COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL ... · COMMONWEALTH OF PENNSYLVANIA...

«l»-AQ-27i««V. «/7fCOMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF ENVIRONMENTAL RESOURCESBureau of Air Quality ind Noto Control

%fiPLAN APPROVAL - °'

Approval No. 39-301-062Pathological

CERTIFIED MAIL 1306984 S*1"* . »«•?• incinerator

Allentown & Sacred Heart Hospital Center Mfr- of S0""* Control A-201200 S. Cedar Crest BoulevardAllentovn. Pennsylvaai, 18105

Attn: RobertDirector of Engineering _Location 1200 S. Cedar Crest Blv

Salisbury Township

Lehigh County .

In accordance with provisions of the Air Pollution Control Act, the Act of January 8, 1960,P. L 2119, as amended, and with Chapter 127 of the Rules and Regulations of the Departmentof Environmental Resources, the Department on ____ Hay 25, 1976 _____ approvedplans for __ ____ construction ________________ of the above Indicated *Ircontamination source.

The plan approved Is subject to the following conditions:A. General

(1) The eource _______ I* to be constructed in accordancewith the plans submitted with the application.

B. Special

(1) This PLAN APPROVAL expires May 30, 1976 __________ .

Notify the person noted below when the installation is completed so that the source can beinspected for issuance of an OPERATING PERMIT.

NOTE:Reading Regional Office16 Angelica StreetReading, Pennsylvania 19611

CONTACT: Mr. Charles S. KoVbray 202563Acting Chief of EngineeringServices - 5/12/76

f/ Rtgionvl Air Pollution ConttSJr En0inttr

COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCESBUREAU OF AIR QUALITY AND NOISE CONTROL

OPERATING PERMIT

In accordance with provisions of the Air Pollution Control Act, the Act of jfityary 8, 1960,P. L. 2119. as amended, and after due consideration of an application received indfe Chapter127 of the rules and regulations of the Department of Environmental Resources, tn$/Departmenthereby issues this permit for the operation of the air contamination source described below.

Permit No. 39-301-062_______ Manufacturer Comotrol A-20______

PathologicalSource Waste Incinerator

Owner Allentown & Sacred Heart Location of Unit .. 1200 S. Cedar Crest Blvd.

, ™«Pctai S^f « i 'A Salisbury Township '• ••1200 S . Cedar Crest Boulevard —— t fr T- i . -.v ——— c ——Allentown, Pennsylvania 18105 Lehigh County _____ _ • ;

Attnt Robert L* Swing, Director of EngineeringThis permit is subject to the following conditions:

A. General

(1) That source is to be operated in such a manner as not to cause air pollution.

(2) That source is to be maintained as set forth in the application and/or as amended.

(3) That source is fo be 'in compliance with plan approval issued under the sameapplication No.

(4) This permit is valid only for the equipment and location named above.

B. Special

(1) Thts OPERATING PERMIT expires January 31. 1979(2) and (3) See Attached.

This permit may be suspended or revoked by the Department of Environmental Resources atany time it is determined that the air contamination source is being operated in violation ofany provision of the rules and regulations of the Department of Environmental Resources orin violation of the general and special conditions stated herein.

Date May 25, 1976

ReJohn B. McGroglm, P.B.

gional Air Pollution Control Bnginee

NOTE: This permit is to be retained in your files. It must be shown to investigating personnelwhen requested.

§02564

Allentown & Sacred Heart Hospital Center"Bureau of Land Protection

Person to contact: Mr. Emil WashkoSolid Waste Director

EJDEC 2 3 1975 )

COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCES

Bureau of Solid Waste ManagementReading Regional Office

Hernersvllle, Pennsylvania 19565AC(215)678-5657

June 4, 1980Re: Application for Permit for

Proposed Incinerator

Allentown & Sacred Heart Hospital Center1200 South Cedarcrest BoulevardAllentown, Pennsylvania 18105Attn. of Mr. Leonard A. Farkas

Director of EngineeringDear Mr. Farkas:

As per our telephone conversation this day, enclosed are thenecessary applications, modules, and forms to be completed forapplication for permit of the proposed Incinerator to be locatedat the Allentown & Sacred Heart Hospital Center.

Kindly complete the same and submit the original and four (4)copies to this office. If you have any questions, do not hesitateto contact this office.

GltschlerActing Operations SupervisorReading Region

Enclosure

£02586

ER-SWM-14-. . . , . . .

COMMONWEALTH OF PENNSYLVANIA. .DEPARTMENT OF ENVIRONMENTAL RESOURCES PERMIT NUMBER OF PROPOSED'• •'"• BUREAU OF SOLID WASTE MANAGEMENT

INDUSTRIAL WASTE DISPOSAL AT PERMITTED SITES J1|0|0|2MODULE NO. 1

A. DISPOSAL SITE INFORMATION:

1. Facility Name: Grand Central Sanitary Landfill

2. Facility Location: R.D. 01. BOX 211

Pen Argyl, Penna. 18072

3. Facility Owner: Grand Central Sanitary Landfill. Inc.

4. Facility Mailing Address: R.D. 11. Box 211________Pen Argyl, Penna. 18072

5. Facility Manager: Nolen A. Perin____ Telephone No.- (215)..863-6057 '_____

6. Facility Contact: ' Koi«r. A, Perin Telephone No. msv fifi3-60S7_____<p*rtcm ratpontlbli for providing dru tor thlt *urv*y) • .'. . . . ;'.,•

7. Does the facility discharge Industrial wastes to a municipal sewer system? x Yes __ NoIf yes, name of system Pen Argyl Sevage'Treatment Plant - under a signed agreement.

8. Does the site have a leachate treatment facility? __ Yes __;_ NoIf yes, attach discharge standards. . . - '.

9. If the site is a landfill, attach last monitoring analysis. If last analysis is more than three (3)months prior, attach a current analysis to this module.

DESCRIPTION OF SPECIFIC WASTE: l

1 . Company origin of waste (name and address) : ******

I9f)o «5f»Mf->i fjaA- - en tox.tp. FACompany Contact: Leonard A. Faricas _______ _ Telephone No. R?i-?nnn _

2. Treatment: Is waste conditioned prior to disposal? Yes ____ How? IncineratedAt 1800°F in Secondary Combustion Chamber as per D.E.R. requirements. •

, - - . . - . , . . . £

3. Disposal: Present Method Untreated waste from normal hospital operations is hauled

to a'landfill (100265) by conventional roll off container and mixed vith othercommercial and residential waste."7

4. Provide and attach speciaj characteristicsof this waste which determine the method of disposalinclude chemical analysis, physical description, precent of water and leaching analysis relative todisposal proposal. Provide the date of all data submitted. (Attachment as per previous analysis

5. What difficulties do disposal of this waste presently present? None .__________•

6. What difficulties are anticipated for the disposal of this waste In the future? __None

EIS-SWM-"14A

5/79 , COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCES PERMIT NUMBER OF PROPOSED•'•BUREAU OF SOLID WASTE MANAGEMENT DSPOSALSITE

DATE PREPARED9-10-80I—y~AU~gu———————I INDUSTRIAL WASTE DISPOSAL AT PERMITTED SITES 110

f . MODULEN0.1 - Off. . Qlfi!

.7. What other processes can be used effectively? None

8. Average Daily Volume 3.6 Tons (7.200 Ibs)9. Annual Volume I.MS10. What process generated this waste? (Describe) Normal'hospital operations to include

bed patient care and cafeteria wast*** and gpn«»rat building

operations wastes.______

TABLE A - WASTE DESCRIPTIONS11. CHECK APPROPRIATE CATEGORY

_____ A-1 Concentrated sulfuric acid solutions with heavy metal__ A-2 Concentrated mixed acids with heavy metals__ A-3 Dilute acid solutions containing hexavalent chromium and/or other oxidants__ A-4 Dilute acid solutions containing heavy metals but no hexavalent chromium or ammonia__ A-5 Dilute acid solutions containing heavy metals and ammonium salts \__ A-6 Acidic nitrate solutions containing heavy metals__ A-7 Acidic wastes with hazardous metals except Cr*6__ B-1 Alkaline solutions containing cyanides__ B-2 Alkaline solutions containing su If ides__ B-3 Concentrated alkaline solutions containing no sulfide nor cyanide__ B-4 Miscellaneous alkaline solutions containing contaminants other than hazardous metals__ B-5 Alkaline solutions containing hazarouds metals__ C-1 Combustible organic sludges, solids and liquids__ C-2 Sludges, slurries and solids containing cyanides__ C-3 Sludges, slurries and solids containing hexavalent chromium__ C-4 Inorganic sludges, slurries, solids-containing no hexavalent chromium nor cyanide__ C-5 Wastewater contaminated with high concentrations or organic substances__ C-6 Organic contaminated solidsX C-7 Other (describe) Powdered Ash from Type 0,1,2,3,4, Solid Waste

12. Phsyical State At Ambient Temperature:09 Solid and non-pumpable liquid • solid mixturesn Liquid and pumpable liquid - solid mixtures 202568 \

EH-SWM-14B6/79

• •••' COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCES PERMIT NUMBER OF PROPOSE

BUREAU OF SOLID WASTE MANAGEMENT DISPOSAL STEDAT

INDUSTRIAL WASTE DISPOSAL AT PERMITTED SITES.MODULE NO. 1 • Ma l

°°2

V-/

13. Primary Characteristic Secondary CharacteristicInorganic OrganicD Acid D Oil & Oily Sludge D Heavy MetalsO Alkaline Q Paint & Pigment Residue D Other MetalsO Cyanide ED Plastic, Pasticizers, Resins, D Sulfides

. Clastomer Residues .O Filter Aids & Clays ED Solvent • D Hexavalent ChromiumD Heavy Metal . D *WWT Sludge ED OrganicD «WWT Sludge D Pesticides D HalogenatedD Pesticides D Still Bottoms, Heavy Residue D SulfonatedD Catalyst O Pharmaceutical Waste • D InorganictS Other, describe QD Other, describe Ql Other, describe

1 . ——————Powdered ash type 0, 1, 2, 3, A, solid waste——————— ••

- 14. Hazards None

O Toxic Substance O PoisonD Skin Irritant ' D Explosive

^O Respiratory Irritant O CarcinogenD Corrosive to Steel D Reactive, acidD Corrosive to Concrete. ED Reactive, waterD Corrosive, other .... . . .,D-Reactive, etherED Flammable D Other, describeD Cyanogen

C. DISPOSAL METHOD: (describe applicable Items)«

Type of disposal (i.e., landf iH, lagoon; pond, etc.). Landfill_______,

DESIGN SPECIFICATIONS.

1. Liner type (i.e., concrete, asphalt, clay, etc.) and thickness. See design plans submitted

Dec. 13. 1976, for Grand Central Sanitary Landfill (100265)_________________

2. Leachate collection and treatment capability at site for waste to be disposed of. (Describe)Toe drain and liner collection and force main delivery of leachate to thePen Argvl Sewage Treatment- Plant._______

•WASTCWATCR TREATMENT CI.UOGE

202569

ER-SWM-14CV79 , .

'COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCES PERMIT t ™, e,T. ,

—,———.—————————, BUREAU OF SOLID WASTE MANAGEMENT , OISPOSAUSITI-'DATE PREPARED I - . • • Offlf;.!, L L I «L I.9-10-80 _____( INDUSTRIAL WASTE DISPOSAL AT PERMITTED SITES 14 |0 |0 I 2|6 |!

^ MODULE NO. 1 • {tfefy

3. Methods of burial (i.e., mixing-hazardotis waste-vgitrrotiiCT wastes, contamerization, etc.) . /!? § &.: if ;

Co-disposal of waste with other solid wastes______________________ . •i . B ^ *———• ___«««« _ ___«BB*» __«MMBM H».«««« ___ ___ . - Wl _____ > B ___ _ M W___a«« «BIMMa ^ M ^ MMW ,- .'> '. ' . ' '

4. Identify and describe method of transportation of the waste the site. Grand Central' Sanitation!

Inc., will transport the waste "by conventional refuse truck via highway to the dispoaksite.

' D. ENVIRONMENTAL ASSESSMENT OF DISPOSAL: State briefly the anticipated impact of disposal at f Athe site and provide the data or substantiation for the stated conclusions.

• . . "%$?Disposal of sterile powdered ash from the waste being .burned at 1800°F will ' -'reduce the volume of waste taken to the Grand Central Sanitary Landfill.. ; : >Presently, approximately 10,520 cubic yards of solid waste is being disposedof annually. Incineration will .reduce.-the waste to approximately 526 cubicyards of sterile ash waste per year.

E. ENGINEER-

1. Name Junu* A. Fg-lTT. ____ 3. Registration Number

2. Address /2-t 3<?r*\gr //, 4. Signature

. 5< Sea, of Reg}stered professiona, EngineerTelephone Number & Area Code:

___ SEAL5. Seal of Registered Professional Engineer

20207U

j Answer to Question #4 • '.,,,.-,.. .•:• ':• * • . * '. . • • • -1* . ' • • - . '

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ALLENTOWN AND SACRED HEART HOSPITAL

WASTE ANALYSIS

MATERIAL PERCENTAGES

Cardboard 55%

Paper 34%

Plastics 8.5%

Syringes .5% .5%

Cafeteria (Garbage) 1%

Human Tissue , ' 1%

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* d&C \ AMERICAN RESOURCE CONSULTANTS, INC.

802577

cifC \ AMERICAN RESOURCE CONSULTANTS, INC. fy450 East Street, Doylestown, PA 18901 ^

Telephone: 215-348-0402 "

RECEIVEDDecember 1, 1986 DEC 051986

Mr. Lawrence H. Lunsk i Ah!ah 1/aiiau Uru.-i4.~iPA Department of Environmental Resources Uh'gh cJnferBureau of Solid Waste Management FNftlNPPPiMr> P»CDT1875 New Hope Street cniainttKlWa UhPF.Norristown, PA 19401

Re: Generic ApprovalGrand Central Sanitary LandfillARC Project No. 20185

Dear Mr. Lunsk:

Enclosed please find an original and one (1) copy of the HospitalWastestream Assessment for the disposal of incinerator residue fromthe Lehigh Valley Hospital Center at Grand Central Sanitary Landfill,Inc. (GCSL). Included in the report are the Module 12.and Module 1forms for your review and approval.

Incinerator ash of a comparable nature has already been approved fordisposal at GCSL by a permit amendment issued on May 31, 1985 forwaste from Merck, Sharpe and Dohme's West Point facility. The ashfrom MSD included incinerated waste from their laboratories on-site.Therefore, generic approval of the Lehigh Valley Hospital Center ashwastestream is requested.

Your prompt review and approval is appreciated. Please call with anyquestions.

Sincerely,American Resource Consultants, Inc.

Thomas G. Pullar, P.E.Director of Environmental Engineering'

TCP/map

Enclosure

cc: Mr. Grosskettler, GCSMr. 0. Glenn Schneider, LVHC

202578

AMERICAN RESOURCE CONSULTANTS, INC450 East Street, Doylestown, PA 18901

Telephone: 215-348-0402

August 6, 1987

Mr. Lawrence H. LunskSolid Waste Facilities SupervisorPA Department of Environmental Resources1875 New Hope StreetNorristown, PA 19401

Re: Generic ApprovalGrand Central Sanitary LandfillARC Project No. 20185

Dear Mr. Lunsk:

Enclosed please find one (1) copy of the Hospital WastestreamAssessment for the disposal of Incinerator residue from the LehighValley Hospital Center at Grand Central Sanitary Landfill, Inc.Included in the report are the Module 12 and Module 1 forms for yourreview and approval. The original Assessment is currently on file atthe Norristown Regional Office of PA DER.

Incinerator ash of a comparable nature has already been approved fordisposal at GCSL by a permit amendment issued on July 8, 1987 for ashfrom Allentown Hospital. Therefore, generic approval of the LehighValley Hospital Center ash wastestream is requested.

Your prompt review and approval is appreciated. Please call with anyquestions.

Sincerely,American Resource Consultants, Inc.

Thomas G. Puller, P.E.- Director of Environmental' Engineering

TGP:lkw

Enclosure RECEIVEDcc: Mr. J. Grosskettler, GCS vvf

Mr. 0. Glenn Schneider, LVHC AUG10 1987

—____tchigh Valley HospitalCenter

AR202579 ENGINEER1NG*"'

fftCOMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF ENVIRONMENTAL RESOURCES1875 New Hope Street ,//

Norristown, PA 19401 "tx-215 270-1948

September 8, 1987

Mr. Joseph GrosskettlerGrand Central Sanitary Landfill1963 Pen ArgylPen Argyl, PA 18072

Re: Landfill SiteDear Mr. Grosskettler:Your Module No. 12 submission for the disposal of Incinerator ash wastegenerated by Lehigh Valley Hospital Center at your landfill site has beenreviewed by our Regional Chemist Charles Formeck, and has been found to besuitable for disposal.Approval 1s granted for you to accept 400 tons annually of Incinerator ash wastegenerated by Lehigh Valley Hospital Center at your landfill site.Very truly yours,

LAWRENCE H. LUNSK ,Waste Management Facilities Supervisorcc: Glenn Schnelder-^

Joe Pompon1Re 30 (CLC)251.1

202580

Lehigh Valley HospitalCenter

ENGINEERING DEPT.

. .VM-38: 5/82 COMMONWEALH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCES

BUREAU OF SOLID WASTE MANAGEMENT

FORMNO/13-A

MODIFICATION TO SOLID WASTE DISPOSAL AND/OR PROCESSING PERMIT*

Under the provisions of Act 97, the Solid Waste Management Act of July 7. 1980, Solid Waste PermitNumber________100265___issued on (date original permit was issued) _______11/13/80(permittee.)(address) . _ .

Grand Central Sanitary Landfill, Inc.1963 Pen Argyl Road, Pen Argyl, PA 18072 —

- " - - ; - - ~ s. '*. » '--'''

is hereby modified as follows:This amended solid waste permit is issued based upon application No.100265 which was received in the Norristown Regional Office of theDepartment of Environmental Resources on February 20, 1985. Thisamended solid waste 'permit is for the disposal of incinerator ash,plant trash and shredded plant trash from Merck Sharp £ Dhome atthe Grand Central Sanitary Landfill located in Plainfield Township,Northampton County. This is based upon approved Module No. 1submissions. This approved application includes a letter datedMay 6, 1985 indicating that landfill leachate will be hauled to aDepartment approved treatment facility.

Nothing in this permit shall be construed to supersede, amend orauthorize violation of, the provisions of any valid and applicablelocal law, ordinance or regulation, provided that said local law, ordi-nance or regulation is not pre-empted by the Pennsylvania Solid WasteManagement Act, the-Act of July 7, 1980, Act 97, 35 P.S. 6018.101, etseer.

The plant trash and the chredded plant trash do not have to be analyzedon An annual basis unless they contain residual waste which isgenerated from a chemical manufacturing process . The incinerator ashmust be analyzed on an annual basis for all parameters included in the•approved Module No. 1 submission. The results of these tests are to besubmitted to the Norristown Regional Office. The generator of thisapproved waste stream is to keep you informed concerning any change inthe manufacturing process which creates this waste. If such changesare made, than an updated analysis of the waste stream mist be sub-mitted for the Department's approval and the disposal of this waste.must be discontinued until the Department approves the updated analysis"of this waste. -

This modification shall be attached to the existing Solid Waste Permit described above and shall becomea part thereof effective on (date! ______5/31/85——————————.

