Reactive

• Allergen, contact sensitizer

• Explosive

• Infectious

• Radioactive

• Corrosive

• Caustic

• Isopropyl alcohol

• Cancer chemotherapy, tar-based products

• Sulphuric acid, chlorine powder

• Glutaraldehyde

• Picric acid, fertiliser, ammonia

• TB cultures

• Barium enema, X-rays

• Bleach

• Lye

AFAMS

Hazardous Health Care Waste

Infectious hazard:

• Anatomic waste

• Laboratory cultures

• Sharps

• Live viruses

Corrosive, teratogenic, reproductive hazard:

• Heavy metals

• Pesticides

• Cleaning products

• Pressurised containers

• Mercury

• Cancer therapy

AFAMS

Is Health Care Waste an Important Source of Infectious Disease?

Yes!• IF needles and syringes are

scavenged and re-used, then many diseases can be spread

• Keep used sharps and syringes out of public access

No!• Most medical waste does not have more

germs than household waste

• It causes visual pollution, generates fear, but unless re-use of sharps occurs, medical waste causes little disease

AFAMS

Then Why does this Waste Matter?

• Sharps injuries may harm workers and communities

• Medical waste potentially impacts patients, workers, community, and economy because of the volume and permanence of waste

• Insert Dari

AFAMS

Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day

Health care waste may: • Contain infectious organisms, including drug

resistant ones• Place cancer causing agents into air or

ground water• Cause radiation-related illnesses • Contribute to global warming harm

atmosphere (CFC containing refrigerant gas)• Cause injury (sharps, explosion)• Cause congenital defects or stillbirth,

prematurity, infertility

• Insert Dari

AFAMS

How to Safely Dispose of Infectious Sharps

• Do not recap sharps before disposal • Dispose of sharps at the point of use in a leak

proof puncture proof container • Avoid handling, emptying or transferring

used sharps between containers • Autoclave highly infectious waste before

disposal• Control public access to syringes and

medical equipment • Shred, encapsulate and bury according to

national legislation

• Insert Dari

AFAMS

For Non-Infectious Hazardous Waste, the Risks Depend on:

• Severity of acute or chronic exposure– Duration of exposure– Frequency of exposure– Concentration agent (1% versus 50%)– Individual vulnerability including

pregnancy, weight– Route of exposure (skin, respiratory,

oral, etc.)– Steps taken to protect (PPE, relieved

from immediate contact etc.)

• Insert Dari

AFAMS

Who is at Risk?

• Doctors - anesthesiologists, pathologists • Nurses - oncology nurses, OT, ER• Hospital support staff - X-ray assistants,

pharmacy, morgue, and lab staff• Cleaning staff - those cleaning sewage

lines• General public - those using sharps

found in the waste

• Insert Dari

AFAMS

Common Hazards

• Anesthetic gases

• Glutaraldehyde

• Formaldehyde/formalin

• Cancer therapeutic agents

• Ethylene Oxide

• Radiation

• Asbestos

• Blood contaminated sharps

• Bleach

• Solvents (xylene, toluene, acetone, ethanol)

• Pesticides, fungicides

• Heavy metals (mercury, chronium, cobalt, cadmium, arsenic, lead)

• Latex

• Strychnine and cyanide

AFAMS

12 Steps to Manage Hazardous Wastes before Disposal

1. Know what hazards you have.

2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists.

**Use mercury-free thermometers

AFAMS

12 Steps to Manage Hazardous Wastes (cont’d)

3. Limit use and access to trained persons with personal protective gear

AFAMS

4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards

AFAMS

5. Get Rid of Unnecessary Stuff

• Don’t accumulate unneeded products

• Don’t let peroxides and oxidising agents turn into bombs

Photo of bomb robot called into hospital to dispose of picric acid.

