Approximately 16 million people in the United States have diabetes. According to the American Diabetes Association, this number will rise to 22 million by the end of the decade. A large percentage of them will be self-administering insulin several times a day. For many other diseases, the number of days patients stay in the hospital is decreasing, leading to more sick patients undergoing treatment in their own homes. And that means a lot of medical waste generated in peoples’ homes.

Remember the IV needles and other medical waste that washed up on the East Coast beaches in the 80s? Many people believed this was from hospitals illegally dumping their waste. The real reason was that many people flush hypodermic needles down the toilet. These needles can work through waste water treatment plants, especially during heavy rains, and these same needles come back to us on our beaches!

One of the most hazardous waste generating areas in a health care facility is the public rest room. Why? Many patients administer medication in rest rooms and discard their needles into the waste container. It is a little-known fact of liability law, but if a patient leaves your office with a hypodermic needle and uses that needle in the public rest room, discards the needle in the regular waste container, and a housekeeper or maintenance worker is stuck, the responsibility falls to you, as a health care provider. Your waste is your responsibility.

You know how important education is. Waiting rooms may have literature on nutrition, diet and exercise, but how about proper medical waste disposal? Patients can be educated to protect themselves, their families, community members and waste handlers from needles and other potentially infectious materials in their household waste. According to the American Diabetes Association, approximately one million people suffer puncture wounds from hypodermic needles every year. Improper disposal causes half of those injuries. It is up to health care givers to make patients aware of the potential hazards of household medical waste.

Rhode Island is the first state to implement a residential needle collection program. Contact your state Department of Health to obtain literature on proper sharps segregation. This literature should be given to patients who will be self-administering medications with hypodermic needles, and explained when reviewing the medications. Some physician offices are starting to accept sharps waste from patients as a way of showing a commitment to the environment and safety of community members.

There are a few very basic rules, that all doctors should be teaching their self-medicating patients: 1) Never flush needles down the toilet! While this practice may seem easy, these needles can end up on our beaches!! 2) Needles or any other sharps waste should be segregated into a rigid container such as a laundry detergent bottle. Sharps containers of the type used in hospitals or medical offices can be purchased in pharmacies, but detergent bottles work just fine. 3) Do not bend or break needles. When filled, the container should be taped shut with the word “Sharps” written clearly on the side of the container. In most states, this waste can be discarded with regular household waste, but many health care facilities are now accepting patient-generated sharps for more proper disposal. In New York, for example, health care facilities MUST accept needles generated in the home. 4) Do not place contained sharps with recyclables. Check with your state health department for details.

In some home-care situations, there may be some regulated medical waste (potentially infectious material) generated, including blood-soaked material. This should be double-bagged, tied shut and placed with regular waste. Care providers in the home should practice the same safety procedures as in a health care facility—wearing gloves, gowns and eye protection, where there is a risk of splashing.

Cytotoxic drugs, or chemotherapy wastes require special attention because these hazardous drugs are mutagenic. Care must be taken to keep other family members and health care workers from being exposed. Excreta from patients on chemotherapy can contain high levels of the medication and should be handled with care and flushed down the toilet. If the patient is using a bed pan, the waste should be slowly poured into the toilet and the lid put down before flushing to avoid splashing. Any family members handling excreta from a family member on chemotherapy should wear gloves, and eye covering if there is a risk of splashing.

With increased home care, and little or no regulations for home-generated wastes, we have to educate patients and families to use common sense to help reduce the risk of exposure to the public. Please email specific questions to jbrown@bethisraelny.org.

Janet Brown is the medical Waste Manager for Beth Israel Medical Center, New York City. Beth Israel is firmly committed to reducing the volume and toxicity of its waste stream. Many of the strategies that work for Beth Israel can also work for you.