-202581FOR THE'DEPARTMENT OF ENVIRONMENTAL RESOURCES

P»fl« T''" a* 1

HOSPITAL WASTESTREAM ASSESSMENT*'• V. :'••••

__ Prepared for •'. ••LEHIGH VALLE7 HOSPITAL

ALLENTOWN, •_• PENNSILVANIA

•. i-l::, *'

IRC Project

; •*•*'£•'

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AMERICAN RESOURdEcNSULTANTS, INC.450 East Street, Doylestown, PA 18901

Telephone: 215-348-0402

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.•-.••'• .-:" i*-.> ,,TABLE OP CONTENTS *'C//

1.0 INTRODUCTIONFIGURE 1 - SITE LOCATION MAP

2.0 HOSPITAL FACILITY DESCRIPTION3.0 HOSPITAL WASTE DESCRIPTION4.0 WASTE PROCESSING AND DISPOSAL DESCRIPTION5.0 INCINERATOR SPECIFICATIONS

FIGURE 2 - INCINERATOR SCHEMATIC "6.0 WASTESTREAM SAMPLING AND ANALYSIS

FIGURE 3 - CHAIN OF CUSTODY I'-"*.•• '

7.0 INCINERATOR RESIDUE CHARACTERISTICS i7.1 ANALYTICAL REPORT #1, BIOIjOGIC TEST

.•£U'-- & »£*&-•• ~-.v,7.2 ANALYTICAL REPORT #2, CHEMICAL TESTpRESULTS?8.0 PA DER MODULE 12 |!; ; "9.0 PA DER MODULE 1 .' ..,'}£.'*'''C'."".••"••• ft?.*'-'$*.'••? H"' 10.0 ARC EVALUATION AND RECOMMENDATIONS L il v; '-»

10.1 1985 EPA DRAFT GUIDELINES : j10.2 HOSPITAL SELF AUDIT GUIDELINE

APPENDICES-., :•••• ' . v" •*. ;••-•i-*s» :-:•:••

1. PA Department of Environmental Resources Letter DatedSeptember 6, 1985

2. Module 1 Instructions

3. Summary of 1982 EPA Infectious Waste ManagementGuidelines

202584

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i.o- DnRpjocnpNO- ' ' •• ~~~~'""————"% This report presents the results of a wastestream assessment ,-w//-

performed at the Lehigh Valley Hospital Center, located at 120#e§o'ffthCedar Crest Boulevard, Allentown, Pennsylvania 18105 (See Figure'1).

The purpose of the wastestream assessment is to comply with newPennsylvania Department of Environmental Resources and Department ofHealth requirements (See Appendix 1), to enable LVHC management tounderstand the characteristics of the "wastes" generated at theirfacility, and to establish mechanisms which assure that eachwastestream is disposed of in an efficient, economical and

f ; environmentally sound manner. vt

£••• The following report includes the following elements:V*V ...... • . ;;• vr..;.. ..'.v> - - • v- • ;'

* A waste audit which identifies the components of the waste' _ . flow to LVHC's' on-site incinerator';'3r'>:

* Representative sampling of the incinerator residue forlaboratory analysis;' r • ;'-: »'|^'- \.' •

* Laboratory analytical data for the incinerator residue. Thelaboratory analysis meets all PA .DERjand US EPA criteria andstandards; , • " 'P ' '••

* A determination of the regulatory status of the incineratorW***'. residue; /•" : . :> • (. 'V';.O .-''

* Report on the monitoring of the incinerator for effectivenessof the sterilization process; .: ; i ; :

* PA DER Module 1 and Module 12 prepared for submission to GrandCentral Sanitary Landfill for approval;

* Recommendations concerning management of all wastes which areincinerated by LVHC. ; - ;>' - t '

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LEHrGH VALLEY HOSPITAL CENTER

DATE8/18/86ÂMERICAN RESOURCE CONSULTANTS. INC

45° Ea$l s«««.Doyl«'<>wn. PA 18901215-348-0402 APP-DBY

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2.0 HOSPITAL FACILITY DESGRIFTICW

The Lehigh Valley Hospital Center is a not-for-profit acute carehospital and a not-for-profit Acute Care, Department of HealthLicensed Trauma Center located on a 118 acre campus at theintersection of Route 309 and Cedar Crest Boulevard in suburbanAllentown. Opened in 1974 with a constructed capacity of 472 beds,it is a state-of-the-art regional teaching hospital developed by acommunity with vision to meet very specific needs.

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HealthEasl is a not-for-profit organization whose fy>basic purpose is the encouragement of good health and^the provision of quality health services to the public. It is-"<?a fullv integrated health system seeking to bring optimumhealth status for the region it serves. HealthEast iscommitted to proviojng comprehensjv high-quality,cost-effective and convenient inpatierit, outpatient, homeand work-site-based health services. Health promotion.disease prevention and programs for education ofdoctors and other health professionals are also amongits priorities. . " :f''4l

HealthEast service components include TheAllentown Hospital, the Lehigh yalley;Hospital Center,and the Slate Belt Medical Center P™1" -

Hospital is accredited by: Joint Commission forAccreditation ofHospitals and the PA State Department H ajtlip "

Residency Programs are accredited by the Accreditation Council forGraduate Medical Education (ACGME) and its respectiveResidency Review Committee (RRQ. Programs which areaccredited follow: ^ 'l ff *Internal Medicine - RRC/Internal MedicineTransitional '-RRC/Internal Medicine yGeneral Surgery - RRC/General Surgery JCobn-RectalSurgery - RRC/Colon-RectalSurgeryPlastic Surgery - RRC/Plastic SurgeryVascular Surgery -RRC/General Vascular Surgery

Accredited Fellowship Programs offered through the AllentownAffiliated Hospitals (educational programs of The Allentown Hospitaland the Lehigh Valley Hospital Center) include:—Cardiovascular Disease - Residency Review Committee/InternalMedicine and Liaison Committee for Graduate MedicalEducation ; ;.c^5;H;•.•>-•

—Diagnostic Radiology r' H W*—General Internal Medicine - Residency Review Committee/Internal Medicine and Liaison Committee for Graduate MedicalEducation

Laboratory/Pathology: . -± .- , r_>—Laboratory -Accredited by the College of American Pathologists—Post Doctoral Program in Clinical Chemistry -Accredited by theCommission on Accreditation in Clinical Chemistry

LehrghVfclleyHospital CenterA HeanhEast Hospital

Post Office Box 689 . J1200 S. Cedar Crest Blvd. „-;Allentown. PA 18105 V

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3.0. HOSPITAL WASTE DESCRIFTIOK ; 0

Upon completion of a review of the various activities performed atthe hospital, including discussions with the hospital staff,representatives of ARC performed a field study of the composition ofthe wastes which are generated,.transported internally, andincinerated at the facility. The hospital facility -was then touredto observe the areas of waste generation, handling"procedures, andcollection and disposal practices, as well as to interview keypersonnel on practices employed on the various floors.

The solid waste generation field evaluation performed at the hospitalshowed that the following types of wastes are generated:

1. General Office and Food Preparation Waste r- this component ofI the wastestream is composed of waste'whicn meets the

definition of municipal solid waste and includes office trash,f .. food preparation wastes, and generalLrefuse frdm throughout

the facility; .o'fS"""""""""'""

2. Infectious or Potentially Infectious Wastes - this componentof the wastestream is composed of the following wastes:

' rf f- Isolation wastes •- '} ;••?-•• ^

. •:'•-•«.;•••'-. i- Cultures and other etiologic agentsv

II|

/ - Pathological wastes ,.1 - Other wastes from surgery a n d autopsy

- Contaminated laboratory wastes >;',v- Chemotherapeutic wastes . • ,•I ..;. ..••>•*•. •;

| - Sharps- Discarded biologicals and pharmacy waste

I - Contaminated food a n d other products. : • • _ •*.(:• .-:. :;.*>•; "~ •• •

- Contaminated equipmentI - Wound dressings .

_ These wastes are handled and incinerated fin'?accordance withI established hospital policy; i ^ M -

3. Hazardous Wastes (ECRA) - small'quantlTties; of potentially( h a z a r d o u s wastes (anti-neoplestic drug-waste and chemotherapy

wastes) are segregated .and incinerated,in accordance withspecial procedures. "•' • :::.;':':.:/<f:?«;?.- -:-- '•

202595

•' *C* . k .A

•*™1 '" • . ; * _ . * • • . •

4.0 WASTE PROCESSING AND DISPOSAL DESCRIPTION

('•-The following Waste Processing and Disposal Policy Statement :U!-thegeneral operational procedure currently in use by LVHC. "'*.•?*"'>'

202596

e

/ arc

IIIIIIIII

IIIIIII*I

The Purpose y^t? ^'ii'//,,

To define the solid waste generated by L.V.H.C. by type, kinofftjroutineand hazard.

Definition - Hazardous Waste

A hazardous waste is any one, item or substance, that is harmful,toxic, dangerous or infectious to the environment, wild life end/orhumane. • ;-;v; -: .' .

Implementation ... , .,,; t . :. ' - • • • ' . ; . . * . • •• . - ,: - ;_ : !.• . . . . . • • . ' • - • .. •;•*• .-: :" •A. This procedure will define what BUSt be burned and what trash will

£o to the land fill when the incinerator is.not in .operation.• - ' ' -

B. The point of origin ie the only tine en individual item of wasteshould be handled outside a closed containeri; any'item generatedfrom an isolation room, the operating ro'oin"s|| enytltiing that isbloody or any item used to puncture the skinj ofl a iperson with ecommunicable disease must be handled as infectious waste and redbegged. _ ' . .• _:-t,-.-•.'. :••"•' .•,!'-•'&.•';?*•*'•*•*•••'••<'. • '. . . ..-

1. In e patient room the waste baskets are,to house paper, emptycane, etc. No tubing, IV bags or dressings/will be disposed ofin these containers. Hazardous type'trash will be placed in thelarge waste cans located in the soiled utility room or in •,containers provided-for the-disposal of sharp items. The largecane will have the red(orange) bio-hazardliners in them.

2. ALL TRASH, MEDICAL OR NOT FROM AN ISOLATION ROOM WILL BECONTAINED IN RED BIO-HAZARD BAGS. THE USE OF ISOLATION TAPE ONTRASH BAGS IS TO BE DISCONTINUED. ;

3. These red bags will be picked up at least once in every 24 hours7 days e week, or more often as needed, by'Housekeeping andimmediately taken to the incinerator room."The remainder of thetrash that is generated on the floors will be picked up byHousekeeping in accordance with procedures set by housekeepingand delivered to the incinerator room if the burning schedulewill permit or to the compactor for. hauling to the landfill.

4. All operating room trash from the Short,.-Procedure OperatingRooms and THE MAIN OPERATING ROOMS SHALL BE CONTAINED IN RED BAGAND HANDLED AS IF IT WERE ALL HAZARDOUS MATERIAL AND TAKEN TOTHE INCINERATOR ROOM. ;- ; „ ^j^'t1 '

S. All other speciality areasishall continue" to separate theretrash to insure that everything remotely infectious or in ^^^^^origin is in either a sharps container or a bio-hazard beg an8£597that only office or common trash be enclosed in normal trashbags.

6. ALL HUMAN TISSUE AND FLUIDS SHALL BE HANDLED AS A BIO-HAZARD.ONLV THE LABS AND MORGUE MAY STORE THESE ITEMS. STORAGE MUST BEIN ACCORDANCE WITH PROPER PROCEDURES AND INSURE THAT WHENRELEASED SAMPLES ARE TRANSPORTED DIRECTLY TO THE INCINERATORROOM FOR DISPOSAL. -• :;

Implementation continued

' C. The incinerator shall be operated 7 days a week, for approximatelygdjp, . 14 hours a day on weekdays and 7 hours a day on weekends. The'**'• incinerator shall be kept in good repair and operated in accordance

with proper procedures as set by the Engineering Department andD.E.R. In the event that the main incinerator is out of order theback up unit in the Power Plant will be used to burn the RED BAGSAND SHARPS CONTAINERS, this waste will be delivered to the mainincinerator room and Engineering will transport it to the back up

... incinerator. . . • .• \ ••• ..y*.'& ;,,% •,•

Responsibility For Implementation . . - . - , '

Under the point of origin format the first perVonTto handle the wasteis the person to determine how it should be handled down stream. Inaost cases the first person is a nurse, lab technician or doctor. TheInfectious Control Department and the Nursing Department itself shallbe responsible for instructing the nursing staff. • The specialty areassuch as labs and the morgue shall be the responsibility of theirrespective Department Heads. Transportation of the Red Bag, SharpsContainers and routine trash shall continue to be that of( isekeeping, however they will be instructed by there Department Headto be double careful to insure that no Red Bag, Sharps Containers or

I Operating Room Waste shall be put in the trash compactor. Once thewaste reaches the incinerator.room the Engineering Department ischarged with proper disposal. ' -

AR202598

IIIIIIIIIIIII

III

- ;^ —

LEHIGH VALLEY HOSPITAL CENTER Ofy,

MEMORANDUM '

DATE: August 8, 1986 ;

TO: Thomas Puller, American'Resource Consultants, Inc.

RE: Infectious Wastes

The following departments at Lehigh Valley Hospital Center have directcontact and may be generators of potentially infectious wastes:

I ^ v : ^ ^ t i y : J v - . c l v • : •Employee Health ...Microsurgery -..-'•• ,.;:;:jtv,:v .RadiologyNuclear Medicine • ':Cardiac Catheterization Lab'':v>rwr> • ;•'•'••' ••*''.•:•"•••'LEG -• ... .- v .••'-:•

• H e a r t StationPulmonary Function vfPhysical Therapy v.'.:.j,«-v ..«

I Respiratory Therpay : cOutpatient LabsCardiac RehabilitationVascular LabPathologyEngineeringSecurity

I S P DSPUPharmacy

• O p e r a t i n g Room/Recovery RoomPerfusionists ^Anesthesia " •''*•'•Emergency Medicine Department

I Mary Elren Beideman, EN, ESN, CICInfection Control Coordinator

--' - - ^ ^ ^

MEB:deb

cc: Glen SchneiderTerry Andrews

AR202599;j

AUG 12J986 ••*

5.0 INCINERATOR SPECIFICATIONS

The following schematic and permit documentation describes thecharacteristices of the Environmental Control Products (ECP)incinerator which-is-used for destruction of infectious wastes at theLVHC (see Figure 2). Approximately 6500 pounds per day of waste andrefuse are incinerated at the hospital on averagei . Operatingtemperatures range between 1600° F and 2000° F in the secondarychamber as recorded by a strip chart mechanism.

LVHC also maintains a 100 pound per hour incinerator which is usedfor destruction of infectious waste only when the primary incineratoris inoperative. This is a Comptro A-20 unit and the operating permitis also included.

202800

e/ arc \

i

SECONDRRVCHRMBER

HERT

INFECTIOUS, PRTHOLOGICRL MRSTE

GENERRL REFUSE «^ ' *k \ S X PRIMBRV^CHRMBER

OFFICE, CfiROBORRO, RNO KITCHEN MRSTE

1:T?;TJ

COMPfiCTOR

E

TOPERMITTED,

LINEDLflHDFILL

TOPERMITTED,

LINEDLRNDFILL

202601

FIGURE 2SCHEMATIC

LEHIGrltLEY HOSPITAL CENTER* :;.---:-._-__

[OflTETarcAMERICAN RESOURCE CONSULTANTS. INC.450 East Street, Doylestovn,PA f 8901 PROJECT «

215-S48-O4O2 22286

15AUG66FILE NRME:INCINERATOR SCH.

ICOMMONWEALTH OF PENNSYLVANIA^ '

DEPARTMENT OF ENVIRONMENTAL RESOURCESHeading Kegional Office

Wernersville, Pennsylvania 19565"215-670-0301

January 16, 1981 .,*

ALlentown & Sacred Heart Hospital1200 S. Cedarcrest Blvd. .

, T>a, PA

Attenticn: Mr. Gary Steinberg .Associate Administrator '•

. v '•*'•Gentlenen:

Acoonpanying this correspondence is a. Plan Approval foran incinerator and heat recovery system at/Allenbown & SacredHeart Hospital. In addition, you will find a j Solid WasteManagement permit for this disposal facility.]'

Please be guided by the contents of these permits and theacccnpanying correspondence. Should you have, any questions,you nay contact either ire or the of f ici als mentioned on thepermits.

'. . .Sincerely/

'-c-lc^--. cvJLJjfcrf /_. :. -:A., ,. .,.,>- ..aV -v I ''jOCBN B. M3XER ~Regional Director

. 'i-.v •202602

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ER-AO-27: R**. 6/79

; Commonwealth 'of Pennsylvania f 'Department of Environmental Resources

Bureau of Air Quality Control

.PLAN APPROVAL

' "*,,-.. Permit No. 39-301-067 ______________ Source & Incinerator/Heat Recovery Systeir.f £-. ——— " ——— " —————— r~~~., — ~ —— -;': — ———— • ———————————I Owner Allentown & Sacred Heart Hospital jr Environmental Control Prod.

Address J.2QO S. Cedarcrest Blvd.____ Cleaning

Allentown, PA 18102_____' Device

Attention: Mr. Gary Steinberg________ Location' -'Salisbury Township

•L. •'' Associate Administrator j> j j . ;;Lehigh County?*?!•;• "~~————————————————TT—'- .:..' ..;. v...1—— ~

In accordance with provisions of the Air Pollution Control Act, the Act of January 8, 1960,P. L. 2119, as amended, and with Chapter 127 of the rules and regulations of the Departmentof Environmental Resources, the Department on January 16, 1981 approved plansf°r the construction of ' ^ •• ' -.the above indicated aircontamination source. :, ,, ^

. - -. t -" — "'---• i ^ '' - ' . : ' • * • . - . - - • •

This PLAN APPROVAL expires OctdSer 30, 1981 ' .

The plan approved is subject to the following conditions: .M>;

(1) The ____________source ___; ; • * is to bein accordance with the plans submitted with the

application (as approved herein).(2) Both chambers shall be equipped with temperature censing and recording

devices to chow the temperatures exiting each-chamber. The exittemperature from the secondary chamber shall be 1800° F.

(3) There shall -be no visible emissions from the source.

Notify the person noted below when the installation is completed so that the source can beinspected for issuance of an OPERATING PERMIT.NOTE: '; — '•.•._ .. • _.;|||-

Reading Regional Office •' • • • ' , • ' ; ; •"•*Jlv : :' •• v •<'• •'•/.. ;. :'Wernersville, PA,:-19565 "•"• ' > - • • ' • >t-W!-C- '. 4' -'•'• - •'. - lPhone (215) 678-0825 '- ^

COKIRCT, Hr. tojer A. FltterllngRegional Air Pollution Control Engineer


Bureau of Solid Waste ManagementRegional Office

Wernersvllle, Pennsylvania 19565AC(215)678-5657

January 16, 1981

Allentown & Sacred Heart Hospital1200 South Cedar Crest BoulevardAllentown, PA 18102

,> Gentlemen:Kfe i:>_ ,

I am pleased to enclose Amended Permit No. 400374 for the operation ofyour processing or disposal facility. It Is Issued 1n accordance with thePennsylvania Solid Waste Management Act, Act 97.' Compliance with the limitations and stipulations that have been set forthon your permit 1s mandatory. You have the right to appeal any limitation orstipulation as stated on your permit.

This action of the Department may be appealed to the EnvironmentalHearing Board, First Floor Annex, Blackstone Building, 112 Market Street,

/ rrisburg, PA, AC(717)787-3484, by any aggrieved person pursuant to Section 1921-Aui the Administrative Code of 1929, 71 P. S. §510-21; and the Administrative AgencyLaw, 2 Pa. C. S. Chapter 5A. Appeals must be filed with the Environmental HearingBoard within thirty (30) days of receipt of written notice of this action unlessthe appropriate statute provides a different time period. Copies of the appeal'form and the regulations governing practice and procedure before1 the Board may beobtained from the Board.