AFAMS

6. Label with Agent, Concentration and Hazard Warnings

• Examples of hazard labels:

Accumulating ToxicDari

Poisonous Dari

FlammableDari

Compressed GasDari

ReactiveDari

BiohazardousDari

Oxidizing AgentDari

CorrosiveDari

AFAMS

7. Communicate about Workplace Hazards

• Job descriptions

• Posters on doors

• Labels on hazards

• Give feedback on use of PPE and disposal in evaluation

• Role model safe use and disposal

• Contact point who is responsible

AFAMS

8. Recycle Products When Possible

AFAMS

9. Segregate Hazards at the Source

• Separate sharps and infectious waste where they are used – This prevents injuries that can

occur when people sort the trash after it is disposed

• Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members

• Insert Dari

AFAMS

10. Have Written Policies on Waste Disposal

• Sharps and infectious waste• Chemotherapy (cancer)• Heavy metals (batteries) • Chemicals

Post brief, colorful instructions on walls to remind workers

• Insert Dari

AFAMS

11. Minimise the Handling of Wastes

• Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly

• Insert Dari

AFAMS

12. Conduct Walk-Around Interviews

• Ask about the hazardous substances staff work with, how they dispose of them, and what they need to be able to dispose of them properly

• Have a no-blame philosophy that strives to solve problems, NOT to assign blame

• Insert Dari

AFAMS

Part II: Waste Management Methods

Modified Presentation from Chennai Government Hospital For Thoracic

Medicine

Insert Dari

AFAMS

Options for Specific Types of Waste

• Pharmaceutical• Cytotoxic• Other chemical wastes• Heavy metals• Pressurised containers• Radiation • Infectious

• Insert Dari

AFAMS

Pharmaceutical Waste

Small amounts:• Disperse in landfill sites,

encapsulate or bury on site• Discharge to sewer• Incinerate

Large amounts• Incinerate at high

temperatures or encapsulate• LANDFILL IS NOT

RECOMMENDED

• Insert Dari

AFAMS

Cytotoxic Waste

• NEVER LANDFILL or DISPOSE TO SEWER

Disposal Options:• Return to supplier• Incinerate at high

temperature• Chemical degradation

• Insert Dari

AFAMS

Chemical Waste - Further Recommendations

• Keep different hazardous chemicals separate

• Do not dispose into the sewers or street

• Do not encapsulate large amounts of disinfectants as they are corrosive and flammable

• Do not bury large amounts of chemicals

• Insert Dari

AFAMS

Wastes with Heavy Metals

• Wastes with mercury, cadmium, lead, arsenic, strychnine, are poisonous (e.g., thermometers, batteries, lead paints, dyes)

• Never incinerate or burn• Never dispose of in municipal

landfills

Best solution: Avoid purchaseOR• Recycle in specialised cottage

industry or export to countries with specialised facilities

• Encapsulation

• Insert Dari

AFAMS

Pressurised Gas Containers

• NEVER INCINERATE• Return undamaged gas

cylinders and cartridges to the manufacturer for reuse

• Damaged containers: empty completely and crush, landfill

• Insert Dari

AFAMS

Radioactive Waste

Use requires a national strategy including:

• Appropriate legislation• A competent regulatory

organisation• Trained radiation protection officer

to monitor exposures • Return to the manufacturer

Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme

• Insert Dari

AFAMS

Simple Chemical Disinfection

• Requires shredding of waste• May introduce strong chemicals

into the environment (chorine bleach turns into dioxin when burned)

• Efficiency varies• Only the surface is disinfected• Does not disinfect human tissue • Special disposal required to avoid

pollution

• Insert Dari

AFAMS

Waste Disposal Options Include

• Disinfection – Autoclaving/ Microwaving, treatment, shredding

• Land Disposal• Burial• Encapsulation• Incineration• Inertisation• Managed Land-fill• On-site disposal

• Insert Dari

AFAMS

Infectious Waste: Autoclaving

• Pressure and temperature• Holding time• Sterility indicators• Type of waste• Followed by shredding /

burial / recycled

• Insert Dari

AFAMS

Burying Inside Hospital Premises

Apply the following rules:• Access to the site restricted and

controlledIf waste is retained on site, ensure rapid

burial to isolate from animal or human contact

• Only hazardous HC Waste to be buried

Management controls on what is dumped

• Each deposit covered with soil• Site lined with low permeable

material-concrete• Groundwater pollution must be

avoidedNot recommended for untreated

hazardous waste

AFAMS

Disposal to Land by Encapsulation

• Fill metal or plastic containers to 3/4, add:– plastic foam– bituminous sand– cement mortar– clay material

• When dry, label and seal containers and landfill

• May be used for sharps, chemicals, drugs etc.

