Oncology Nurses Can Improve the Safety of Chemotherapy Disposal

SAN DIEGO—Oncology nurses can implement simple measures to ensure the safe disposal of cytotoxic therapies, according to Baltimore researchers.

The measures are aimed at reducing the hazards posed by chemotherapy disposal to neighboring communities and the environment.

According to standard policy at most cancer centers, chemo therapy waste is collected in designated yellow plastic containers, which are disposed of as regulated medical waste and incinerated,

Amanda Choflet, BSN, RN, OCN, nurse manager of the Blood and Marrow Transplant Unit at the University of Maryland Medical Center, pointed out.

Choflet and her colleagues found, however, that there was no scientific basis to support the practice. What’s more, yellow plastic containers, popularly referred to as “yellow buckets,” may be harm ful to individuals and the environment when manufactured and disposed of.

The group recommends that the use of yellow plastic containers be discontinued. Red biohazard containers (the same ones used for sharps disposal) should be used instead for the disposal of trace chemotherapy. Bulk chemotherapy, greater than 3% of the original dose, should be handled as hazardous waste and disposed of in black containers. “These practice changes mean that all biohazard waste can be streamlined into one container,” Choflet observed.

Preliminary results using the new strategy have been encouraging. “We can now save the roughly $40,700 that our institution spent each year on the purchase of yellow chemotherapy buckets plus the estimated $2600 on the disposal of yellow buckets including their contents,” she said. In addition, about 10,000 lb of plastic are now diverted from the incinerator each year, she added.

Choflet explained that concern about the environmental damage caused by purchasing and waste disposal practices at her cancer center and elsewhere prompted her group to examine the “greening” of chemotherapy.

The energy used to manufacture polypropylene yellow chemotherapy containers, which constitute the majority of yellow chemotherapy containers, along with the combustion of used containers cause emission of greenhouse gases and other toxic by-products, she said.

Also, patients who live near medical waste incinerators have higher rates of cancer, heart disease, diabetes, and learning disabilities. “Preventing unnecessary waste from reaching the incineration facilities protects these vulnerable communities,” she said.

Choflet’s group reviewed a comprehensive body of literature on chemotherapy waste disposal methods and found a complete lack of evidence to justify the use of yellow plastic containers for chemotherapy and the incineration of such containers.

“That’s why we de cided to remove the yellow buckets,” she said.

Finally, she noted that additional opportunities for change include the use of smaller flush bags with chemotherapy, the implementation of measures to ensure that recycling containers are available in patient care areas, and the implementation of a paper recycling program aimed at protecting patient privacy.