If you have any questions concerning the enclosed permit and/or therequirements set forth by the Pennsylvania Solid Waste Management Act, please contactMr. Ronald F. Klinikowskl, solid waste facilities supervisor, Bureau of Solid WasteManagement, Regional Office, Wernersvllle, PA 19565, AC(215)678-6312.

Sincerely,

Leon L. KuchlnsklRegional Solid Waste Manager

Enclosure

AR2026Q1*

Ii-SWM-B: R««. 9160 COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL RESOURCES

• BUREAU OF SOLID WASTE MANAGEMENT

" Permit >-~C" v' '? / ORIGINAL* , . *" (Red)

I1

Solid Waste Disposal and/or Processing FacilityFORM NO. 8

• Permit No. 400374 AmendedDate Issued January m»Date Expired inaetlnlte

Under the provisions of the Pennsylvania Solid Waste Management Act of July 7, 1980,, .• •\...st.c--*.;3.;.. 'vn -

Act 97, a permit for a solid waste disposal and/or processing facility at (municipality)Salisbury Township ______ ___ jn the County' *&$$&$• LehJ gh !- ______ isgranted to (applicant) Allentown & Sacred Heart Hospital ' ; ___________(address) 1200 South Cedar Crest

Allentown. PA 18102This permit is applicable to the facility named as Allentown Sacred HeartHosP1ta1 and Ascribed as:

Allentown Sacred Heart Hospital Incinerator/Heat Recovery SystemMfg: Environmental Control Products, Inc.;Model: 800 E -o" ;-VWaste Types: 0, I, II, III & IV ^1^ .

Latitude 40° 34' 00" K -i:pLongitude 75° 31' 15" W ;

This permit is subject to/modification, amendment and supplement by the Departmentof Environmental Resources and is further subject to. revocation or suspension by theDepartment of Environmental Resources for any violation of the applicable laws or the rulesand regulations adopted thereunder, for failure to comply farwhole or in part with theconditions of this permit and the provisions set forth In theVpp'fication no. 400374 Amendedwhich is made a part hereof, or for causing any coiilditipnJi rAcal jo the public health,safety or welfare.See attachment for waste (imitations and/or specialconditions

FOR|THE DEPARTMENT OFENVIRONMENTAL RESOURCES

I THIS PERMIT IS NON-TRANSFERABLE

DEPART OF ENV, S S SS aBUREAU OF SOLID WASTE M AeSr

PermitFor

Solid Waste Disposal and/or Processing FacilityFORM NO. 8

Permit No. 400374 Amended

Date

, .- .~ :•!.*!*•* -• - •1. Incinerator ash must be disposed at a permitted sanitary landfill.

:'+&?*">' '2. Ash must be stored in a closed container untllfdisposal at a permittedsanitary landfill. , ; 3 ;-;

^ :-: '-;}'i3. Unprocessed pathological waste may not be disposed in a sanitarylandfill. j

902606

THIS PERMIT IS NON-TRANSFERABLE

Page 2 of 21

II

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ER-AQ-zfl - „6/78 ; • • " :<$f$ ;/

Commonwealth of Pennsylvania :Department of Environmental Resources

Bureau of Air Quality Control

OPERATING PERMIT(RENEWAL)

In accordance with provisions of the Air Pollution Control Act; the Act of January 8, 1960,P. L. 2119, as amended, and Section 127.24 of Chapter 127 of the rules and regulations ofthe Department of Environmental Resources, the Department hereby reissues this permit for theoperation of the* air contamination sources described below: j '

- Pathological WastePermit No. 39-301-062 Source & •' •'-"' Incinerator__________

Allentown & Sacred Heart »,-> «-:Z ^ T~Owner Hospital Center r l; Air -:" '•'%- Cooptro' A-20___________

Address 1200 S. Cedar Crest Blvd.' Cleaning ;"

Allentown. PA 18105 Device £1

Attention: Mr. Leonard Farkas • ' Location -1200 S.'Cedar Crest Blvd.• • . •. l •• -y.

Director of Engineering -. . ;•.' Salisbury Township____

^Lehigh County• This permit is subject to the following conditions:

l • • • - • * • - . . ! • ' . • ' ' - " '

(1) That the source and any associated air cleaning devices ere to be:

(a) operated in such a manner as not. to cause air pollution;(b) in compliance with the specifications and conditions of the plan approval issued

under the same number; r ? ; • v -(c) operated and maintained in a manner consistent with good operating and

maintenance practices.

(2) This permit is valid only for the specific equipment, location and owner named above.(3) All burners shall operate at their maximum rated capacity while the

source is in operation.

Failure to comply with the conditions placed on this permit is a violation of Section 127.25.Violation of this or any other provision of Article III of the rules and regulations of the Departmentof Environmental Resources will result in suspension or revocation |of this permit and/orprosecution under Section 9 of the Air Pollution Control Act. -'* -<

Issued Harch 19 , 1981• C/

Expires January 31, 1986 ________ Mtegional Air Pollution Control Engineer

IIIV RECEIVED S02607I aw 16 1381 AR2Q2607

Allentown-Sacred Heart

6.0 WASTESTREAH SAMPLING AND ANALYSIS

Upon completion of an in-depth review of the LVHC facilities,operations, waste generation characteristics, and waste managementprocedures, an incinerator testing program was implemented. Thepurpose of the testing program was two-fold: 1) to evaluate thebiological destruction efficacy of the on-site incinerators, and 2)to analyze the incinerator residue and evaluate its chemicalcharacteristics. Both components of the testing program are requiredby the Pennsylvania Department of Environment Resources.

-• f.zffl'ffi--Sampling protocol for monitoring incinerator biological efficacy isincluded with analytical procedures included in Section 7.1.Representative samples of the incinerator residuetwere obtained,using sampling techniques approved by the USEPA and PA'. DER.Efficiency testing was performed on each LVHC incinerator butchemical analyses were performed on ash samples from both unitscombined into one composite sample. ":\$.&;if .t_%,:.'•'•.-• T'-.'r* * _*?[••*•••;

r . .' -. •-.. V. ;'•*:-•-* -'- •

Representatives of ARC maintained custody of the .samples between thefacility site and the contract laboratory (See Figure 3, Chain ofCustody). ;,-.. ., v

' • -t- 11'2. '';<;:.. . -•.:: •*>$••$*i':-..At the contract laboratory, test samples are systematically enteredinto a carefully regulated logging system and are subsequentlytracked through the laboratory where they undergo a variety of -analyses. USEPA and PA DER approved analytical techniques andmethodologies are assiduously applied.

Analytical reports and all associated information regarding workperformed by the contract laboratory are maintained-in a confidentialmanner. Records and raw data are maintained on file at the contractlaboratory for the appropriate time period, in accordance with USEPArequirements. t

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7.0 INCINERATOR RESIDUE CHARACTERISTICS

,.,,.The following analytical reports present the results of the fa '%biological and chemical testing of the incinerator and incineratorresidue.

The results of the biological testing (See Section 7.1, AnalyticalReport #1) shows that the incineration process is more than adequateto kill all test organisms.

The results of the chemical testing (Section 7.2, Analytical Report12) show that the composite incinerator residue from the main andback-up incinerators does not exhibit hazardous characteristics andis suitable for disposal in a lined sanitary landfill.

II

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I AR2026IO /

202610

I7.1 ANALYTICAL REPORT 11. BIOLOGICAL TEST RESULTS I

INCINERATOR BIOLOGICAL DESTRUCTION EFFICACY

LOCATION: Lehigh Valley Hospital Center, Allentown, PA

DATE: March 20, 1986

INCINERATORS: Environmental Control ProductsComptro A-20 . f ••-• ^ IV •_•-_••

INTRODUCTION / v ^ f;;;• : . i! , '•• 4'"r>:f ;V "- :•••'- ;

This test program was designed to demonstrate that the incinerationprocess at Lehigh Valley Hospital Centervis .adequate to destroymicroorganisms and other infectious agents that may be present in thehospital's waste. This test procedure is to verify that the ash fromthe incineration process is biologically safe for disposal in anapproved sanitary landfill. ; . |>u;;

Biological indicators are used routinely to monitor the effectiveness|v of sterilizing processes. Therefore, incineration, a type of

i , dry-heat treatment, can be evaluated by challenging the incinerator; \-x with dry-heat-resistant spores* A known concentration of BacillusI s u b t i l i s variety niger spores.was added to the waste feed to

determine the potential of any surviving spores. Subsequently, thesamples were cultured to ascertain if any of the recovered sporestrips contained viable spores* • V :

I Concern for the possible health significance of microbiological wastecontaminants has,led to several investigations of industrial refuse

• i n c i n e r a t o r s and waste processing facilities* However, the lack ofstandardized procedures for sampling ash .for bacteria and fungi inindustrial environments and the absence of standards for assessing

« the health significance of the microbes incinerator residue have• hindered investigations. The study design is included to explain the• sampling and analysis strategies employed during the test program.

'202611

ftR2026ll•* •:•".

ANALYTICAL REPORT II (CONTINUED)—————— ——— — ————— \nect)SELECTION OF BIOLOGICAL INDICATOR

The best means at >ur disposal to determine the efficiency of asterilizing process is strictly of a biological nature.Bacteriological culture tests, designed to confirm the presence orabsence of living microorganisms with the use of biologicalindicators, constitute the most commonly employed methods.Biological indicators are standardized preparations of specificmicroorganisms, routinely bacterial spores, that are resistant to theparticular sterilizing process in question. .- . '

Incineration is a type of dry heat treatment,, and. therefore,qualifies as a sterilization process when burning'' Infectious waste.Lehigh Valley Hospital Center burns all infectious waste and somegeneral refuse in its main Environmental Control Products (ECP)incinerator located at the hospital. In;brder$tjo challenge theprocess, it was necessary to find a heat resistant -genus in theselection of a microorganism for this incinerator test program. Areplication of the types, numbers, and concentrations ofmicroorganisms that actually are present in hospital waste would havebeen required for the most theoretically desirable .and representativeefficiency test. However, these data were not available. Therefore,the spore of Bacillus subtilis variety niger was ; chosen as the mostappropriate biological indicator from among several possiblecandidates. The Bacilli are preferred, as they, are nonpathogenic andwidely distributed in soil, water, air, and decomposing materials.

PREPARATION OF THE BIOLOGICAL INDICATOR • ,

The main ECP hospital incinerator has a ram loader to push the solidwaste into the incinerator combustion chamber. The back-up ComptroA-20 unit utilises a manual feed system where the operator opens theunit door and feeds several bags at a time into .the primary chamber.Hospital waste arrives as solids by cart in plastic bags. A knownconcentration of B. subtilis spores was fed into the incineratoralong with other solid wastes and run through a normal burning dayand final burndown cycle.

In order for the test to be meaningful, the incinerators had to bechallenged with a sufficient number of sample containers to verifythe overall uniformity of destruction. Following .common-practicetesting procedures of sterilization, a theoretical challenge of 3.1 X10 spores per sample was used in this program. Five samples wereloaded into the ECP incinerator over a 15 hour charging period. Thelast load was followed by a 3 hour burn-down. The back-up Comptrounit was fired up and charged with several loads of waste before 502812feeding with sample containers over a half -hour period. A normalburn-down cycle followed as is standard procedure with this unit.

Test strips with 3.1 X 108 of B. subtilis spores were individuallywrapped in stainless steel foil. Each foil packet was placed inblack iron pipe container with caps on each end. Each sample spcontainer was sequentially numbered. 4r

AR2026I2 '

IiiIiniIiii

ANALYTICAL REPORT i 1 (CONTINUED)/.'..

INTRODUCTION OF BIOLOGICAL INDICATORS INTO THE INCINERATOR

Steel sample containers were placed in plastic bags of non-infectioushospital waste. The sample bags were loaded at prescribed intervalswith other bags of waste following normal loading procedure.

PRIMARY UNIT (ECP) LOADING SCHEDULE; .• '• . .v ? V • i : : ; - . -

Sample Number Time1 8:00 AM2 12:00 NOON3 '- '• 4:00 PMA 8:00 PM,5 11:00 PM

BACK-UP UNIT (COMPTRO) LOADING SCHEDULE

Sample Number16 11:40 AM6 12:05 PM

SAMPLE RECOVERY? ' • - .„ .. :• - ' . ; '

The following day at 7:00 .AM when the ash is "normally removed fromthe incinerator prior to the start of the next burning day, theoperator was instructed to look for the steel sample containers. Ashremoval is by manually raking and shoveling the esh out of the rearaccess door of the incinerator. As each shovel full of ash waspoured into the metal ash container, several 'people watched forsamples. Sample recovery from the Comptro unit followed a similarprocedure and both sample tubes were recovered. !,

When the access door was initially opened there. could be observed thesmoldering of hot carbon residual in the ash bed. The operatorrecovered a total of 4 of the 5 spore sample •containers that werecharged. The unrecovered container most probably disintegrated byoxidation in the heat of the primary chamber. Two of the fourrecovered sample containers were partially -disintegrated byoxidation, losing the spore test strip. -t%liff^.v

. '• - • " " '! i j '.: ' : •'• *'»_$f$£- f* *-.'•?'.

RECOVERED SAMPLES ;:*:*.?• ;v r./v««4 *%•• ' : • - •- ^ •>• ••• .•• 4 ter :- 202613Sample Number Condition

—————— - . • '::•• •• •r: - 'two were partially destroyed,

( end one vap completely destroyed- v.r.,, , ; , ; • : - • --..x..^,-.-. ; ; -slightly oxidizedslightly oxidized and slag encrusted

16 slightly oxidized6 slightly oxidized

_ANALYTICAL REPOgT II (CONnNUED)

SAMPLE ANALYSIS

The recovered sample containers were opened and the test stripaseptically remtrved and placed in sterile Trypticase Soy Broth (TSB)culture tubes. Wisual observation of each test strip showed completecharring, but the strips maintained their integrity as they wereplaced into the TSB media. A quality control test strip from thesame test lot wa.-s also placed in a TSB tube. All the samples in theTSB tubes were held at 37° C for 7 days. '

••'•-.;;•

SPORE GROWTH TEST RESULTS X

Sample Number4 negative;-: Primary Unit5 negative 'f1 -

16 negative" * Back-Up Unit6 negative

QC positive

CONCLUSION

The spore test strips were produced and tested to comply withMilitary Specification MIL-S-36586A with the following resistancecharacteristics: ""—

Survives KilledDry Heat 121° C 30 min. ———

160° C 5 min. , 30 min.

All samples recovered from the incinerator had total spore kill andthe quality control sample showed positive spore growth verifyingviable test samples. This confirms that the samples were exposed toa temperature of at least 160° C for 30 or more minutes, or somehigher temperature, shorter, effective kill time.

The sample containers that were partially or completely destroyed byhigh temperature oxidation were exposed to temperatures of at least650° C for substantial periods of time to result in destruction ofthe metal pipe. Exposure to these temperatures exceeds the sporekill requirements and we can therefore assume that those samples also 2026 1experienced total kill. " •

Testing of the imcinerators over the entire burning day with theresulting total biological destruction of the samples verifies thatthe incinerators uniformly and totally destroy all biological factorsin the residue.

/ arcAR2026U

II

v,

I

I

7.2 ANALYTICAL REPORT 12, CHEMICAL TEST RESULTS

ENVIRONMENTAL SERVICESFricks Lock Rd.. RD * 1. Pottstown, PA 19«U54 15) 326-9662

*•

CERTIFICATE OF ANALYSIS

LABORATORY NO: See Below SAMPLE DATE: NASAMPLED BY: NA

CLIENT: • American Resource Consultants, Inc. RECEIVED: 3/24/86 .450 East Street REPORTED: 4/27/86Doylestown, PA 18901

SAMPLE DESCRIPTION: Total Analysis

Parameter

Cyanide, TotalAntimony, TotalArsenic, TotalBarium, TotalCadmium, TotalChromium, TotalCopper, TotalLead, TotalMercury, TotalMolybdenum, TotalNickel, TotalSelenium, TotalSilver, TotalZinc, TotalOil and GreasepHTotal SolidsVolatile SolidsHeating ValueIgni labilityCorrosivityReactivityFamous 21

Units

mg/kgmg/kgmg/kgmg/kgmg/kgmg/kgmg/kgmg/kg

• mg/kgmg/kgrog/kg* •*mg/kgmg/kgmg/kgmg/kg

Standard' - - ma/koW3f 1*5Jmg/kg

BTU/fb. . 4 -.

;; '- ..1 . •

••

ARC1P02229RMC1824-86

0.920.6125636.056

26002300.036.3

1200.480.32

1180<3.211.98

74100077000760

Not Igni tableNot CorrosiveNot Reactive*

aWet Weight*See Attachments

Approved By :-- fw *fr_ ~f**t i*"*" 1F-*"*yg _________KyieF. Gross, Supervisor 'Environmental Chemistry Laboratory

ACanben*Company (. '> -AR2026 I 5

ANALYTICAL REPORT t2, (CONTINUED)

ENVIRONMENTAL SERVICESFficks Lock Rd.. RO * 1 . Potlstown. PA 1 9464 (21 5) 326-9662

ORIGINALCERTIFICATE OF ANALYSIS

LABORATORY NO: See Below SAMPLE QATE: NA

CLIENT: American Resource Consultants, Inc. RKEIVEof ' 3/24/86450 East Street RFpnpTFn. A/OJ/OKDoylestown, PA 18901 REPORTED. 4/27/86

Sample Description: E. P. Toxicity Leachate Analysis

Parameter

Ammonia-NitrogenTotal Organic CarbonChemical Oxygen DemandCyanide, TotalAntimony, TotalArsenic, TotalBarium, TotalCadmium, TotalChromium, TotalChromium, HexavalentCopper, TotalLead, TotalMercury, TotalHolybdenum, TotalNickel, TotalSelenium, Total •'Silver, TotalZinc, TotalOil and GreaseTotal Organic HalogensPhenol icspHTotal Dissolved SolidsVolatile Solids

Units

mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1mg/1rag/1mg/1pg/1mg/1

Standardmg/1rag/1

ARC#02229RHC#824-86

1.01'14003490<0.0010.014<0.001<0.50.030.0200.0031.40.37<0.0002<0.051.00.014<0.001

10601.6690.105.26

50902180

202616Approved By:

.Kyle'F. Gross, SupervisorEnvironmental Chemistry Laboratory

AR2026I6 ACanbemComp*ny

IIIIi'iIiiIiiiiiii

ANALYTICAL REPORT ,2, (CONTINUED)

S&& & ENVIRONMENTAL SERVICESPricks Lock Rd., RD # 1. Pottstown, PA1 I6/?X215)326*9662

CERTIFICATE OF ANALYSIS.' " a ;:' .'• ' '.: • ••

LABORATORY NO: 824-86 (ARCS02229) SAMPLE DATE: NA<•-•'•' SAMPLED BY: NA

CLIENT: American Resource Consultants, Inc. RECEIVED: 3/24/86450 East Street REPORTED: 4/28/86Doylestown, PA 18901

SAMPLE DESCRIPTION: Famous 21

. •••• .:• SampleParameter____________Units ConcentrationMethanol mg/kg^ i • <1.0Methylene Chloride mg/kg - . <1.0Acetone mg/kg <1.01,1-dichloroethane mg/kg . <1.0Cis-l,2-dichloroethylene mg/kg <1.0Trans-l,2-dichloroethylene mg/kg <1.0Chloroform . mg/kg <1.51,2-dichloroethane mg/kg <1.0Hethyl ethyl ketone mg/kg <1.01,1,1-trichloroethane mg/kg <1.0Carbon Tetrachloride mg/kg <2.51,2-dichloropropane mg/kg <1.0Trichloroethylene mg/kg <1.01,1,2-trichloroethane mg/kg <1.0Benzene mg/kg <1.0Methyl Isobutyl ketone mg/kg <1.01,1,2,2-tetrachloroethane mg/kg <1.0Tetrachloroethylene mg/kg <1.0Toluene mg/kg <1.0Chlorobenzene mg/kg <1.0Ethylbenzene mg/kg <1.0Xylenes mg/kg <2.0

Approved By:.