• Insert Dari

AFAMS

Incineration

Combustible waste turned to ash at temps >800 C

• Reduces volume and weight

• Residues are transferred to final disposal site

• Treatment efficiency depends on incineration temperature and type of incinerator

• Not all wastes can be incinerated

• Costs vary greatly according to type of incinerator

• Produces combustion gases

AFAMS

Do not Incinerate

Do not incinerate the following:

• Plastics especially halogenated plastics (e.g. PVC)

• Pressurised gas containers• Large amounts of reactive

chemical waste• Radioactive waste• Silver salts or radiographic

waste• Mercury or cadmium• Ampoules of heavy metals

AFAMS

Advantages of Incineration of HC Waste:

• Good disinfection efficiency• Drastic reduction of weight

and volume• Good for chemical +

pharmaceutical waste

• Insert Dari

AFAMS

Disadvantages of Incineration of HC Waste:

• Doesn’t destroy chemical waste at lower temperature for rotary kiln

• Toxic air emissions if no control devices in place

• Maintaining temperature levels (and efficiency) in field incinerators is difficult, need to balance loads with non-hazardous materials

• High costs for high temperature incineration

• Insert Dari

AFAMS

Land-fill in Municipal Landfills

If hazardous health-care waste cannot be treated or disposed elsewhere:• Designate a site for hazardous HC

Waste• Limit access to this place• Bury the waste rapidly to avoid

human or animal contact• Investigate more suitable treatment

methods

• Insert Dari

AFAMS

Because no Disposal Method is Easy or Completely Safe…

Prevention is best!• Eliminate purchase by buying safer

alternatives• Recycle • Use smallest quantities possible, use

with engineering controls and Personal Protective Equipment

• Segregate hazards into separate waste streams at source

• Supervise disposal using best available ecologic option

AFAMS

Questions?Insert Dari

AFAMS

NMH Chemical Storage RequirementsInsert Dari

AFAMS

Storage of Chemicals in Pharmacy(Dari)

• Flammable materials should be stored in an approved, dedicated, flammable materials storage cabinet or room if the volume exceeds ten (10) gallons.

• Liquids must be stored in unbreakable or double-contained packaging, or the storage cabinet should have the capacity to hold the contents if the container breaks.– The pharmacy will not store chemicals on

the floor. – Chemicals should be stored no higher than

eye level and never on the top shelf of a storage unit.

– Shelf assemblies should be firmly secured to the walls.

– Store acids in a dedicated acid cabinet. – Store severe poisons in a dedicated poison

cabinet (e.g. insecticides). – All chemicals should be labeled and dated

AFAMS

Insert Dari

AFAMS

Storage of Chemicals in Pharmacy(Dari)

Chemical storage areas should be monitored for unusual conditions, such as: • improper storage of chemicals • leaking or deteriorating containers • spilled chemicals • temperature extremes (too hot or cold in

storage area) • lack of or low lighting levels • blocked exits or aisles doors blocked open• lack of security • trash accumulation • smoking or open lights or matches • fire equipment blocked, broken or missing • lack of information or warning signs ("No

Smoking", "Flammable Liquids", "Acids", "Corrosives", "Poisons", Chemical Storage")

AFAMS

Insert Dari

AFAMS

Pharmacy Incompatible MaterialsInsert Dari

ALKALI METALS such as calcium, potassium, and sodium

میتالز و الکالی پوتاشیم کلسیم، مانندسودیم

DO NOT CONTACT with: water, carbon dioxide, carbon tetrachloride, and other chlorinated hydrocarbons.

اوکساید، دای کاربن آب، مانند موادی باکلورین هایدروکاربن و تتراکلوراید کاربن

نیاید تماس در شده

ACETIC ACID

DO NOT CONTACT with: chromic acid, nitric acid, hydroxyl containing compounds, ethylene glycol, perchloric acid, peroxides, and permanganates.

اسید انتینایتریک اسید، کرومیک مانند موادی بامرکبات شامل که هایدروکسیل اسید،

اسید، پرکلوریک گالیکول، ایتایلین مانندتماس در پرمنگنات و ها پراوکساید

نباشد. ACETONE

DO NOT CONTACT with: concentrated sulfuric acid and nitric acid mixtures.

اسیتون

و غلیظ اسید سلفوریک مانند موادی با. نباشد تماس در اسید نایتریک مرکبات

ACETYLENE

DO NOT CONTACT with: copper (tubing), fluorine, bromine, chlorine, iodine, silver, mercury, or their compounds.

اسیتایلین برومین، فلورین، مس، مانند موادی با

تماس در سیماب نقره، آیودین، کلورین،نباشد.

AMMONIA, ANHYDROUS

DO NOT CONTACT with: mercury, halogens, calcium hypochlorite, or hydrogen fluoride.

