What are the proper procedures for biomedical disposal of blood?

Proper Procedures for Biomedical Disposal of Blood

All blood must be disposed of as hazardous waste according to established institutional protocols, with unused autologous blood being disposed of preferably in the theater where it was collected and documented accordingly. 1

General Principles of Blood Disposal

Blood is classified as regulated medical waste that requires special handling and disposal procedures to prevent transmission of blood-borne pathogens. The following guidelines should be followed:

Standard Disposal Methods

1. Sanitary Sewers

   • Sanitary sewers may be used for safe disposal of blood, suctioned fluids, ground tissues, excretions, and secretions
   • This method is acceptable only if:
     • Local sewage discharge requirements are met
     • The state has declared this an acceptable method of disposal 1

2. Hazardous Waste Disposal

   • Blood and blood-containing materials should be disposed of as hazardous waste
   • Used containers and giving sets must be disposed of according to hospital policy for hazardous waste 1
   • All disposal must be properly documented

3. Autoclaving/Inactivation

   • For laboratory settings, blood and microbiologic wastes should be inactivated using approved methods (e.g., autoclaving) before transport to sanitary landfills 1
   • Biosafety level 1 and 2 laboratories should inactivate cultures and stocks onsite rather than shipping untreated wastes 1

Special Situations

Autologous Blood Disposal

For blood collected during procedures such as acute normovolemic hemodilution (ANH) or cell salvage:

1. Unused autologous blood:

   • Must be disposed of as hazardous waste
   • Preferably disposed of in the theater where it was collected
   • The fate of all units must be documented 1
   • Must never be transferred to the general blood supply

2. Blood with known viral infections:

   • Blood from patients with known markers for viral infections (HIV, HBV, HCV) must not leave theater unless infusion has already commenced 1

Special Pathogens

1. Viral Hemorrhagic Fever (VHF) Patients:

   • Contain regulated medical wastes with minimal agitation during handling
   • Bulk blood and body fluids must be decontaminated using approved inactivation methods (autoclaving or chemical treatment) before disposal 1

2. Creutzfeldt-Jakob Disease (CJD) Patients:

   • Medical wastes must be contained and decontaminated using appropriate inactivation methods
   • Incineration is recommended for contaminated materials from brain autopsy or biopsy procedures 1

Institutional Requirements

1. Documentation:

   • All blood disposal must be documented
   • For autologous blood, the number of units and total volume removed from the patient must be recorded in patient's case notes 1

2. Standard Operating Procedures:

   • Institutions should develop written protocols for disposal of blood and blood products
   • These should include instructions to ensure no autologous blood is transferred to the general blood supply 1

3. Reporting:

   • Serious adverse events related to blood handling should be reported to the hospital transfusion committee and appropriate national reporting systems 1

Safety Considerations

Healthcare workers are at significant risk of exposure to blood-borne pathogens during handling and disposal of blood. The average risk after percutaneous exposure is approximately 0.3% for HIV, 6-30% for HBV, and 1.8% for HCV 2.

To minimize these risks:

• Always adhere to standard precautions
• Use appropriate protective barriers
• Exercise care in the disposal of needles and sharp instruments
• Follow institutional protocols for prompt reporting and evaluation of occupational exposures 2

Common Pitfalls to Avoid

1. Improper segregation of blood waste from regular waste
2. Inadequate documentation of disposal, particularly for autologous blood
3. Failure to use appropriate personal protective equipment when handling blood
4. Recapping needles or improper disposal of sharps, which increases risk of needlestick injuries
5. Allowing blood from patients with known viral infections to leave controlled areas

By following these guidelines, healthcare facilities can ensure safe and appropriate disposal of blood while minimizing risks to healthcare workers and the environment.