KyTe F. Gross, SupervisorEnvironmental Chemistry Laboratory

i202617

ACanberraCompany J ' ftR2026!7

8.0 PA DER MODULE 12 QR\GW&;-

PA DER Module No. 12 - Request for approval to process, or dispose ofinfectious, pathological, or chemo therapeutic wastestreams.

The following section presents a completed PA DER Module No. 12 forthe LVHC Incinerator Residue. The biological and chemical analyticalreports show the characteristics of the waste which will betransported to an approved solid waste facility for final disposal.

202618

AR2026I8

WM-«5:7/64

PARED,"

/UATE REVISED

DEPARTMENT OF ENVIRONMENTAL RESOURCESBUREAU OF WASTE MANAGEMENT

MODULE NO. 12DATE SUBM1TTEO

DEPARTMENT^E (fc'_F?--»' '/i - ^Vj

« REQUEST FOR APPROVAL TO PROCESS. OR DISPOSE OF INFECTIOUS. PATHOLOGICAL" tf l:: OR CHEMOTHERAPEUTIC WASTE STREAM(S)isjsgfj.-'. • ••:-.';•' '•'\:Fotm *A«* ** fceomptnffd by ER-WM-4

i$ll-GENERAL INFORMATION (must be completed by processing or disposal facility)

A. Processing or Disposal Facility ~ f,- 1. Name of Mitv 0°"* Central Sanitary landfill. Inc._______________'_..]•

C Address RDtfI/Box 211. Pen Argyl. PA____________Zip: 18<>72 >( j

Location of site if different from mailing address 1963 Pen Argvl Road_________.:, * i l ' : * " ' " ' ' " - . . ' • •

2. Name and address of permittee (if different from (1) above). ________________ ,

Municipality ___ Plainf ield Township_______ County Northampton

3. Hazardous Waste Identification number (if applicable) I M I I M I I I I I I M N/A

4. Solid waste permit number(s) for the processing or disposal facility to be utilized _______________100265 •••;_______________________________

S. Facility contact personName________Joseph Grosskettler______fjt|e Manager, Residual Wastes

Phone no.______(215) 863-6057_________/

6. Authorized Signature of Owner or Officer for the FacilityName _______________ Kolan Perln TM<» ChairmanI

K B. Generator or Processor of the Waste (must be completed if different from A. (1.) above)I . . . , • . . .

1. Name of farHity <fr Vel y Hospital Center_______._________', 1200 S. ft**«-r Crest Blvd., P.O. Box 689•l Mailing address »n«>nt-r»Mp P& J____ Zip; 18105:

Location of she if different from mailing address _• Municipality _____Sai-ishnTy TVwngMp _______ County JLehigh

2. If a subsidiary, name of parent CQ. HealthEast______________

3- Hazardous Waste Identification number of generator I I I M M I I I M I M(if applicable)

. - - AR202&I9

I;

I

DATE REVISED

DATE SUeMfTTED

4. If processor is not the generator of the infectious waste, list all generators ___Allentown Hospital, SlateBelt Medical

HealthEast mercber organizations: Center, and Mauch Chunk Medical Center

8400374•5. Solid Waste pefmit number(s) for the processing facility (if applicable) ______

6. Facility contact person.. _ O. Glenn Schneider „.„, Director, EngineeringName ________________________________ title ___________

Phone no. ' *2isi 776-8S15

7. Authorized signature of owner or officer for the facilityLionel Kier Vice President of

Name ___________________________________________ title Bnvi TY>nmon<- gtvr-iri rvag

II. WASTE DESCRIPTION (Must be completed by Generator or Processor)j

A. General Properties (include chemical name, toxicity data, and sterilization method(s) utilized, ifapplicable)

1. Description of the waste, its origin, and containerizatton.

See attached "Hospital Waste Description"

2. U.S; DOT proper shipping name UN/NA number, and hazard class (if applicable):

3. Typical volume of waste to bo shipped to processing or disposal, facility:a. Monthly ______________ gal., tons (circle one)

b. Annually 40°_______ gal.. or§>(circle one)

4. Processing or disposal frequency: ifi___ times per month; D one time .,J

5. Current volume to be shipped to processing or disposal facility M/&____ gals., tons(circle one)

AR202620 ....,v

III'IIIIIII1IIIIIII

HOSPITAL WASTE DESCRIPTION

Upon completion of a review of the various activities performe& at cthe hospital, including discussions with the hospital staff,representatives of ARC performed a field study of the composition ofthe wastes which are generated, transported internally, andincinerated at the facility. The hospital facility, was then touredto observe the areas of waste generation, handling procedures, andcollection and disposal practices, as well as to interview keypersonnel on practices employed on the various floors.

The solid waste generation field evaluation performed at the hospitalshowed that the following types of wastes are generated:

1. General Office and Food Preparation Waste - this component ofthe wastestream is composed of waste which meets thedefinition of municipal solid waste and Includes office trash,food preparation wastes, and general refuse from throughout

• the facility; .. : v-; , ).•%$!#..;.:,;.-* "V ( ' ' • r

2. Infectious or Potentially Infectious Wastes - this componentof the wastestream is composed of the following wastes:

- Isolation wastes I:- Cultures and other etiologic agents- Pathological wastes- Other wastes from surgery and autopsy- Contaminated laboratory wastes- Chemotherepeutic wastes- Sharps- Discarded biologicals and pharmacy waste- Contaminated food and other products- Contaminated equipment- Wound dressings

These wastes are handled and incinerated in accordance withestablished hospital policy.

20262

MODULE 12 PAGE 3£•;=:, . I OATS HverARED DATE SUBMITTED

DEPARTMENT USE ONLY

6. a. Is the waste a hazardous waste defined in 75.251? D Yes Q No•'•'''• •*.

b. If yes, describe the hazardous waste according to its description and hazardous wastenumber in 75.261.

7. Has the waste been delisted as a hazardous waste by DER? D Yes D No £GN/A.

8. Check the following box(es) for applicable wasto type(s):

0 pathological wasto09 chemotherapeutic wasto

0 infectious waste

D other (specify) _______________

( B. Chemical and/or Bacteriological Analyses — P/easa attach tho following:

1. The results of tho total analysis of the waste as specified by the Department, if applicable.(A Modulo No. 1 may bo required)See attached "Analytical Report #2"

2. A description of tho sampling method and biological indicators utilized.See attached "Analytical Report #1"

HI. DESCRIPTION OF PROCESSING. AND/OR DISPOSAL METHOD (must be completed by the processingand disposal facility. Use additional sheets If necessary.) For each waste type processed or disposed.

A. Processing Facility See attached

1. Description and schematic off processing procedures to bo used for each typo of waste.

2. Description off tho container(s) to bo used for storage of each type of waste during collectionand during movement within the facility and length of storage.-

3. Description of the alternatives to be used if process equipment is inoperable; and the procedurfor the storage of wastes, if they cannot be promptly processed. -

AR202622 -

Is-.*. •mB-IK*-!: .4 ' ' ANALYTICAL REPORT «2, CHEMICAL TEST RESULTS

ENVIRONMENTAL SERVICESPricks Lock Rd.. RO * 1. Pottstown. PA 19464 (215) 326-9662


H^,LABORATORY NO: See Below SAMPLE DATE: NASAMPLED BY: NA

3/24/86 .4/27/86

PI P: CLIENT: American ResourceJM jjjg&-. 450 East Streetit |$$t' Doylestown, PAm $&£• ' '

Consultants,18901

•8 Pij SAMPLE DESCRIPTION: Total Analysism i .--:~ '••• FPV;';'m&P"''' ' •$JIJ§v- Parameterm fe^ ~ • J • '8 M Cyanide, TotalM b; •. Antimony, TotalWf: Arsenic, Total• |'r Barium, Totaljafl*; Cadmium, TotalS; pi Chromium, Total• Copper, TotalJL; Lead, Total|e.5f:.. Mercury, Total1- Molybdenum, Total* Nickel, Totalf Selenium, Totali£. Silver, Total• * Zinc, Total• Oil and Grease*, PH||>> Total Solids' Volatile Solids

«. Heating ValueIlgnitability

CorroslvltyReactivityFamous 21£

•i "' "i ' • I 1 - ' ' '

Units

mg/kgmg/kgmg/kgmg/kgmg/kgmg/kc•"s/ **•»mg/kgmg/kgmg/kgrog/kgrog/kg~w •*»rog/kq*••«/ . *rog/kgrog/kgrog/kg

Standardmg/kgB?U/?b

'« «•>

,- -f f

**• *• •• bkV 1

Inc. RECEIVEDREPORTED

• * • '. • '

ARPtfn^PPQRMC1824-86

0.920.6125636.056

2600230

0.036.3. ; 1200.480.32

1180<3.211.98

74100077000760

Not Igni tableNot CorrosiveNot Reactive. .. *

IIIi

a«et Weight*See Attachments

Approved By: 202623

• .——————KyfeT. Gross, Supervisor, Environmental Chemistry Laboratory

*~i: • . .-.,.:. ,• •. •- .' "A Canberra Company

% j.NftLYTICAL REPORT 92. (OCfJTIMJED)W-

'('" ===________ ________—————==—————-——————————————— •——• ~——- - ENVIRONMENTAL SERVICES

Pricks Lock Rd.. RD * 1. Poltslown. PA 19464 (215) 326-9662


LABORATORY NO: See Below SAMPLE DATE: NASAMPLED BY: NA



Parameter

Ammonia-NitrogenTotal Organic CarbonChemical Oxygen DemandCyanide, TotalAntimony, TotalArsenic, TotalBarium, TotalCadmium, TotalChromium, TotalChromium, HexavalentCopper, TotalLead, TotalMercury, TotalMolybdenum, TotalNickel, TotalSelenium, TotalSilver, TotalZinc, TotalOil and GreaseTotal Organic HalogensPhenol icsPHTotal Dissolved SolidsVolatile Solids

Units

mg/1mg/1mg/1mg/1mg/1rag/1mg/1mg/1rag/1mg/img/1mg/lrag/1mg/1mg/1mg/lmg/1mg/1mg/1yg/mg/1

Standardmg/1mg/1

ARC402229RMCJ824-86

1.0114003490<0.0010.014<0.001<0.50.030.0200.0031.40.37<0.0002<0.051.00.014<0.001

10601.6690.105.26

50902180

Approved By: 202624

Kyle'F. Gross, SupervisorEnvironmental Chemistry Laboratory

flR'202621.

ANALYTICAL REPORT $2. (CONTINUED)

'*..'

p ENVIRONMENTAL SERVICESPricks Lock Rd.. RD « 1. Pottstown. PA 19464 (215) 326-9662


LABORATORY NO: 824-86 (ARM02229) SAMPLE DATE: NASAMPLED BY: NA



Parameter

MethanolMethyl ene ChlorideAcetone1,1-di chl oroethaneCis-l,2-dichloroethyleneTrans - 1 , 2 -d 1 chl oroethyl eneChloroform .1, 2 -di chl oroethaneMethyl ethyl ketone1,1,1 -trichl oroethaneCarbon Tetrachloride1,2-dichloropropaneTri chl oroethyl ene1,1, 2- trichl oroethaneBenzeneMethyl Uobutyl ketone1,1, 2, 2- tetrachl oroethaneTetrachl oroethyl eneTolueneChlorobenzeneEthyl benzene ,Xylenes

Units...-.„', _¥!. ->V -» _.

mg/kgmg/kgmg/kgmg/kgmg/kgrog/kgmg/kgrog/kgmg/kgrog/kgng/kgmg/kgrog/kgmg/kgrog/kgrog/kgmg/kgmg/kgrog/kgrog/kgrog/kgmg/kg

SampleConcentration

i- •»•••-'!.: •• ...V- ;•_ •:•••! ' --

' ! ( ' ^ '

<1.0<1.0<1.0

" : <1.0

• : ; <1.S<1.0<1.0<1.0<2.5<1.0<1.0<1.0<1.0<1.0

• <1.0"• -"• <1.0

<1.0<1.0<1.0<2.0

Approved By:

Kyre t. Gross, supervvsorEnvironmental Chemistry Laboratory

A Canberra Company

202625AR202625

••< '•=>-'

ANALYTICAL REPORT 11, BIOLOGICAL TEST RESULTS

INCINERATOR BIOLOGICAL DESTRUCTION EFFICACY

LOCATION: Lehigh Valley Hospital Center, Allentown, PA

DATE: March 20, 1986

INCINERATORS: Environmental Control ProductsComptro A-20

INTRODUCTION

This test program was designed to demonstrate that the incinerationprocess at Lehigh Valley Hospital Center-is adequate to destroymicroorganisms and other infectious agents that may be present in thehospital's vaste. This test procedure is to verify that the ash fromthe incineration process is biologically safe for disposal in anapproved sanitary landfill. .

Biological indicators are used routinely to monitor the effectivenessof sterilizing processes. Therefore, incineration, a type ofdry-heat treatment, can be evaluated by challenging the incineratorwith dry-heat-resistant spores. A known concentration of Bacillussubtilis variety niger spores was added to the vaste feed todetermine the potential of any surviving spores. Subsequently, thesamples were cultured to ascertain if any of the recovered sporestrips contained viable spores.

Concern for the possible health significance of microbiological wastecontaminants has'led to several investigations of industrial refuseincinerators and waste processing facilities. However, the lack ofstandardized procedures for sampling ash for bacteria and fungi inindustrial environments and the absence of standards for assessingthe health significance of the microbes incinerator residue havehindered Investigations. The study design is included to explain thesampling and analysis strategies employed.during the test program.

AR202626

S02825 _/ |/*** c<\arc \ l

IiIIIIIIII

' . ' . ORIGINAL " •ANALYTICAL REPORT II (CONTINUED) (Red)

SELECTION OF BIOLOGICAL INDICATOR

The best means at our disposal to determine the efficiency of asterilizing process is strictly of a biological nature.Bacteriological culture tests, designed to confirm the presence orabsence of living microorganisms with the use of biologicalindicators, constitute the most commonly employed methods.Biological indicators are standardized preparations of specificmicroorganisms, routinely bacterial spores, that are resistant to theparticular sterilizing process in question.

•; Incineration is a type of dry heat treatment, and therefore,; qualifies as a sterilization process when burning infectious vaste.

Lehigh Valley Hospital Center burns all. Infectious vaste and somegeneral refuse in its main Environmental Control Products (ECP)

•1;?i incinerator located at the hospital. In order to challenge the' process, it was necessary to find a heat resistant genus in the

selection of a microorganism for this Incinerator test program. A\ replication of the types, numbers, and concentrations of

microorganisms that actually are present in hospital vaste would havebeen required for the most theoretically desirable and representativeefficiency test. However, these data were not available. Therefore,the spore of Bacillus subtilis variety niger vas chosen as the mostappropriate biological indicator -from among several possiblecandidates. The Bacilli are preferred, as they are nonpathogenic andwidely distributed in soil, vater, air, and decomposing materials.

PREPARATION OF THE BIOLOGICAL INDICATOR

The main ECP hospital incinerator has a ram loader to push the solidvaste into the incinerator combustion chamber. The back-up ComptroA-20 unit utilizes a manual feed system where the operator opens theunit door and feeds several bags at a time into the primary chamber.Hospital vaste arrives as solids by cart in plastic bags. A knownconcentration of B. subtilis 'spores vas fed into the incineratoralong with other solid wastes and run through e normal burning dayand final bur ndown cycle. .

In order for the test to be meaningful, the incinerators had to bechallenged with a sufficient number of sample containers to verif jthe overall uniformity of destruction. Following common-practicetenting procedures of sterilization, a theoretical challenge of 3.1 X10 epores per sample vas used In this program. Five samples vereloaded Into the ECP Incinerator; over a 15 hour charging period.. Thelast load vas followed by a 3 hour burn-down. The back-up Comptrounit vas fired up and charged vith several loads of vaste beforefeeding vith sample containers over a half-hour period. A normalburn-down cycle followed as is standard procedure vith this unit. 2026 7

, . . D .,...Test strips vith 3.1 X 10° of subtilis spores vere individual. ,,.,*wrapped in stainless steel foil. Ea ket v *black iron pipe container vith capscontainer vas sequentially numbered.

AR202627

ANALYTICAL REPORT f1 (CONTINUED)

INTRODUCTION OF BIOLOGICAL INDICATORS INTO THE INCINERATOR

Steel sample containers were placed in plastic bags of non-infectioushospital waste. The sample bags were loaded at prescribed intervalswith other bags of waste following normal loading procedure.

PRIMARY UNIT (ECP) LOADING SCHEDULE

Sample Number Time1 8:00 AM2 12:00 NOON3 4:00 PM4 8:00 PM5 11:00 PM

BACK-UP UNIT (COMPTRO) LOADING SCHEDULE

Sample Number Time16 11:40 AM6 12:05 PM

SAMPLE RECOVERY

The following day at 7:00 AM when the ash is normally removed fromthe incinerator prior to the start of. the next burning day, theoperator was instructed to look for the steel sample containers. Ashremoval is by manually raking and shoveling the ash out of the rearaccess door of the incinerator. As each shovel full of ash waspoured into the metal ash container, several people watched forsamples. Sample recovery from the Comptro unit followed a similarprocedure and both sample tubes were recovered.

When the access /door was Initially opened there could be observed thesmoldering of hot carbon residual in the ash bed. The operatorrecovered a total of 4 of the 5 spore sample containers that werecharged. The unrecovered container most probably disintegrated byoxidation in the heat of the primary chamber. Two of the fourrecovered sample containers were partially disintegrated byoxidation, losing the spore test strip.

RECOVERED SAMPLES

Sample Number _ Condition

-.two were partially destroyed,and one was completely destroyed

slightly oxidizedslightly oxidized and slag encrusted

16 slightly oxidized6 slightly oxidized • ^

/AR202628

IIIIIIIII

ANALYTICAL REPORT II (COSTIMUED)

SAMPLE ANALYSIS

The recovered sample containers were opened and the test strfpaseptically removed and placed in sterile Trypticase Soy Broth (TSB)culture tubes. Visual observation of each test strip showed completecharring, but the strips maintained their integrity as they wereplaced into the TSB media; A quality control test strip from thesame test lot was also placed in a TSB tube. All the samples in theTSB tubes were held at 37° C.for 7 days.

SPORE GROWTH TEST RESULTS

Sample Number Result.4 negative Primary Unit5 negative

16 negative Back-Up Unit6 negative

QC positive

CONCLUSION

The spore test strips vere produced arid tested to comply vithMilitary Specification MIL-S-36586A vith the following resistancecharacteristics:

Survives KilledDry Heat 121° C 30 min. ———

160° C 5 min. 30 min.