انهایدروز امونیا،

هلوجن سیماب، مانند موادی باهایدروجن و هایپوکلورایت کلسیم ها،

نباشد تماس در فلوراید

AMMONIUM NITRATE

DO NOT CONTACT with: acids, metal powders, flammable liquids, chlorates, nitrates, sulfur, and finely divided organics or other combustibles.

نایتریت امونیم

فلزی، پودرهای ها، اسید مانند موادی بانایتریت ها، کلوریت احتراق، قابل مایعات

در احتراق قابل مواد دیگر و سلفر ها،نباشد تماس

ANILINE

DO NOT CONTACT with: nitric acid, hydrogen peroxide, or other strong oxidizing substances.

انیلین

هایدروجن اسید، نایتریک مانند موادی باقوی کننده تحمض اعوامل یا و پراوکساید

. نباشد تماس در

BROMINE

DO NOT CONTACT with: ammonia, acetylene, butadiene, butane, hydrogen, sodium carbide, turpentine, or finely divided metals.

برومین

بیوتادین، اسیتلین، امونیا، مانند موادی باکارباید، سودیم هایدروجن، بیوتان،

تماس دیگردر ظریف فلزات و تورپنتیننباشد

CHLORATES

DO NOT CONTACT with: ammonium salts, acids, metal powders, sulfur, carbon, finely divided organics or other combustibles.

کلوریت

ها، اسید امونیم، های نمک مانند موادی بامرکبات کاربن، سلفر، فلزی، های پودر

تماس در احتراق قابل مواد و عضوینباشد.

CHROMIC ACID

DO NOT CONTACT with: acetic acid, naphthalene, camphor, alcohol, glycerine, turpentine, and other flammable liquids.

اسید کرومیک

کمفور، نفتالین، اسید اسیتک مانند مواد باقابل مایعات و تورپنتین گالیسرین، الکول،

دیگر احتراق

AFAMS

Pharmacy Incompatible MaterialsInsert Dari

CHLORINE

DO NOT CONTACT with: ammonia, acetylene, butadiene, benzene and other petroleum fractions, hydrogen, sodium carbides, turpentine, and finely divided metals.

کلورین

بیوتادین، استایل، امونیا، مانند موادی باهایدورجن، پترولیم، مرکبات و بنزین

فلزی مرکبات و تورپنتین کارباید، سودیمنباشد تماس در

CYANIDES DO NOT CONTACT with: acids.

ها سیانید

نباشد تماس در ها اسید با

HYDROGEN PEROXIDE

DO NOT CONTACT with: copper, chromium, iron, most metals or their respective salts, flammable liquids and other combustible materials, aniline, and nitromethane.

اوکساید پر هایدروجن

کرومیم، مس، مانند موادی باو مایعات فلزات، های نمک و فلزات آهن،در میتان نایترو و انیلین احتراق، قابل مواد

نباشد تماس

HYDROGEN SULFIDE

DO NOT CONTACT with: nitric acid, oxidizing gases.

سلفاید هایدروجن

های گاز و اسید نایتریک مانند موادی بانباشد تماس در کننده تحمض

HYDROCARBONS

DO NOT CONTACT generally, with: fluorine, chlorine, bromine, chromic acid, or sodium peroxide.

ها هایدروکاربن

برومین، کلورین، فلورین، مانند موادی بادر پراوکساید سودیم و اسید کرومیک

نباشد تماس

IODINE

DO NOT CONTACT with: acetylene or ammonia.

تماس در امونیا و اسیتایلین مانند موادی بانباشد

AFAMS

Hospital Grade GasesInsert Dari

AFAMS

Overview(Dari)

• Types of hospital grade gases;

• Storage and handling requirements; and

• Disposal of gas containers.

AFAMS

Insert Dari

AFAMS

Most Common Gases in HospitalsDari

AFAMS

Finding Information

If no hospital policy exists for a gas where would you find information about storage and handling?• Product Monograph• Workplace Hazardous

Information System (Internet)

AFAMS

Product Monograph

What is a product monograph?A Product Monograph is a factual, scientific document on a drug product that, devoid of promotional material, describes the properties, claims, indications and conditions of use of the drug and contains any other information that may be required for optimal, safe and effective use of the drug.

AFAMS

Example: Isoflurane

•Isoflurane is used at NMH for initiation and maintenance of anesthesia.Anesthesia:

“insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations”

Oxford Dictionary

•Let’s look at the Isoflurane monograph for storage and handling information.More in depth examination of a product monograph will be done in future classes.

• Insert Dari

AFAMS

AFAMS

AFAMS

AFAMS

Finding Information

•Product monograph contains limited information on proper storage and handling.•More detailed information contained in the Workplace Hazardous Information System (Internet)

AFAMS

Finding Information

Workplace Hazardous Information System– The Workplace Hazardous

Materials Information System (WHMIS) is Canada's hazard communication standard.

• Requires information about a material to be supplied to the purchaser by a manufacturer.

• Material Safety Data Sheets: Created by the manufacturer listing important information about the material.

Health Canada• They are product/ manufacturer

specific. (ie. Isoflurane/ Baxter)

AFAMS

Material Safety Data Sheet

AFAMS

Material Safety Data Sheet Cont’d

• Other information:

AFAMS

Disposal of Gas Containers

• Some gases are stored in pressurized cylinders, cartridges, and aerosol cans.

• Many of these, once empty or of no further use are reusable.

• Whether inert or potentially harmful, gases in pressurized containers should always be handled with care; containers may explode if incinerated or accidentally punctured.

Click icon to add clip art

AFAMS

Questions?Dari

AFAMS

Who is at risk from Hazardous Waste?

• Insert Dari

AFAMS

Who is at Risk?

• Doctors - anesthesiologists, pathologists • Nurses - oncology nurses, OT, ER• Hospital support staff - X-ray assistants,

pharmacy, morgue, and lab staff• Cleaning staff - those cleaning sewage

lines• General public - those using sharps

found in the waste

• Insert Dari

AFAMS

Provide Examples of These Hazards

• Flammable

• Toxic - mutagenic, cytotoxic, teratogenic, etc

• Reactive

• Allergen, contact sensitizer

• Explosive

• Infectious

• Radioactive

• Corrosive

• Caustic

AFAMS

Examples of Hazards

• Flammable

• Toxic - mutagenic, cytotoxic, teratogenic, etc

• Reactive

• Allergen, contact sensitizer

• Explosive

• Infectious

• Radioactive

• Corrosive

• Caustic

• Isopropyl alcohol

• Cancer chemotherapy, tar-based products

• Sulphuric acid, chlorine powder

• Glutaraldehyde

• Picric acid, fertiliser, ammonia

• TB cultures

• Barium enema, X-rays

• Bleach

• Lye

AFAMS

Hazardous Health Care Waste

Infectious hazard:

• Anatomic waste

• Laboratory cultures

• Sharps

• Live viruses

Corrosive, teratogenic, reproductive hazard:

• Heavy metals

• Pesticides

• Cleaning products

• Pressurized containers

• Mercury

• Cancer therapy

AFAMS

12 Steps to Manage Hazardous Wastes before Disposal

AFAMS

12 Steps to Manage Hazardous Wastes before Disposal

1. Know what hazards you have.

2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists.

3. Limit use and access to trained persons with personal protective gear.

4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards.

5. Get Rid of Unnecessary Stuff.

6. Label with Agent, Concentration and Hazard Warnings.

7. Communicate about Workplace Hazards.

8. Recycle Products When Possible.

9. Segregate Hazards at the Source.

10. Have Written Policies on Waste Disposal.

11. Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled

12. Conduct Walk-Around Interviews directly

AFAMS

Label Answers

AFAMS

Identify Labels

Accumulating ToxicDari

Poisonous Dari

FlammableDari

Compressed GasDari

ReactiveDari

BiohazardousDari

Oxidizing AgentDari

CorrosiveDari

AFAMS

Pharmaceutical Waste

What are the recommended methods of disposal for:

Small amounts of pharmaceutical waste.

Large amounts of pharmaceutical waste.

• Insert Dari

AFAMS

Pharmaceutical Waste

Small amounts:• Disperse in landfill sites,

encapsulate or bury on site• Discharge to sewer• Incinerate

Large amounts• Incinerate at high

temperatures or encapsulate• LANDFILL IS NOT

RECOMMENDED

• Insert Dari

AFAMS

Pressurized Gas Containers

• Can you dispose of pressured gas containers by incineration or crushing in landfill?