All samples recovered from the incinerator had total spore kill andthe quality control sample showed-positive spore growth verifyingviable test samples. This confirms that the samples vere exposed toa temperature of at least 160° C for 30 or more minutes, or somehigher temperature, shorter, effective kill time.

The sample containers that vere partially or completely destroyed byhigh temperature oxidation vere exposed to temperatures of at least650° C for substantial periods of time to result in destruction ofthe metal pipe. Exposure to these temperatures exceeds the sporekill requirements and ve can therefore assume that those samples .alsoexperienced total kill.

Testing of the incinerators over the entire burning day vith theresulting total biological destruction of the samples verifies thatthe incinerators uniformly and totally destroy all biological factorsin the residue.

202629

AR20262/

IIIIIIIIIIIIIIIIII

MODULE 12, PAGE 3, SECTION III-A'•."- ; -- • ;

1. Description and schematic of processing procedures to be-used foreach type of waste

All the infectious waste generated in customer hospitals is transportedto the incinerator area and destroyed by high temperature incineration.Chemotherapy drugs are treated as infectious vaste and destroyed in theincinerator. The incineration process is a controlled air combustionprocess that utilizes tvo separate chambers to assure completedestruction of the exhaust emissions. The system is designed todestroy pathological waste, infectious vaste, and general hospitalvaste. • • - ' ' . - . : ' - . - . ' - ;;,-.;../ v -

• .' '''•"•''' ~ • • ' > ' . . ' • • - . . •Infectious vaste is brought to the main incinerator in double-lined,red or orange biohazard plastic bags. When the system is ready foranother load (based on time and temperature), the operator opens thehopper lid, drops several bags of vaste into the^hopper, closes thehopper lid and pushes the load button., The-.guillotine door rises,opening access to the primary combustion chamber/ the ram moves forwardpushing the vaste into the hot chamber. At the. end of the stroke, theram returns to the rear position and the guillotine door closes. Theprimary chamber is nov sealed so that total air.control is regained.

The heat of the primary chamber starts to evaporate vater and vaporizeplastic materials. The chamber is starved for air so that combustionof the exhaust gases can't go to completion. By limiting the flow ofair the pick up of particulate is minimized. The volatiles flowthrough the transition into the secondary chamber vhere heat and excessair assure complete combustion of the exhaust gases, preventing theemission of any smoke. - > : r:-

In the primary chamber, as the burning vaste Is pushed progressivelyalong the hearth, additional low velocity underfire air percolatesthrough the burning .bed-to.oxidize the residual carbonacious material,destroy syringe needles and -assure bed temperature that will destroyall pathogens. .

Following a burn-down and cool-down period, the operator removes theash from the primary chamber in preparation for the next burningperiod. The ash is then manually raked and shovelled from the primarychamber, placed in an appropriate container, and transported to GCSLfor co-disposal vith municipal refuse.

A back-up unit, Comptro A-20, is maintained on-site for use in theevent the main unit is inoperable. The back-up unit is manually fedbut all other items described above are similar.

202630

mi-ii.oju.-., v arc/

2. Description of the container(s) to be used for storage of each typeof waste during collection and during movement within the facility andlength of storage.

Plastic, wheeled carts are supplied throughout the hospital forcollecting and transporting wastes to the incinerator. Non-infectiouswastes are also burned here to regain as much heat as possible from theprocess. As infectious waste is generated, it is placed in adouble-lined orange or red plastic biohazard bag, sealed, and collected /in designated carts. Unmarked carts are used for the storage ofnon-infectious hospital waste. Several times a day the housekeepingstaff moves the carts to the incinerator room, 'exchanges a full cartfor an empty one, and returns to the appropriate floor location.

' •;. , •••'•• -:• .-"..S-i. •Bags of vaste are unloaded directly into the incinerator charge hopperand the cart is cleaned before reuse. All vaste. accumulated during a24-hour period is normally burned during the regular 8 to 12 hourburning period each day. Since the incinerator cannot handle theentire trash production of the hospital, general refuse such as office,kitchen and cardboard waste is placed in either a 40 cu. yd. packer ora 30 cu. yd. open top container for disposal at the landfill.

3. Description of alternatives to be used if the process equipment isinoperable; and the procedures for storage of waste, if they cannot bepromptly processed.

All infectious waste will be placed in double-lined orange or red ~plastic biohazard bags and sealed securely. If the vaste is heavy orvery vet, it will be double bagged to prevent leakage. This procedureassures easy identification and complete isolation.

The incinerator operator utilizes an automatic ran loading system tofeed the incinerator on the main unit and a manual feed on the back-upunit. He wears/gloves when handling the bags which protects him fromexposure to heat, fumes and sharp objects.

Red bag waste is handled separately from the general vaste to preventthe accidental mishandling of a bag of infectious vaste. This alsoreduces the chances of sending a red bag out vith the general trash.

During incinerator downtime, general hospital refuse is placed directlyin the vaste container and taken to the landfill for disposal. Red bagwastes are diverted to the back-up Comptro A-20 unit. If needed, redbag vaste is transported to Allentown Hospital 'for Incineration sinceLehigh Valley and Allentown are both under the same parent company, theHealthEast Organization.

A red bag, in a covered container, is kept right next to thechemotherapy drug preparation area for safe immediate disposal.

W20263*/ \arc \

IIIIIIIII

HXXJLE 12, PAGE 4; SECTION UI-A

IIIIIIIII

The Purpose v

To define the eolid weste generated by l.V.E.C. by type, kind, routineend hazard.

Definition - Hazardous Haste

A hezerdous weste ie any one, item or substance, that ie harmful,toxic, dangeroue or infectious to the environment, wild life end/orhumane.

lap!emen tati on , -r f * -' ' ' .' '

A. This procedure will define whet must be burned end whet trash willgo to the land fill when the incinerator is not in operation.

B. The point of origin is the only time an individual item of wasteshould be handled outside e closed container, any item generatedfrom an isolation room, the operating rooms,"anything that isbloody or any item used to puncture the skin of a person with acommunicable disease must be handled as infectious waste and redbegged. - < .

1. In a patient room the weste baskets are to house paper, emptycans, etc. No tubing, IV bags or dressings will be disposed ofin these containers. Hazardous type trash will be placed in the

i/ large waste cans located.in the aoiled utility:room or incontainers provided for the disposal of sharp items. The largecans will have the red(orange) bio-hazard liners in them.

2. ALL TRASH, MEDICAL OR NOT FROM AN ISOLATION ROOM WILL BECONTAINED IN RED BIO-HAZARD BAGS. THE USE OF ISOLATION TAPE ONTRASH BAGS IS TO BE DISCONTINUED.

3. These red bags will be picked up at leeet once in every 24 hours7 days e week, or more often as needed, by Housekeeping endimmediately taken to the incinerator room. The remainder of thetrash that is generated on the floors will be picked up byHousekeeping in accordance with procedures set by housekeepingand delivered to the incinerator room if the burning schedulewill permit or to the compactor for hauling to the landfill.

4. All operating room trash from the Short Procedure Operating .Rooms and THE MAIN OPERATING ROOMS SHALL BE CONTAINED IN RED BAGAND HANDLED AS IF IT WERE ALL HAZARDOUS MATERIAL .AND TAKEN TOTHE INCINERATOR ROOM.

5. All other speciality areas shall continue to separate theretreeh to insure that everything remotely infectious or inorigin is in either a sharps container or a bio-hezerd beg endthet only office or common trash be enclosed in normal trashbege.

2026326. ALL HUMAN TISSUE AND FLUIDS SHALL BE HANDLED AS A BIO-HAZARD.

ONLY THE LABS AND MORGUE MAY STORE THESE ITEMS. STORAGE MUST BEIN ACCORDANCE WITH PROPER PROCEDURES AND INSURE THAT WHENRELEASED SAMPLES ARE TRANSPORTED DIRECTLY TO THE INCINERATORROOM FOR DISPOSAL.

Implementation continued

C. The incinerator shall be operated 7 days a week*, for approximately14 hours a day on weekdays and 7 hours a day on weekends. Theincinerator shall be kept in good repair and operated in accordancewith proper procedures as set by the Engineering Department andD.E.R. In the event that the main incinerator is out of order theback up unit in the Power Plant will be used to burn the RED BAGS

, AND SHARPS CONTAINERS, this waste will be delivered to the mainincinerator room and Engineering will transport it to the back upincinerator.

Responsibility For Implementation

Under the point of origin format the first person to handle the wasteis the person to determine how it should be handled down stream. Inmost cases the first person is a nurse, lab technician or doctor. TheInfectious Control Department and the Nursing Department itself shallbe responsible for instructing the nursing staff. The specialty areassuch as labs and the morgue shall be the responsibility of theirrespective Department Heads, Transportation of the Red Bag, Sharps"ontaiaers and routine trash shall continue to be that ofhousekeeping, however they will.be instructed by there Department Headto be double careful to insure that no Red Bag, Sharps Containers orOperating Room Waste shall be put in the trash compactor. Once thewaste reaches the incinerator.room the Engineering Department ischarged with proper disposal.

202633

ftR202633,/arc

II

LEHIGH VALLEY HOSPITAL CENTERO ;.MEMORANDUM

I

I

I

I

I

DATE: Augusts, 1986

TO: Thomas Puller, American Resource Consultants, Inc.

RE: Infectious Hastes

The following departments at Lehigh Valley Hospital Center have directcontact end may be generators of potentially infectious wastes:

• Employee HealthMicrosurgeryRadiologyNuclear MedicineCardiac Cetheterization Lab

I E E GHeart StationPulmonary FunctionPhysical Therapy

• Respiratory Therpay• i j Outpatient Labs

- Cardiac Rehabilitation« Vascular Lab

PathologyEngineering

I SecuritySPDSPUPjharmacy

I Operating Room/Recovery RoomPerfusionistsAnesthesia

• Emergency Medicine Department

I Mary Elien fieideman, EN, ESN, CIC* Infection Control Coordinator <- . . 202634

MEB:deb

IV^/ cc: Glen SchneiderTerry Andrews

I RR20263U

ADS i ZB86

'

5. Description of the quality assurance program to be utilized 'ensure sterilization of the waste, if applicable.

Annually, or more frequently as requested, ARC will conduct a review ofthe infectious waste handling program which will include a testing ofthe incinerator ash to assure the total destruction of all pathogens.The test procedure will utilize the spore. Bacillus subtilis varietyniger. as recommended by DER. The final report will be submitted tothe Hospital and Grand Central Sanitation, the landfill operator.

202635

/AR202635 / 8tfC \

I DATEPRETAHEO «00UU 12 PAGE <

DATE REVISED

DATE SUBMITTED

DEPARTMENT USE ONLY

I 4. Description of special handling/safety measures for each type of waste managed. Include per-•, sonal protection and safety needs and any modifications to the operational safety plan.'

, .5. Description of the quality assurance program to be utilized to ensure sterilization of the waste.

|4 if applicable.••'.• :' ".••

&.: - . '• •• • ' . . • ., . . . . . ;.**; ^;, -:,-

6. Provide drawings to any modified structure, operation, contours or sequence of operation/waste• > » . - • • . PJan- Provide operational narrative as necessary to define any modified operational procedures.

*» - '' • " • ' ' -

'*• B. Disposal Facility (must be completed by operator of landfill or incinerator, where applicable)

| 1. Description of disposal method(s). utilized for each type of waste.- • • • •

_ 2. Description of the container to be used for storage of each type of waste during collection• and during movement within the facility and length of storage.

I3. Description of the alternatives to be used if the incineration equipment is inoperable; and the

• procedures for the' storage of wastes, if they cannot be promptly incinerated.

* 4. Description of the special handling/safety measures for each type of waste managed. Include_ personal protection, and safety needs and any modification to the operational safety plan.

15. Description of the quality assurance {program to be utilized to ensure sterilization of the waste.if applicable. -

-. :• 6. Provide drawings of any modified structure, operation, contours, or sequence of operation/waste_. plan. Provide operational narrative as necessary to define any modified procedures.B .•'; ' ! . . . . . . . . . . . . . .$\\ I

I;; .^- RR202636 -

IIii

DATE PREPARED

OATE REVISED

MODULE 12 PAGE SOATE SUBMITTED

DEPARTMENT USE ONLY

IV. CERTIFICATION OF GENERATOR OR PROCESSOR

_ I certify under penalty of law that I have personalty examined and am familiar with the information submitted In this and all attached documents.• and that based upon my Inquiry of those individuals Immediately responsible for obtaining the information. I believe that the submitted infor-™ mation is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility

of fine and imprisonment. .I& Name of ResponsibleW- Official

Signature ff-rtrtjflb* Jr. ^JL^A^Jb^__________________ Oate9i • ;£jrvUL&- KX*-A- VI 08-

V : Taken, sworn and subscribed before me. this

II V. CERTIFICATION OF REGISTERED PROFESSIONAL ENGINEER FOR PROCESSING AND/OR DISPOSAL• FACILITYI . • ' . . : •

This !• to cartlfy that I htvo peraonaOy reviewed aJt engineering information contained In the accompanying mooulei. drawings, specification .•nd other documents which are part of this application and that I have found it to be good engineering quality, true and correct, and it. i.

1Iii .

i

wjiiiunwiibv wiui uiv lequnoiiiwiiLa ui uiw t/ v*"'**111 ul cii*«ui»ii«

NOTICE: It te an often** under PwwwytvanU Crimes Coda to sfl

Nama

Signatura

Data

Address

Phona No.

flDono£'*7

nwi rmwucbw*, •<« i» uv»« iiui. uf uw uo»i 01 my luwwwuga, wiu«K-tjthe requirements of the Department.

(km a f aJw ttatoment In documents submitted to th« D«partm«m.

i

SEAL OF PA REGISTEREDPROFESSIONAL ENGINEER

•

202637 V

DATEFRIPARED

OATE REVISED

MODULE 12 PAGE 6

DEPARTMENT fc&ONLY

£ VI. CERTIFICATION OF OWNER/OR OPERATOR FOR PROCESSING AND/OR DISPOSAL FACILITY

This te to certify that I have personalty examined and am familiar whh the information submitted in this and any attached documents. I am• aware of the Department of Envlronrrwntal resources'penritarKlope ti ^

Information is true, accurate and complete. I am aware that there ere significant penalties for aubmitttng falae information.

I

Ji*;

I

I

I>>, • -fc '

I

Name

Signature ———_______________________ .- Date

202638

AR202638

:jpitt&>

9.0 PA DER MODULE 1 /,— ———— " : 'i',PA DER Module No. 1 - Request for Approval to Treat, Store, orDispose of a Hazardous or Residual Wastestream.

The following section presents a completed PA DER Module No. 1 forthe LVHC Incinerator Residue. The analytical data shows thecharacteristics of the waste which will be transported to an approvedsolid waste facility for final disposal.

••u

£QQHR202639

c'-v

I•**'

•

ER-SWM-14: R«v. 4/61

OATE PREPARED

OATE REVISED

PA DEPARTMENT OF ENVIRONMENTAL RESOURCESBUREAU OF SOLID WASTE MANAGEMENT

MODULE 1

DEPARTMENT USE ONLY

REQUEST FOR APPROVAL TO TREAT. STORE, OR DISPOSE OF A HAZARDOUS OR RESIDUAL WASTE STREAM

f f SEE INSTRUCTIONS BEFORE COMPLETING THIS FORM

I I. GENERAL INFORMATION (must be completed by TSD facility)

^ A. Treatment, Storage, or Disposal SiteI <*•: :•, 1. Name of facility Grand Central Sanitary Landfill, Inc.

Address 1963 Pen Argyl Road, Pen Argyl. PA 18072I|:. Municipality ___Plainf ield Township___ County Northampton________________.»,?»$.„

* 2. Identification number (if applicable) I I I I I I I I I I I I I N/A

• 3. Solid waste permit number(s) for treatment, storage or disposal facility to be utilized* " ___________100265_________

-T-, ————————————V-x 4. Facility contact person

£ Name _______Joseph Grosskettler________ Title Manager, Residual Wastes

Phone no. (215) 863-6057

B. Generator of the Waste

I 1. Name of company Lehigh Valley Hospital Center____________________- _ . . . . .

Mailing address 1200 Cedar Crest Blvd.. P.O. Box 689. Allentown, PA 18105

Location of site If differentL from mailing address _____I Municipality ____Salisbury Township County Lehigh

2. If a subsidiary, nameof parent co. HealthEast____________________ 2026'* ————

3. Identification number (if applicable) I 1 I I I I I I I I I I I

4. Company contact person

Name ________O. Glenn Schneider ____ title Director, Engineering

Phone no. _____(215) 776-8515 . :. n^ Q 2 6 U 0

DATE PREPARED

OATE REVISED

MODULE 1. PAGE 2

DEPARTMENT USE ONLY

II. WASTE DESCRIPTION (Must be completed by Generator)

A. General Properties

1. pH range ___=_____ to 11.98 (based on past analyses or knowledge)

2. Physical state:

a. O liquid (less than 20% solids by c. 13 solid (equal to or greater than 20%dry wt or flowable) by dry wL and non-flowable)

b. O gas (ambient temperature and d D Check here if c. above was checkedpressure) and waste contains free liquids.

3. Physical appearance:

Color Black to Grey_________ Odor IXisty_____________________

Number of solid or liquid phases of separation ____1

Describe each phase of separation

Solid v

4. U.S. DOT proper shipping name UN/NA number, and hazard class (if applicable):

N/A

5. Typical volume of waste to be shipped to treatment storage or disposal facility:*

a. Monthly '__________ gal., tons (circle one)

b. Annually ____200______ gal., tons (circle one) (ash)

6. Treatment or disposal frequency: _________ times per year; D one time

7. Current volume to be shipped to treatment storage or disposal facility N/A____gal., tons (circle one)

i

8. a. Is the waste a hazardous waste asdeffned In 75.261? D Yes g No j

b. If yes, describe the hazardous waste according to Its description and hazardous wastenumber In 76.281, |

202641 '9. Has the waste been delisted as a hazardous waste by DER? O Yes a No B N/A

If yes or N/A, check the appropriate box(es) in Item 10.

AR20261H

II

i

OATE PREPARED

OATE REVISED

MODULE 1. PAGE 3

DEPARTMENT USE ONLY

10. Is the waste a residual waste or a delisted hazardous waste? E Yes O NoIf yes, check the following boxfcs).« applicable:

D discarded commercial chemical product O process waste 'D tank bottomO off-spedfJcation species D Infectious waste

O baghousedustO manufacturing chemical intermediate D waste water treatment plan residue (industrial)O still bottomO spent catalyst O waste water treatment plant residue (sewage)O flyash D water treatment plant residueG bottom ash O incinerator residue

D add mine drainage treatment sludgeO stag O spill residue .O foundry sand ;. • ;**#.:\;%j. ;D SO. scrubber sludge D other (spedfv)_____________

6. Chemical Analyses — Please attach the following: See Attachment 1.11. The results of the total analysis of the waste as described in the instructions.

2. The results of the leaching tests as described in the instructions and the leaching method. 'i

3. A description of the sampling method.

4. The range of concentrations of the constituents based on knowledge or past analyses.

C. Process Description and Schematic — Please attach the following:1. The substantiation for a confidentiality claim as described in the instructions, if portions

of the information you have submitted are confidential.

2. A detailed description of tfie manufacturing end/or pollution control processes producingthe hazardous or residual waste as specified In the Instructions.

See Attachment $2 ... '3. A schematic of the manufacturing end/or pollution control processes producing the

hazardous or residual waste as specified in the instructions.See Attachment #3 "

III. Uner Compatibility Evaluation (must be completed by TSD facility) -

Attach the results of the liner.compatibility evaluation or supporting data as specified in theinstructions.

No liner compatibility evaluation necessary.

AR2026i*2

OATE PREPARED

OATE REVISED

MODULE 1. PAGE 4

DEPARTMENT USE ONLY

IV. PROPOSED TREATMENT, STORAGE, AND/OR DISPOSAL METHOD (mdst be completed byTSD facility. Use additional sheets if necessary.) fa 'fy/

e<9A. Proposed Treatment Method

N/A

B. Proposed Storage Method and Length of Storage

N/A

C. Proposed Disposal Method

Co-disposal with municipal refuse

V. ALTERNATIVES TO PROPOSED TREATMENT AND/OR DISPOSAL METHOD (must be completedby generator. Use additional sheets if necessary.)

A. What Other Treatment, Disposal, Recycle. Reuse, or Reclamation Method(s) Can be Used?Briefly describe viable alternatives to your proposal.

None available

B. Why was the Treatment and/or Disposal Method In Section IV Chosen?landfill ing of incinerator residue is environmentallysound and economically viable.'

A R 202 61* 3

I

I«• -Iiiiiiiiti- •*"

I

I

OAT,

OATE REVISED

FOR -DEPARTMENT USE ONLY

VI. CERTIFICATION OF GENERATOR

I certify under penalty of law that I have personally examined and am familiar with the information submitted i-this and all attached documents, and that based upon my inquiry of those Individuals immediately responsible forobtaining the information, I believe that the submitted information is true, accurate and complete. I am aware thatthere are significant penalties for submitting false information, including the possibility of fine and imprisonment.

Name of ResponsibleOfficial GWLLG <£>. -TcHNSite*,________________________Title

Signature Q JiJb f, JiJL,l*<&-*>_____. . Date

S ~ \

" v

, IBtlGH COUNTY, MM

VII. -CERTIFICATION OF -REGISTERED PROFESSIONAL ENGINEER FOR TREATMENT STORAGEAND/OR DISPOSAL FACILITY

This b to certify that I have personally reviewed all engineering Information contained in the accompanyingmodules, drawings, specifications, and other documents which are part of this application and that I have foundit to be of pood engineering quality, true and correct and is in conformance with the requirements of theDepartment of Environmental Resources, and it does not, to the best of my knowledge, withhold informationthat is pertinent to a determination of compliance with the requirements of the Department.

NOTICE: It is an offense under Pennsylvania Crimes Code to affirm a false statement in documents submittedto the Department.

Name

Signature

Date. .. SEAL OF PA REGISTEREDAddress _;_____

PROFESSIONAL ENGINEER

Phone No./ /

,ftR2026l*l»

.*.>".

ATTACHMENT #1

MODULE 1 - SECTICN II-B

? ENVIRONMENrAV-JSjERVICESPricks Lock Rd.. RO « 1. Pottstowr.. PA


LABORATORY NO: See Below • SAMPLE OATE: NASAMPLED BY: NA


SAMPLE DESCRIPTION: Total Analysis

Parameter

Cyanide, TotalAntimony, TotalArsenic, TotalBarium, TotalCadmium, TotalChromium, TotalCopper. TotalLead, TotalMercury, TotalMolybdenum, TotalNickel, TotalSelenium, TotalSilver, TotalZinc, TotalOil and GreasepHTotal SolidsVolatile SolidsHeating ValueIgni labilityCorrosivityReactivityFamous 21

Units

mg/kgmg/kgmg/kgmg/kgmg/kgmg/kgrag/kgmg/kgmg/kgrog/kgmg/kgmg/kgrog/kgmg/kgmg/kg

. Standardmg/kgmg/kgBTU/lb--—--""

ARC102229RMCf 824-86

0.920.6125636.056

26002300.036.3

1200.480.32

1180<3.211.98

74100077000760

Not Igni tableNot CorrosiveNot Reactive*

*Wet Weight*See Attachments

-Approved By:

•341-Tfr. -%'->Cyle^F. Gross, SupeiKyle F. Gross, SupervisorEnvironmental Chemistry Laboratory

A C-nt*"1 Compiny

I ATTACrlMENT 1 - CONTINUED

I•*"'IiIiI|iiiiiii

ENVIRONMENTAL SERVICESRicks Lock Rd.. RO « 1. Potlslown. PA 19464 (215) 326-9662


LABORATORY NO: See Below SAMPLE DATE: NA1 = SAMPLED BY: NA



Parameter

Ammonia-NitrogenTotal Organic CarbonChemical Oxygen DemandCyanide, TotalAntimony, TotalArsenic, TotalBarium, TotalCadmium, TotalChromium, TotalChromium, HexavalentCopper, TotalLead, TotalMercury, TotalMolybdenum, TotalNickel, Total ,Selenium, TotalSilver, TotalZinc, TotalOil and GreaseTotal Organic HalogensPhenol 1csPHTotal Dissolved SolidsVolatile Solids

Units

mg/1mg/1 .mq/1«iy/ img/1mg/1mg/1mg/rag/1rag/1rog/1mg/1«g/lmg/1HIJj/I

mg/1rog/img/1mg/1tog/1

' mg/1*"af';U9/1ing/1Standard

og/1•wg/ «rag/1

ARC*02229 -RMC#824-86

1.01>14003490<0.001 .0.014<0.001<O.S0.030.0200.0031.40.37<0.0002<0.051.00.014<0.001

10601.6

€9 .0.105.26

50902180

Approved By:

Kyle'F. Gross, SupervisorEnvironmental Chemistry Laboratory

I ;• '•:•*'"'• HR.2-02.6h6

ATTACHMENT 1 - CONTINUED

'ENVIRONMENTAL SERVICESPricks Lock Rd.. RO * 1. Potlstown. PA 19464 (21 S) 326-9662


LABORATORY NO: 824-86 (ARC*02229) SAMPLE OATE: NASAMPLED BY: NA



SampleParameter_____________Units Concentration

Methanol mg/kg <1.0Methylene Chloride mg/kg <1.0Acetone mg/kg <1.01,1-dichloroethane mg/kg <1.0Cis-l,2-dichloroethylene mg/kg <1.0Trans-l,2-dichloroethylene mg/kg <1.0Chloroform . mg/kg <1.51,2-di chl oroethane mg/kg <1.0 . jMethyl ethyl ketone mg/kg <1.01,1,1-trichloroethane mg/kg <1.0Carbon Tetrachloride mg/kg <2.51,2-dlchloropropane mg/kg <1.0Trichl oroethyl ene mg/kg <1.01,1,2-trichloroethane mg/kg <1.0Benzene mg/kg <1.0Methyl isobutyl ketone mg/kg <1.01,1,2,2-tetrachloroethane mg/kg <1.0Tetrachloroethylene mg/kg <1.0Toluene mg/kg <1.0Chlorobenzene mg/kg <1.0Ethylbenzene mg/kg <1.0Xylenes mg/kg <2.0

Approved By:gt<?pr —.F. Gross, supervisor

Environmental Chemistry Laboratory

A Canberra Company

iimI•i

ATTACHMENT 12/ . •

HODUU2 1, SECTION II-C

Process Description

All the infectious waste generated in customer hospitals istransported to the incinerator area and destroyed by high temperatureincineration. Chemotherapy drugs are treated as infectious waste anddestroyed in the incinerator. Some general office refuse is alsoincinerated to add to the heat recovered from the process.

The incineration process is a controlled air combustion process thatutilizes two separate chambers to assure complete destruction of theexhaust emissions. The system is designed to destroy pathologicalwaste, infectious waste, and general hospital waste.

:$vp .'•' . Infectious waste is brought to the main incinerator in sealed red or|f|p double-lined orange biohazard plastic bags. When the system is ready4 for another load (based on time and temperature), the operator opens

*?£*'•"'' the hopper lid, drops several bags of waste into the hopper, closesI* the hopper lid and pushes the load button. The guillotine door

.' rises, opening access to the primary combustion chamber, the ramj.i :l moves forward pushing the waste into the hot chamber. At the end of

the stroke, the ram returns to the rear position and the guillotinedoor closes. The primary chamber is now sealed so that total air

•l; control is regained.r i*.-. r*--

The heat of the primary chamber starts to evaporate water andvaporize plastic materials. The chamber is starved for air so thatcombustion of the exhaust gases can't go to completion. By limitingthe flow of air the pick up of particulate is minimized. Thevolatiles flow through the transition into the secondary chamberwhere heat and excess air assure complete combustion of the exhaustgases, preventing the emission of-any smoke.

iiiiiii

In the primary chamber, as the burning waste is pushed progressivelyalong the hearth, additional low velocity underfire air percolatesthrough the burning bed to oxidize the residual carbonacious :material, destroy syringe needles and assure bed temperature thatwill destroy all pathogens.

Following a burn-down and cool-down period, the operator removes the OOash from the primary chamber in preparation for the next burning ' ' JFperiod. The ash is then manually raked and shovelled from the VOprimary chamber, placed in*an appropriate container, and transported C\Jto GCSL for co-disposal with municipal refuse.

. ..—... . . : - , . . . : . . . '

A back-up unit, Comptro A-20, is maintained on-site for use in theevent the main unit is Inoperable. The back-up unit is manually fedbut all other items described above are similar.

20264S

A'lTACHMENT »J

MODULE 1 - SECTION II-C

HERTIRECOUERY

INFECTIOUS, PRTHOLOGICRL WRSTE

GEHERflL REFUSE

RSH £ S> ^ Bm PERMITTED,LINED

LRKOFILL

OFFICE. CRROBOfiRO. RMD KITCHEN URSTE

TOPERtllTTED,

LINEDLRNDFILL

COMPftCTOB

202649

INCINERATOR SCHEMATICLEHIGH VALLEY HOSPITAL CENTER

ALLENTOWN, PA '--.J

arcAMERICAN RESOURCE CONSULTANTS., INC.450 East Street., Do<jlestova,PA 1 8901

215-348-0402

SCftLE:NTS

PROJECT22286 ^BV-rro^ * TGP

15AUG86FILE NRttE:INCINERATOR SCH

10.0 EVALPATION AND RECOMMENDATIONS

These conclusions are based upon our review of the facility on Tfarch20, 1986, the incinerator ash testing that was initiated that day,and subsequent actions taken by Lehigh Valley Hospital Center to

>:,.- revise their waste handling practices.

The syringes are currently dropped in sharps containers at alladministering locations, keeping them separate from the generaltrash. This is the best way to handle this infectious wastestream,always keeping in mind that this waste must be transported and storedin a secure manner.

A procedure whereby housekeeping supplies separate carts forinfectious waste is a good approach, but the use of non-red bags forinfectious waste at.some locations leaves some room for error. We

. recommend that red bags be used at all locations that generatek*••''•! infectious and pathological waste. The use of isolation waste labels

on regular trash bags is inadequate, color is still the bestuniversal quality control for separation in handling.

Anti-neoplastic drug waste must be treated as red bag waste for safedisposal. Several of the chemicals used in chemo-therapy are on theEPA hazardous and toxic waste lists and should be disposed of by amethod that assures 99.9999% destruction. Considering the smallquantities generated, many facilities destroy this waste in theiron-site incinerators. The higher the temperature the better (loadthis waste into the incinerator after it has been running for severalhours and full, uniform operating temperature is achieved). Packageit and handle it as red bag waste for the safety of hospitalpersonnel and the assurance of segregation for disposal. Label it aschemotherapy waste and instruct the incinerator operators on thetiming and procedures for safe handling and destruction.

The current protocol of treating all patient contact material asinfectious, and disposing of it as red bag waste, follows the PA DERand US EPA guidelines for defining which wastes are infectious.

Oin

202650CDCMcc

Liquid infectious waste is handled as red bag waste, and to provideprotection against leakage, is double-bagged and sealed. '/>" H-f

Red bag waste is picked up on a separate schedule from the generaltrash pick up, to insure segregation of the infectious wastestreamfrom general hospital trash.

Loading of the incinerator requires the handling of the bags from thecart into the loader hopper. The operator, wearing protective rubbergloves, uses tongs to handle each bag, talcing care to preventpuncturing or tearing the bag.

If infectious waste cannot be destroyed the same day it is generated,it should be stored in a secure area, away from the general trash,where unauthorized people will not have access to syringes orinfectious exposure. This also eliminates the chance of trashhandlers picking up infectious waste and placing it in the truck withthe general trash going to the landfill. If infectious waste is tobe stored for more than a couple of days, it is recommended that itbe refrigerated to reduce the growth rate of infectious agents andminimize the possibility of odor. Use of the back-up unit and thealternate Allentown incinerator is recommended if waste accumulatesmore than two days.

P02651

AR20265I

IIIII

*.

IIIIIIIIIIII

y%If the hospital is required to send infectious waste out of the .?/facility, it should be manifested and signed for by the transporterand the final disposal facility. Upon incineration, the disposalfacility should sign a copy and return it to the generator asverification of destrction. This is required by DER and it is animportant step in controlling the liability associated withinfectious waste.

The draft Infectious Waste Policy, while providing an effective planframework, must be expanded to give adequate guidance for effectiveinfectious waste control. Definitions of infectious, pathological orwastes to be incinerated encountered at LVHC should be given alongwith specific examples to insure total segregation. Each area of thehospital should be listed along with type of waste generated andproper handling procedures. .Once completed, the policy must betaught to supervisors and employees alike, and properly enforced toinsure adequate implementation.

As with any other program, your protocol will only be as good as thetraining, supervision, and follow-up that management commits to it.As requested by the Module 12, and to assure the safety of allhospital personnel, transport and disposal personnel, the communityand the environment, the hospital must establish a successful,on-going program, including a detailed written protocol, a trainingprogram and a quality assurance program.

The testing of the incinerators showed that both units providecomplete destruction of all biological agents in the incinerators'residue.

Several items should be noted in regard to the hospital's incineratorpermits which were given to us for the review. The permit for thesmall Comtro A-20 expired January 31, 1986. This unit has definitecombustion burner problems and should be serviced or removed totallyfrom service for safety reasons.

The permit for the large incinerator requires the sensing andrecording of the temperatures leaving both chambers. If we observedcorrectly only the secondary temperature is recorded. Only approvedwastes (i.e., trash, infectious, pathological) should be incineratedby LVHC. Any liquid wastes (i.e., oil, lab waste, fuel) should becollected separately and sent to a proper disposal facility.

CVJin

202652 oCM02«CC

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OfyIncluded for your information and appropriate use are the f ollowdftjf-documents: '

10.1 1985 EPA Draft Guide for Infectious Waste Management10.2 Hospital Self-Audit Guidelines

The Draft Infectious Waste Policy should be a dynamic document thatis revised to included all recommmended changes adopted by LVHC. Theinitial document, while providing a good foundation, must addressspecific areas of waste handling in the hospital to implement tightercontrols and prevent future problems.

202653

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I

10.1 1985 EPA DRAFT GUIDELINES

WGUIDELINES: US/EPA draft guide for infectious wastemanagement, July 1985.

An optimal system for infectious waste management will-vary from facility to "facility and should be based on

fv the following: '

• The nature of the infectious waste stream — theL types, the quantity and appropriate treatmentP*" methods.u.' • On-site and off-site treatment alternatives as well%& as the option of using equipment jointly with other11_", infectious waste generators.

• All relevant regulations and standards at theFederal, state, and local levels.

• Prevailing community attitudes.

• Costs.

Infectious waste management practices should include:

i • Designation: Infectious waste is comprised of: isolation wastes; stocks and cultures of infectious

. agents and associated biological*; human blood andblood products; pathological wastes; use sharps;

contaminated animal carcasses,* body parts, andbedding; and miscellaneous contaminated wastns asidentified by the generat.or.

• Segregation: Infectious waste should be separatedfrom the general waste stream, placed directly intosuitable containers, and labeled at the point ofgeneration. Contaminated reusable equipment shouldhave its own separation system.

• Packaging and Containment:

• I. Selection of packaging materials that areappropriate for the t.ype of waste and type oftreatment to be used. (See chart A)

2. Plastic bags that, are impervious, tear-resistant, and distinctive in color or mnrkiare appropriate exr.*»pt for sharps and 1 Squidinfectious waste. Closing the top of each

by folding or tying as appropriate for thetreatment or transport procedure used.

3. Double-bagging or placement of the bagged wastewithin a rigid,or semi-rigid container in orderto protect the integrity of the packaging wheninfectious waste is moved within the facilityor temporarily stored. Placement of the baggedwaste within a rigid or aeai-rigid containerfor transport off-site for treatment. Tying orsealing of plastic bags or covering thecontainers with secure, tightly fitting lids.

*

4. No use of mechanical devices, chutes, or dumb-waiters for movement of bagged waste.

5. Discard of aharpa directly into impervious,rigid, puncture-resistance containers.Placement of needles directly into collectioncontainers without recapping, clipping, orbreaking.

6. Containment of liquid infectious waste incapped or tightly stoppered bottles and flasks,with use of caps and stoppers that can beloosened easily before steam sterilization (ifthat is the treatment method). Containment oflarger quantities of liquid infectious waste intanks.

7. Use of packaging materials that are strongenough to remain intact during whatever type ofhandling, storage, and transfer the packagesmay undergo.

8. Use of the universal biohazard symbol on allcontainers (together with other labels, asnecessary, to identify multiple hazards).

9. No compaction of infectious waste or packagesof infectious waste prior to treatment.

Storage: - •

1. Avoidance of storage by treatment of theinfectious waste as soon as possible;preferably the same day it is generated.

202655

AR202655

Iiiiiiiiii,iiiiiiiri

2. Minimization of storage time, with storage inrefrigerator or freezer if storage time exceedsone day. " . L':'<-

• " ' -n .T j ':.:::'•-

3. Proper packaging to ensure containment of thewaste and exclusion of rodents and vermin.

4. Limited access to storage areas.

5. Posting of biohaeard signs on doors, wastecontainers,"' refrigerators, and freezers.

' - ; J t - •' r i .

Transport: ' --

1. Proper packaging to ensure containment of thewaste.

2. Handling, transfer, and loading of packages ofinfectious waste in a manner that does notdestroy the integrity of the packaging.

' J' T"i 1 • • '• ' "'

3. Scheduling of pick-ups of infectious waste tominimi re accumulation time at source.

' ' " - - - ' •" '4 . Selection of tine and route of transport so•that exposure to the waste is minimal .

S. Use of dedicated carts for moving infectiouswaste. Frequent routine cleaning anddisinfection of the carts.

_6. No compaction of packaged infectious waste

prior to or during transport.

7. Transport of infectious waste off-site only inclosed and leak-proof dumps t ere or trucks.Routine Cleaning and disinfection of dumps terand tracks used to transport infectious waste.

Treatment :

1. All infectious waste should be treated.

2. Selection of treatment technique in accordancewith the specific recommendations for eachwaste type, (nee chart tt)

3. Treatment operations in accordance with t.h«*standard operating procedures developed for

202656

Jeach treatment, technique that include ^~^monitoring of all treatment processes toestablish standard operating procedures fortreatment of standard loads of infectiouswastes; 'subsequent periodic monitoring of thetreatment processes in order to verify that the vinfectious waste is being sterilized; and useof biological indicators placed within andthroughout the waste load to monitor theefficacy of infectious waste treatment.

• Disposal: Management as ordinary non-hazardouswaste after treatment; disposal by burial in asanitary landfill, discharge to a sewer system, orincineration in accordance with all relevantFederal, state, and local regulations; and specialhandling of wastes with multiple.hazards inaccordance--with the requirements of all applicableFederal, state, or local regulations or with theacceptable management practices.