• Insert Dari

AFAMS

Pressurised Gas Containers

• NEVER INCINERATE• Return undamaged gas

cylinders and cartridges to the manufacturer for reuse

• Damaged containers: empty completely (no pressure) and crush, landfill

• Insert Dari

AFAMS

Do not Incinerate

Do not incinerate the following:• Plastics especially

halogenated plastics (e.g. PVC)

• Pressurised gas containers• Large amounts of reactive

chemical waste• Radioactive waste• Silver salts or radiographic

waste• Mercury or cadmium• Ampoules of heavy metals

AFAMS

Finding Information

You are receiving an order for a new chemical at the Pharmacy Quarter Master Storeroom. You have no information on how to store or handle the chemical. Where would you find information about this new chemical?

AFAMS

Finding Information

You are receiving an order for a new chemical at the Pharmacy Quarter Master Storeroom. You have no information on how to store or handle the chemical. Where would you find information about this new chemical?• Product Monograph• Workplace Hazardous

Information System (Internet)

AFAMS

Scenarios (Assessment)Dari

Formative Assessment:• Not marked•Used to assess the students understanding of lectures material.•Instructors will ask the questions to the class as a whole. Group discussion amongst the students is encouraged to answer the questions.•Instructor will provide a debrief after each scenario question to highlight reasons why response was correct or incorrect.

Insert Dari

AFAMS

Scenario OneDari

You are working as a Pharm Tech conducting your monthly verification of Emergency Cabinets on each ward when a nurse asks you if they can place a used oxygen bottle in the garbage.

What must the nurse consider prior to putting the used oxygen bottle in the garbage?

Insert Dari

AFAMS

Scenario OneDari

You are working as a Pharm Tech conducting your monthly verification of Emergency Cabinets on each ward when a nurse asks you if they can place a used oxygen bottle in the garbage to be incinerated.

What must the nurse consider prior to putting the used oxygen bottle in the garbage?

Insert Dari

AFAMS

Scenario OneDari

What must the nurse consider prior to putting the used oxygen bottle in the garbage?

• NEVER INCINERATE• Return undamaged gas cylinders

and cartridges to the manufacturer for reuse

• Damaged containers: empty completely (no pressure) and crush, landfill

Insert Dari

AFAMS

Scenario TwoDari

You are working at the Polyclinic Dispensary. It is time for you to take your break and you go outside. You see a couple of your co-workers smoking next to this symbol.

Is it safe? Why or why not?

Insert Dari

AFAMS

Scenario TwoDari

Is it safe? Why or why not?

The symbol means “flammable”. There are flammable materials near by and therefore, smoking next to them is not safe.

Insert Dari

AFAMS

Scenario Three

Accumulating ToxicDari

Poisonous Dari

FlammableDari

Compressed GasDari

ReactiveDari

BiohazardousDari

Oxidizing AgentDari

CorrosiveDari

A cleaning closet containing bleach should have the following symbol on the door? Why?

AFAMS

Scenario ThreeDari

Bleach is corrosive and should have the adjacent symbol on the cleaning closet door to indicate a caustic substance is included inside.

Insert Dari

AFAMS

Scenario FourDari

You are working at the NMH Pharmacy Dispensary as a new Pharmacy Technician graduate. The Chief of Pharmacy has asked you to properly dispose of some expired medications. The Pharmacy Accountant has properly accounted for them. You enter the room where they are stored and find drug containers with about 500 tablets in them.

How should you dispose of them?

Insert Dari

AFAMS

Scenario Four

Large amounts• Incinerate at high

temperatures or encapsulate• LANDFILL IS NOT

RECOMMENDED

• Insert Dari

AFAMS

Scenario FiveDari

You are working in the NMH Warehouse when you receive a MoD Form 14 request for a new drug to be used in Anesthesiology. You check and find out it is listed in the ANA Formulary. You want to become aware of the storage and handling requirements for the drug.

What are two possible sources for this information?

Insert Dari

AFAMS

Scenario FiveDari

You are working in the NMH Warehouse when you receive a MoD Form 14 request for a new drug to be used in Anesthesiology. You check and find out it is listed in the ANA Formulary. You want to become aware of the storage and handling requirements for the drug.

What are two possible sources for this information?

Material Safety Data Sheets or Product Monograph.

Insert Dari

AFAMS

Scenario SixDari

You and a co-worker are receiving an order for the drug Isoflurane late on a Thursday. You don’t know how to store it. Your co-worker says it is time to leave and to just put it in the refrigerator until Saturday in case it needs to be cold.

Is this ok?

Insert Dari

AFAMS

Scenario SixDari

NO, it should not be put in the refrigerator.

Insert Dari

AFAMS

Questions?Dari