Infectious waste management policies should include:

• Contingency Planning: Policies and procedures forthe clean-up of spills of infectious waste;procedures for the repackaging of infectious wastewhen the integrity of the packaging has beencompromised; and alternative arrangements forstorage and treatment of infectious waste whennormal procedures cannot be followed.

• Staff Trainitig: Training for all employees whogenerate or handle infectious waste; revisedtraining whenever infectious waste managementpractices are changed; and continuing educationprograms on a regular basis.

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10.2 HOSPITAL SELF AUDIT GUIDELINE

i ; -::

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"": INFECTIOUS WASTE AUDIT

Yes No CommentsPERSONNEL

1. Is normal trash being placed in \_\ \_\infectious waste containers?

2. Do staff filling the collection Cl I'llcontainers know the differencebetween infectious and

1 non-infectious waste?• 3. Has a policy been established |_| |_|

to define infectious waste?

4. Does it conform to the EPA |_| |_Jguidelines?

5. Are records kept of your annual |_| |_|amount of infectious waste generated?

6. Is it increasing within the last ill Cifew years?

7. Are employees trained to separate I_| I_Iinfectious waste by type and routeof disposal?

8. Are new employees trained about l_| |_|infectious waste?- _••••-.. i • r--- •• -.•.: • •. • -

HIf? COLLECTION AND CONTAINERS

S. Are all types of infectious waste |_| |_|containers clearly identified?

10. Is infectious waste collected from l_l !_(patient areas and.laboratoriesdaily? " CM

202660

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Yes No Comments

11. Do your collection bags tear often? |_| 1_|

12. Is their failure rate acceptable? |_J Cl

SPILLS .

13. Have procedures been established |_| I_|to clean up infectious waste spills?

' — —14. Have staff handling infectious |_| I_|waste been trained for spillresponse?

15. Were your procedures followed when |_| |_Iyou've had an infectious wastespill? .

16. Did your procedures work well? 1_1 |_I

STORAGE AND PROCESSING

17. Is raost infectious waste treated 1_I |_Ion the day its collected?

• *

18. Is the storage area(s) posted |_| |_!where infectious waste waits fortreatment?

/ __ _19. Is this storage area(s) an adequate \_\ !_1

size? .* • - . . • • " "

22. Is infectious waste stored in this I_l l_larea(s) longer than two days?

21. Does your daily generation rate everl_l |_Jexceed your daily treatmentcapacity? ""•

R20266I

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. f Yes No CommentsTREATMENT '

22. Is your infectious waste treated |~| |~|to render it non-infectious?

23, Does your treatment method comply O iZlwith the EPA guidelines?

, ' • ! • . . - • • • ; , . • ' , - . »34. Has the destruction efficiency of O |~1

your treatment method been tested?

25. Has it been re-tested? |~| |~|

26. Does 3.t reliably sterilize your O iZlwaste? - • ' ' ;••<"••*. ..." •" .

"' :'; : — —27. Have the treatment equipment oper- |_I |_|ators received training aboutinfectious h?»rards?

DISPOSAL

28. Are any of your infectious waste |_l I_|- types landfilled without treatment?

29. Do you use the sanitary sewer for I_| l_itreated or untreated infectiouswaste?

30. Do you have a copy of your local |_| 1_J• sanitary sewer .authority's rules?

' ' . . " _31. Are they being followed? |_l |_|

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Yes No CommentsYOUR MANAGEMENT PLAN

32. Has a person been desinated to |_| Osupervise your infectious wastemanagement?

33. If your treatment equipment breaks |_l l_ldown/ have alternative treatmentmethods been arranged?

34. Do you know your annual costs of |__1 |_ 1infectious waste management?

35. Do your plans account for trends in |_1 I_|treatment and disposal costs, wastevolume and equipment replacement?

— END — •

202B83

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AR2026614

APPENDIX 1

202665

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Post Office Box 2063. Harriaburg, Pennsylvania 17120

. _ „ . ... .. - September 6. 1985Bureau of Solid Waste Management 717-7S7-9S70

_..••*

- SEP 10J985Dear Hospital Administrator; c ,,.-.:

• ? This correspondence is being sent jointly for your information by the PennsylvaniaDepartment of Environmental Resources and the Pennsylvania Department of Health. The Departmeof Environmental Resources has been charged by the Legislature to regulate the disposal ofhazardous and nonhazardous wastes In Pennsylvania, and the Department of Health is mandated toinspect and regulate the hospitals in Pennsylvania. It has become evident to both Departmentsthat the health-care institutions in Pennsylvania are not complying with the Department ofEnvironmental Resources' regulations concerning waste evaluation and waste disposal.

The Department of Environmental Resources' hazardous waste management regulations(75.262(b)) require all generators of waste to perform a waste evaluation to determine if theirwaste is hazardous. If your institution has not yet conducted the waste evaluation, an evaluationshould be completed. If you find that your institution is a generator of hazardous waste, theDepartment of Environmental Resources must be notified. If your institution generates onlynonhazardous waste, the Department need not be notified; however, you must retain copies of theevaluation and furnish it to the Department upon request.

The waste stream generated by hospitals which is currently of most concern ispathological and infectious waste. For the purpose of defining which wastes are pathological andinfectious, the following examples are provided:

'; • -

Pathological Wastes - All laboratory, surgery, and autopsy wastes, tissues, blood,excreta, excretions, cultures, organs, body parts, dialysis unit wastes, laboratoryanimal carcasses and bedding, or other wastes or materials which may be contaminatedby pathogens.

. . . . . . . . . : ; ; ;• • f ,. •

Infectious Wastes * All disposal equipment, instruments, utensils, bandages, bedding,towels, tongue depressors, syringes, needles, end other pathologically-contaminatedmaterials which have been exposed to humans or animals that are expected or diagnosedas having a communicable disease and must, therefore, be isolated. In addition,pathologically-contaminated foods, drugs, cosmetics, and pharmaceutical wastes fromthe production of antibiotics and/or vaccines may be considered infectious wastes.

• . . - . ' " • - * • - ' • -, : . - «• . " • • . . . • . - . « . ', • mAll pathological and Infectious wastes must be processed (sterilized) or incinerated

prior to disposal by landf illing; however, pathological wastes such as body parts, organs, and othertissues, should be Incinerated regardless of their potential to transmit disease.

202666JVR202666

-2- September 6, 1985

%.'Approved processing (sterilization) methods are autoclaving, _dry heat sterilization, chemical sterilization, irradiation, or other methods wntch render suchwastes non-infectious. Incineration of these wastes is also an approved method, but It must beaccomplished in an incinerator designed for these wastes and must be permitted by the Departmentof Environmental Resources.

Ideally, these wastes should be processed at the source of generation. If this is not -possible, the waste should be isolated from other wastes at the source of generation and placed indouble plastic bags, or air-tight, leak-proof disposal containers and transported in covered(tarped) or enclosed non-compaction type equipment. Nondisposable containers may be used, butshould be cleaned and sterilized between uses. Bags and containers should be labeled to properlyidentify the wastes in case of an accident during transport. After the wastes have been processed,the permitted processing facility should provide a letter of certification to the disposal facilityassuring the disposal facility operator that the wastes have been properly sterilized. Certifi-cations should be available to the Department during inspections.

•

Existing disposal facilities proposing to manage processed infectious and pathologicalwastes must apply for a permit modification before accepting these wastes. When the permitmodification is issued, it should thereafter authorize the disposal of all processed pathological andinfectious wastes within the scope of the approved submittal.

It is important to emphasize that pathological and infectious wastes will not be approvedfor disposal at any landfill in Pennsylvania unless they are properly processed or incinerated priorto disposal. To ensure that this is accomplished, it is imperative, that processors properly monitorthe processed wastes. The best method for monitoring these wastes is to use biological indicate .which are standard commercial products routinely used to determine the adequacy of a sterilizav /process. The following biological indicators should be used in conjunction with the appropriateprocess during system adequacy testing:

1. Spores of Bacillus stearothermophilus for steam sterilization;

2. Spores of Bacillus subtilis variety niger (globigii) for dry heat, ethylene oxide,incineration, and chemical sterilization; or

3. Spores of Bacillus pumilus for irradiation.

For the purpose of determining if the wastes are properly processed or incinerated,there should be an absence of viable spores. The biological indicator must be strategically locatedin the center of the mass of the waste to be processed and the bags and containers must be opento allow adequate exposure during processing. Frequency of testing for biological indicators willbe on a case-by-case determination based on the practices and procedures proposed by the operatorof the processing or Incinerator facility. • •

The hospital surveyors employed by the Pennsylvania Department of Health will beevaluating your institution relative to the requirements discussed above beginning 3uly 1985. TheDepartment of Environmental Resources will be notified of noncompliance so that a joint enforcemenaction may be taken.

202637

-3* September 6,' 1.8.

It is hoped that this information adequately conveys Pennsylvania's Department ofHealth and Environmental Resources' position in this matter; however, if you have any furtherquestions, please feel free to contact either Department. The Department of EnvironmentalResources and the Department of Health may be contacted at (717) 787-6239 and (717) 787-5314,respectively.

Sincerely,

Donald A. Lazarchik, DirectorBureau of Solid Waste ManagementDepartment of Environmental Resources

1; r 3ennifeY Riseon, Director' '"" -. Bureau of Quality Assurance

Pennsylvania Department of Health

I#*'-.I . .* - - • •• t.;:?.. •t>g.r ' • • .-

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IE • ,ftR202668

APPENDIX 2

Module 1 Instructions

202669

AR202669

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.' ~* ' •' REQUEST FOR APPROVAL TO TREAT, STORE. OR DISPOSE OF AHAZARDOUS OR RESIDUAL WASTE STREAM

• ' . , . . . ' . - (Fora ER-SVM-14) : . - . . - .

IMPORTANT: Read ell Instructions careful 1 v to*form completing module and submit only en*wast* stream per module.

SECTION I - GENERAL INFORMATION - 8«lf explanatory.

SECTION II - WASTE DESCRIPTION

item A. G«n«r&1 Properties

*3. Describe the color and odor of the waste. (This cuestion is subjective.)For example, prey, solvent odor. Enter number of solid or liquid phases ofseparation and describe each phase. For example. 2 phases of separation.one sol Id and one 1iquld.

t*.. Provide the proper U.S. DOT shipping name. UN/NA number and hazard class forthe waste stream. For example, solvents, waste, n.o.s. (toluene. MEK.butane!). UN 1898. flammable.

te. a. Check yes if the waste stream is a hazardous waste as described in76.261.

b. If yes. describe the waste by its characteristic (T6.26l(o)l. the non-specific or specific source lists (7S.261(h)(2) and (3)). and/or thecommercial chemical product or manufacturing chemical Intermediatelists [75.2€1(h)(4)(v) and (vl)). List all the reasons which cause thewaste to be hazardous. For example, spent pickle liquor front steelfinishing operations.*K062. Corrosive (DOO2). and EP toxic (DOO7).

item B. Chemical Analyses

These analyses and tests must be performed for all treatment and disposalactivities except Incineration and thermal treatment. Activities utilizingsurface impoundments and wast* piles for storage are also required to performthese teats and analyses. Analytical requirements for Incineration and thermaltreatment can be obtained by contacting the Department.

•

All analyses submitted oust specify the method used and any special preparation.deviation from the method, or pertinent observations. The Method of standardAddition must be employed to take Into account interferences in the matrix of thesample. See CPA's Test Methods for Evaluating Solid Waste (SW-646) or Methodstor Analysis £f Water and Wastes <EPA-600/4-7g-O2O).

The laboratory performing the analysis must employ the quality control proceduresdescribed In EPA's Handbook for Analytical Quality Control jn Water andWastewater Laboratories (EPA €OO/*-7&-Otfi). The procedures and documentation ofthe quality control procedures Rtust be available for inspection 1f requested bythe Department.

<rl. Total Analysis of the Wast* -This analysis must include the following listof parameters (a-n) unless the generator certifies m writing the absence ofthe parameters based on his knowledge of the manufacturing or pollutioncontrol processes. Additional parameters. 1f necessary, nust be analyzed tocompletely characterize tti* wast*. Each analysis sheet must include: date

specified in clt*d wethod.'

No single analytical method 1s applicable for all waste streams ana somemodifications stay be necessary for unusual waste types. Any modification,however, oust be approved ty the Department.

~." ' ' . - •

If the sample Is of unknown origin or characteristics contact the Departmentat (717) 787-7381 prior to analysis.

a. Total Residue

1. Liquid - EPA-6OO/4-76-O20. Method 160.311. Solid • Sta. Math. J4 £D. Method 2O8 G. pp. 96-88

1. •

b. Total Dissolved Solids - Liquids Only EPA-6OO/4-79-O20. Method 16O.1.

c. Volatile Residue on Total Residue (from a. 1. above)

•1. Liquid - EPA-6OO/4-79-O2O. Method 16O.4

( 11. Solid - Std. Meth. 14 M, Method 2O8-a. pp. 96-98 rt^ __ r *f\.

*:'; d. PH ft£ffyt1. Liquid - EPA-6OO/4-79-02O. Method 150.1 "'

11. Solid - 4O CFR Part 25O (Mon. Dec. 18. 1978). Part IV.Appendix IV. Methods for Determining Soil PH. p.S9O22 reference:

jj~.. . "Methods of Soil Analysis* Part II Chemical ana Microbiological ' ,•"-"•'"'' Properties C. A. Slack Ed. (American Society of Agronomy). 1965. '-

e. Cyanide - EPA SW-846. Method 8r55• . •'•-• ,'x"

f. 011 and Grease , .

1. Liquid - EPA-6OO/4-79-O2O. Method 413.1

11. Solid - Std. Meth. .14 6d.. Method 5O2 D. pp. 519-520.

g. Ammonle-Nltrogen -..Liquids Only•EPA-6CO/4-79-O2O. Method 35O.1 or 350.2

h. Phenol1cs - Liquids Only EPA-6OO/4-79-O2O. Method 42O.1 or 42O.2

1. Total Metals - EPA SW-846, General Requirements. Method 8.49. and EPA-600/4-79-O2O. Metals (AA Methods). Section 2OO

1. Arsenic. EPA SW-846. Method S.sr

11. Barium. EPA. SW-846. Method 8.52

111. Cadmium. EPA SW-846. Method 8.53

1v. Chromium. EPA SW-846. Method 9.34

v. .Lead. EPA SW-846. Method 8.56 }

vl. Mercury. EPA SW-848. Method 8.57

vll. Nickel. EPA SW-846. Method ft.58

v111. Selenium, EPA SW-846. Method 8.59

1x. Silver. EPA SW-846. Method 8.60

x. Copper. EPA-600/4-79-O2O. Method 22O.1t

xl. Molybdenum, EPA-60O/4-79-O2O. Method 246.1

xll. Zinc. EPA-6OO/4-79-O20, Method 289.1

j. Organics - Wastes must b* tested for specific solvents, pesticides, orother organic constituents known to be used or produced as a product orbyproduct 1n the process that generated the waste stream. For methodsof analysis for specific compounds refer to 75.261 Table A. p.75.68 andEPA's Teat Methods for Evaluating Solid Waste (SW-846). or otherpublished procedures.' Other, methods or modifications may be acceptableIf approved by the Department. Contact the Department at (717) 787-7381 for such approval. . /

k. Heating Valu* .

1. Sol Id = ASTM Methods 02015. D3826

11. Liquid - ASTM Method 0240

1. Ignitability - Test as described in 75.261 or submit certification thatwaste is not Ignitable

m. Corroslvlty - Test as described m 75.261 or submit certification that v Jwaste 1s not corrosive. . ^-^

202671AR20267I

n. reactivity - i«sx asjoeacrtbea in /s.it>i or euoren certification tnaxwaste 1s not reactive.

*2. Leaching Tests • ; - ' - , • :To dewonstrete a wast* stream 1s or is not hazardous by EP toxlcltycharacter1sties, use the EP Toxlclty Extraction Procedure as described In78.261. Appendix II only for parameters listed in 78.261. Table 1. For

. codlsposat of a waste stream with municipal refuse, the EP ToxlcltyExtraction Procedure or the ASTM Method B Leaching Procedure may be used.For segregated disposal of a waste stream, either the ASTM Method A leachate

?4> or the EP Toxlclty Extraction Procedure leachate may be used. !f.w analyses•*• should be conducted on sampler. 1n the condition in wmch they uiytOfef*

treated, stored or disposed.'

The following constituents and parameters are required in the leachateanalysis unless they are not present in the total analysis, or if the totalanalysis of the waste Indicates leas than O.OO1 mg/kg or O.O1 mg/1 for agiven constituent or parameter, then that constituent or parameter need notbe analyzed. Report all results In mg/1 or as otherwise specified Inmethod. •"" ""-•'• : -' : ''•-' ...''. .a. pH - EPA-6OO/4-78-O20, Method 180.1 report"as pH units. .

b. Oil and Grease - EPA-6OO/4-79-O20. Method 413.1

c. Ammonia-Nitrogen - EPA-COO/4-78-O20, Method 350.1. or 35O.2.

d. Phenol1ca - EPA-6OO/4-79-020, Methods 420.1. or 420.2.

e. Cyanide - EPA SW-846. Method 6.65.

f. Total Metals - EPA SW-646. General Requirements. Method 8.48. and EPA-6OO/4-79-O2O. Metals (AA Methods). Section 200.

i. Antimony. EPA SW-646. Method 8.80

11. Arsenic. EPA SW-646. Method 8.81

111. Barium. EPA. SW-846. Method 8.82

iv. Cadmium. EPA SW-646. Method 8.S3

v. Chromium. EPA SW-646. Method 8.64

vl. Hexavalent Chromium. EPA 600/4-78-O20. Method 218.4

vll. Lead. EPA SW-846. Method 8.86

vl11. Mercury, EPA SW-846. Method 8.67

ix. Nickel. EPA SW-646.-Method 8.86

x. Selenium. EPA SW-846. Method 6.89

x1. Silver. EPA SW-846. Method 6.6O

X11. Copper. EPA-6OO/4-79-O20. Method 220.1

xlll. Molybdenum. EPA-6OO/4-78-020. Method 246.1

xlv. Zinc. EPA-600/4-78-020. Method 289.1

B- Organlcs - For methods of analysis for specific compounds, refer to78.261 Table A, p.78.68 and EPA'* Test Methods jFpr Evaluating -Sol 1dWaste (SW-646). or other published procedures. Other methods nay beacceptable if approved by the Department.

h. Total Organic Halogen'- Adsorption with •icrocoulemetrlc det*ctlon1. COD - EPA-60O/4-78-020. Method 410.1. or 410.4

J. TOC - EPA-6OO/4-79-020. Method 415.1

k. Total Volatile Residue - EPA-600/4-79-O20. Method 160.4

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IS3. Description of th* sampling method - The> procedure* outlined In Appendl«t I

of 79.261 must b* followed when sampling wast* stream*.

Item c. Process Description and Schematic - Plea** attach to thla module tha> foil owing:• ' . . ' £?A

*1. Confidentiality claim (if any) - Information submitted to th* Oepart*em..ln }thla portion or the- module may b* claimed a* confidential by the appWcam. ^^XIf no claim 1s mad* at th* tlm* of submission, th* Department shall make th*Information available to tne publ1C without further notice.

Clalma of confidentiality snail address th* following:

a. Th* porti-ons of the information claimed to be confidential.

b. The length of time the information is to remain confidential.

c. The measures taken to guard against undaslred disclosure of theInformation to others.

d. Th* extent the information ha* been disclosed to other* and th*precaution* taken m connection with that disclosure.

*. A copy of pertinent confidentiality d*t*rm1nations by EPA or any otherfederal agency. .

• 9

. * f. Tn* nature of th* substantial harrt to the comp*tltiv* position bydisclosure of.the information, th* reasons. It should b* viewed a*substantial and th* relationship b*tw**n th* disclosure and th* harm.

*2. Descrlb* th* manufacturing process which produced th* wast* and any 'pollution control methods involved. This must include th* raw materialsused m th* process, any Intermediate products formed, final products, andany substances adaed during treatment. For example:

•Resol Resin Manufacture*

•These resins are formed by reacting phenol, or a substituted pnenol withformaldenyde wnicn contain* an excess of formaldenyde. An alkali (sodiumhydroxid*) is used to catalyze th* polymerization whicn take* place at a pHof between a and 11 and at a temperature of SO'C. j

•When th*- d**lr*d degre* of polymerization ha* occurred, th* kettle iscooled to about 35*C to inhibit further reaction. Th* caustic may b*neutralized in th* kettle with sulfunc acid at this time. Th* water fromthis distillation forms a concentrated waat* of unreacted materials and lowmolecular weight r**1n.

•Th* batch 1* dumped, and depending on th* specific resin, tne batch may b*washed several times and a vacuum nay b* used during th* dehydration cycle.It 1* Important that molten resin b* handled quickly to avoid its setting upto an insoluble, infusible mas*, which would beeorn* a waste.*

'3. Provide, on 8 1/2* x 1-1* *1z* paper, flow schematics of th* manufacturingand/or pollution control processes generating th* hazardous or residualwaste stream starting with th* raw materials and ending with th* finalproduct*. For example:

Catalyst Phenol Formaldehyde

PI WeighI I Tanks

1

VacuumSystem

Condenser

ReactorRe-ceiver

Wastewater•*"Unreacted

Product Chemicals.__fc Off -grade

AR202673 Product Resi" 202673

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iECTION III - LINER COMPATIBILITY EVALUATION\ \ • . iLiner compatibility testing - any facility utilizing a liner must conduct an.evaluation of the liner compatibility with the waste stream before accepting thatwaste stream .for storage, treatment or disposal m a waste pile, surface Impoundment,or landfill, unless the approval to accept-that waste stream 1s granted In thefacility's permit. The evaluation procedure must be approved by the Department priorto its commencement.

The test protocol will vary with the type of liner system and tne characteristics ofthe waste stream. The Department should be contacted for appropriate test';crptocots.In lieu of actual testing, existing published or documented data on the hazarj uswaste or waste generated from similar processes proving the liner comoatlb^Vjlty may besubstituted in some Instances.

SECTION IV - PROPOSED TREATMENT. STORAGE. OR DISPOSAL METHOD

Use additional sheets of paper if necessary.

item A. Proposed Treatment Method - If applicable, briefly describe the methodproposed to treat this wast* stream. For example. "Solvent removed fromwaste by solvent recovery apparatus to less than 1% solvent. Recoveredsolvent 18 sold to XYZ. Inc. for reclamation. Solids are polymerized andthe renaming solvent Is driven off by heat.*

item B. proposed Stprage Jvethbd - If applicable, briefly describe'the methodproposed to store this wast* stream and the compatibility with Itscontainer, the wast* p11* liner, or the surface impoundment liner. For

' • example. *Pa1nt waste 1s placed into 65 gal. steel drums and Is proposed tobe stored at th* XYZ Wast* Disposal Company's storage building for 6O daysprior to processing. The paint waste is compatible with Its container andthe other wastes stored In the Immediate vicinity. The proposed locationfor the paint waste within the building Is indicated on the attacheddraw1ng.•

item c. Proposed Disposal Method - If applicable, briefly describe the metnocproposed to dispose of this waste stream. For example. 'Polymerized solidsare to be placed In a segregated cell of the XYZ Waste Disposal Company withcompatible wastes as indicated on the attached drawing. The cell is locatedat coordinates D-7. The cell design has been approved as part of thefacility permit.'

SECTION V. ALTERNATIVES TO PROPOSED TREATMENT AND/OR DISPOSAL METHOD

Item A. What Other Treatment. Disposal. Recycle, Reuse, or Reclaim'Method(s) Can beUsed? Briefly describe viable alternatives to your proposal.

item B. Why was the Treatment and/or Storage Disposal Method in Section III Chosen?Briefly describe why the proposed method was chosen. For example. "Theproposed method offers the most cost effective means of disposal over a10 year period. Capital investment of solvent apparatus and polymerizationequipment will be off-aet by Income from-sale of recovered solvent anasmaller volumes of waste to be disposed.*

SECTION VI. CERTIFICATION OF GENERATOR " '

The Application Must be Certified in the Following Manner:

*i. Corporations - A corporate officer must sign the document and the corporate sealmust be affixed.

'2. Limited Partnerships - A general partner must sign the document.

*3. All other partnerships - A partner taust sign the document.

*4. sole proprietorships •- Th* proprietor.ft. Municipal, state, or federal authority or agency - An executive officer or

ranking elected official rasponslbl* for compliance of the authority's.oragency's hazardous-wast* activities and facilities with all applicableregulations.

All signatures affixed to the document must be notarized.SECTION VII. CERTIFICATION OF REGISTERED PROFESSIONAL ENGINEER FOR TREATMENT. STORAGE. ORDISPOSAL'FACILITY - Self-Explanatory.

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!j||: APPEm)lx 3&;":'' Summary of 1982 EPA Infectious Waste Management Guidelines

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SUMMARIZED. *• .' ..

^ EPA Designation of Infectious Wastes*1*Mti-"——————————,"' "):•:. -r;-! The most rational approach to defining, infectious waste is to designate as infectious those?M^w wastes that in all probability contain pathogenic agents that — because of their type,pP- f concentration, end quantity — may cause disease in persons exposed to the waste. In the&€& "interests of clarity and for ease of reference, EPA recommends that 13 types of waste beI' .ll designated infectious wastes. This designation is based primarily on specific waste type$$$•'*- rather than on the source of the waste. Therefore, o particular type of infectious waste£-V. may be generated by different industries and by more than one source within a facility.jp'f '• ' • • •p;,./';". EPA has concluded that infectious wastes can be classified into 13 categories. Certain ofP'- these wastes (e.g., pathological wastes and sharps) are not necessarily always infectious,If but they are included in the list because they should always be handled in accordance with'p management practices that minimize the hazards and address the special problems of these'' wastes.

#£ EPA recommends that the following types of waste be considered infectious waste and that£# they be managed accordingly:

^_/ • isolation wastes• cultures and stocks of etiologic agents

: • blood and blood products• pathological wastes• other wastes from surgery and autopsy• contaminated laboratory wastes• sharps« dialysis unit,wastes •• animal carcasses and body parts« . animal bedding and other wastes from animal rooms• discarded biologicals

* • contaminated food and other products• contaminated equipment

Draft Manual for Infectious Waste Management - U. S. EnvironmentalProtection Agency, SW. 957, Sept. 1982.

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Isolation Wastes

Isolation wastes are those that ere generated by hospitalized patients who arcisolated in separate rooms in order to protect others from their severe andcommunicable diseases. These wastes contain pathogens that are shed by thepatients. It should be noted that the wastes from hospital patients who arc placedin protective isolation (i.e., isolation imposed only in order to protect these patientsfrom the diseases of others) are not infectious, and these wastes should be handledas part of the general non-infectious waste stream.

f2. Cultures and Stocks of Etiologic Agents

All cultures and stocks of etiologic agents constitute infectious wastes with aparticular hazard because the pathogenic organisms are present at high concentra-tions in these materials. Included in this category are cultures of specimens from

H v medical and pathological laboratories, cultures and stocks of etiologic agents from'•"* research laboratories and pharmaceutical companies, and wastes from the production

of biologicals and antibiotics by pharmaceutical companies (e.g., eggs used in theproduction of vaccines).

3. Blood and Blood Products

The principal hazard in blood and blood products (e.g., plasma, serum) is the possiblepresence of the hepatitis agent. Less common are the pathogens of other diseases(malaria, congenital rubella, disseminated neonatal Herpesvirus hominis. dengue,smallpox, Lassa fever, Marburg virus disease, yellow fever, and Colorado tick fever)in which the etiologic agent circulates in the blood. Hospitalized patients with thesediseases are placed in isolation, and the Centers for Disease Control recommendsthat blood precautions be taken with these patients "to prevent acquisition ofinfection...from contact with blood or items contaminated with blood". Even thoughblood samples are often tested in the laboratory, it is impractical to test for thepresence of all infectious agents. In addition, a negative hepatitis virus test, bycurrent technology, only demonstrates that the viral concentration is below the limitsof detection. Therefore, all waste blood and blood products should be managed asinfectious waste regardless of test results. Hospital and medical laboratories, bloodbanks, dialysis centers, and pharmaceutical companies generate wastes in thisinfectious waste category.

4. Pathological Wastes

Pathological wastes consist of tissues, organs, body parts, blood, and body fluids thatare removed during surgery and autopsy. Pathological wastes from patients withinfectious diseases should be* managed as infectious waste because of the probabilitythat these wastes contain pathogens. However, it is prudent to handle allpathological wastes as infectious because of the possibility of unknown infection~mthe patient or corpse — it has been reported that pathogens are consistently removed-from the bodies of people who were certified as. having died of causes other

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infectious diseases. Furthermore, there arc also other considerations (e.g.,aesthetics) that affect practices in pathological waste disposal. The best andsimplest procedure is to manage all pathological wastes uniformly. Pathologicalwastes are usually generated in -hospitals in the operating rooms, pathologicaldepartments, autopsy departments, and laboratories.*

P 5. Other Wastes from Surgery and Autopsy

The surgery or autopsy of septic ("dirty") cases or patients with infectious diseases: generates waste that may be contaminated with pathogens from the patient, andi: these wastes should be managed as infectious waste. Wastes in this category include

soiled dressings, sponges, drapes, casts, lavage tubes, drainage sets, undcrpads, andsurgical gloves. The American Hospital Association recommends that all surgicaldressings from patients should be regarded as contaminated whether or not clinicalevidence of infection is present. Because of the possibility of unknown disease, itwould be prudent to manage as infectious all wastes from surgery and autopsy thathave been in contact with patient tissues, blood, body fluids, secretions, andexcretions.

Contaminated Laboratory Wastes

Contaminated laboratory waste refers to the wastes that were in contact withpathogens in any type of laboratory work — e.g., in medical, pathological,pharmaceutical or other research, commercial, or industrial laboratories. Thevariety of wastes in this category includes culture dishes; devices used to transfer.inoculate, and mix cultures; and paper and cloth items that were in contact withspecimens or cultures. Wastes from medical and pathological laboratories that aregenerated in the process of culturing patient specimens pose a special hazard becauseof the prevalence of resistant strains of microorganisms that have developed in

^ . hospitals and other institutions. Table 1 lists contaminated wastes that arc• :?', frequently generated by medical laboratories. Contaminated wastes from the•L culturing and handling of pathogens in research, commercial, and industrialJ..| laboratories should ajso fee-managed as -infectious waste because they are usually|.i, contaminated with etiologic agents from pure cultures, often at high concentrations.

or-. . . - . • - • - -!*•"' ; In addition, there are the wastes that are generated in research and industrialI applications of various biotechnologies (including recombinant DNA). For example,

biotechnologies ere utilized in vaccine production, fermentation biology, cell biologyjy£ and virology, microbiology, and other aspects of applied biology and applied

';•>/• microbiology. At this time there is divergence of opinion among experts in the field:|; about the extent and degree of the potential hazard posed by these wastes.

•*,£..? Therefore, in the interests of safety, all biotechnological wastes — that is/fromresearch work as well as from commericial production — should be managed as

'! infectious waste. * '3! f r'':'1

practices in this country provide sufficient containment to prevent dispersalof Vlable Pathogens into the environment. Because of the long period of time thatwould elapse before disintegration of both the outer container (or vault) and thecaskct, it is highly unlikely that pathogens from the cadaver would still be viablewhen dispersal would be possible.

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TABU- 1

COMMON CONTAMINATE) WASTKS FROM Ml-DICAL LABORATORIES

Culture dishes

Pipettes

» > Syringes and other sharps

Tissue culture bottles and flasks

II Membrane filters in plastic dishes,_;•&. •»Hf;* Collection bottles, cups, and tubes from specimens of blood, urine, feces, saliva, cxudatcs,I'K, or secretions

I-i&I {.. Micro-titer plates used for hemagglutination testing, complement fixation, or antibodyIB'I liter.•3:S'.i|v Slides and plates from immunodiffusion testing

• T Slides and cover slips from blood specimens or tissue or colony picking

Disposable rubber gloves, .lab coats, and aprons

£ Swabs, capillary tubes, and spreaders used to take or transfer samples containing pathogens

I Tubes, cards, tabs and assemblies used for diagnostic purposes to speciate enteric or otherpathogens

Centrifuge tubes

Reprinted from Laboratory Management, 16(6): 37-44. 1978.> A -

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A special source of contaminated laboratory waste is the maximum containmentfacility. (Under accepted laboratory practices and the proposed biosafety guidelinesprepared by the Centers for Disease Control and the National Institutes of Health,certain levels of containment should be instituted to protect the laboratoryemployees, the general public, end the environment from the etiologic egents thatarc used in these experiments. (In the United States, containment or biosafety levelsare designated 1 through 4 or PI through P4, with level 4 denoting the greatestdegree of containment. The facilities that provide these levels of containment areknown es the basic laboratory, containment facility, high containment facility, andmaximum containment facility.] The specific biosafety level that is appropriate fora particular experiment depends on the type of etiologic agent involved, itsconcentretion end quantity, end the types of laboratory procedures that ere used.)Wastes from the maximum containment facility consist of laboratory wastes.laboratory waste water, and effluents from showers and toilets. (Wastes from otherlevels of containment facilities can be classified in the various other categories ofinfectious wastes — e.g., stocks and cultures of etiologic agents, sharps — and shouldbe managed in accordance with the recommendations for those types of waste.)

7. Sharps

Discarded sharps (c.g., hypodermic needles, syringes, pasteur pipettes, broken glass,scalpel blades) present the double hazard of inducing disease and inflicting injury.The disease potential is great if the sharp was used in the treatment of e patientwith en infection or infectious disease; however, even with apparently healthypersons, there is always the possibility of unknown hepatitis. Other contaminatedsharps are generated in the inoculation of people or enimals. All sharps also posethe hazard of physical injury through cuts or puncture wounds. A typical injury ratefrom sharps is 15 per month for a 475-bed hospital with an average cost of $ 65 perinjury. With good management practices, the hazards of disease and injury fromsharps can be minimized. All waste sharps should be managed uniformly inaccordance with the practices established for infectious sharps.

8. Dialysis Unit Wastes

This category of infectious wastes consists of wastes that were in contact with theblood of patients undergoing hem'odialysis at hospitals or independent treatmentcenters. These wastes are classified es infectious because of the high rate ofhepatitis among these patients. The wastes in this category include disposabledialysis equipment such as tubing and filters end other wastes such es sheets." towels,gloves, aprons, end lab coats. Sharps from dialysis units should be managed inaccordance with the practices Tor all sharps.

9. Animal Carcasses and Body Parts

This infectious waste category includes the carcasses and body parts of ell enimals'•that were exposed to pathogens in research or were used in the production of

202680-5-

biologicnls or in Ihc in^vivo testing of pharmaceuticals as well us thojte Hint died ofknown or suspected infectious disease.*

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Animal l_cddinj.!f__«i«l Other Wastes from Animal _Kooms

AninuiT bedding .and other wastes that were in contact with diseased and laboratoryresearch animals (as described in <) above) or llxjir secretions, excretions, carcasses,or body parts probably contain path6gens shed by these animals.* For this reason,these wastes arc designated as infectious.

•

I. *v. Discorded Biologicals

This infectious waste category is designated for waste biologicals (e.g., vaccines)produced by pharmaceutical companies for human or veterinary use. These productsmay be discarded because of bad manufacturing lot (i.e.. off-spceification materialthat docs not pass quality control or that is recalled), out-dating, or removal of theproduct from the market. Because of the possible presence of etiologic agents inthese products, the discarded material constitutes infectious waste. It should benoted that wastes from the production of biologicals arc included in other infectiouswaste categories such us stocks and cultures of etiologic agents, sharps, and animalcarcasses.

Contaminated Food and Otticr Products

Food and other products that are being discarded because of contamination withetiologic agents arc infectious wastes. Examples of wastes in this category are

.;.;" contaminated foods, food additives, cosmetics, and drugs. In addition, canned food' .. that is recalled because of the danger of botulism resulting from the presence of thei toxin of the Clostridium botulinum bacterium should be managed as infectious waste';• in order to prevent exposure to the toxin, dispersal of the toxin in the environment,

and access to the contaminated food.

13. Contaminated Equipment'•'• /Equipment and equipment parts that arc contaminated with etiologic agents and arc

to be discarded constitute a category of infectious waste. These wastes includeequipment that was used in patient care, in medical laboratories, in research withctiological agents, and in the production and testing of various pharmaceuticals.Another example is the HEPA filter that is sued in biological safety cabinets and inthe ventilation systems of biological containment facilities — if the filter is notdecontaminated in situ, it should be handled as infectious waste.

Another factor that should be taken into consideration is the prevalence of zoonoticdiseases (i.e., diseases transmissible from animals to man) in animal colonies (secTable 2). Nearly 200 zoonoscs have been identified, and animals or animal tissuesarc probably involved in 30% to 40% of laboratory -acquired infections. Experts inthe biosafety field recommend that it may be prudent to regard alj laboratoryanimals — those used in research of infectious diseases as well as apparently healthylaboratory research animals — as infectious, and ulso to manage their carcasses,excretions, secretions and bedding as infectious waste.

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TAlil.1-: 2

IMPORTANT X.OONOSKS

iii U.S.;'';V- Aniiiiul Srv«-ritv

ornitliosisturkeys. Ncwoiistlc discqscJnfvincsc quail equine onceptwloftiyclitis

siilmoncllosis

lymphocytic choriomcntngitisluimstcrs. enccphiilomyocarditis

pigs Icptospirosis

KiibMls tulurcmin . .<**

Opossum, skunk, rabies «•• ; <•»+fox Icptospirosis •» ' *•»

Cats toxoplasmosis ++ 44cat scratch disease * 4ringworm +•» *

Dogs rabies . * 44*Icptospirosis 4 **visceral larva roigrens 4+* *(Toxocara ennis)

Cattle, sheep looping ill 4 +-.goals, pigs Q-fevcr 4 4

anthrax 4 <tuberculosis 4 44brucellosis 4 44listeriosis 4 4contagious cothyma 4 4ringworm - 44 4vesicular stomatitis 4 «cow pox 4 4

f erysipelas 4* .»«Icptospirosis •• *

Nonhumun tuberculosis ** «••primates hepatitis 4 <•»

Marburg viral disease 4 .*<xalmonellosis 44 4shigellosis 444 44Herpes sitniae infection 44 444

molaria 4 44yaba end tanapox * 4measles *+ 4ameblasis. ^ " + ^ • **SV 40 i *4 *rabies • 4 *44

' Courtesy of R. A. Criescmcr and J. S. Manning. "Animal Facilities." in Biohnzards inBiological Kcscnrch. A. Hcllmnn, M. N. Oxman. and R. Pollock, cds.. Cold Spring Harbor

ii liborutory, <:old Spring H«rtx>r. New York. 1873.

'v> •* Low frequency or degree of severity.44 Moderate frequency or degree of severity.**4 nigh frequency or degree of severity. ^ n202682

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