Here’s a hilarious story of a preceptor orienting a new grad to the finer points of medical waste management.
Follow Katelin through her shift as she learns an important nursing skill:
Knowing What to Put Where
Should you use the yellow container for biohazardous dressings ? The black one? Definitely the red container for sharps. What’s the black container for again?
“Hazardous medical waste has to be placed in special containers by highly trained medical professionals such as ourselves and then hauled to a special regulated waste management plant in Utah by long-haulers certified to drive semi-trucks containing medical waste. Where it’s incinerated. Or autoclaved. Or something.”
“Our hospital can be fined $500,000,00 dollars for violating federal waste management laws. Which will be deducted from your paycheck in small but regular payments if you mess up.”
Katelin: <responds excitedly > “I know, it’s about social responsibility and embracing the planet and..”
Preceptor: “No. It’s because we live in California.”
Preceptor: “OK, then. You have 3 containers to pick from. Red, yellow, or black. Sharps, biohazarad, or RCRA. Pick the right one. So. Got that?”
Lying, Katelin nods “Yes”.
Scenario: Katelin is passing meds and has just removed a small, used nicotine patch from her patient. She is going to replace it with a new one. She moves towards the trash can in the room to dispose of the patch. Preceptor enters the room.
Preceptor: “What exactly is going on here?”
Katelin: <enthusiastically> “I’ve been educating my patient about Smoking Cessation and wellness-”
Preceptor: <interrupts>” Are you throwing that used nicotine patch in the trash?”
Katelin: <freezes>”Umm..yes ?’
Preceptor: “That is a NICOTINE patch!! It contains NICOTINE. NICOTINE is P-listed.”
Katelin:< appears horrified, and holds the offending 2 cm patch in mid-air, arms length away from her body > “It’s P-listed??…”
Preceptor: “P-listed hazardous drugs go in the black container for RCRA waste. Do you want to be responsible for the infertility of the High Desert Dwelling Spotted Brown Lizard?”
Katelin: “Ewwww, I hate lizards. What’s RCRA?”
Precptor: “No one knows. It’s a government thing. Stay focused, please.”
Scenario: It’s later in the day and Katelin has just successfully completed a complex dressing change with a lot of blood-soaked and saturated material. She has re-positioned her patient, cleaned up the room, neatly placed all her biohazardous waste in a red bag and tied it securely per policy. She has followed the Bloodborne Pathogen Standard to a t. She is now leaving the room, red bag in hand.
Preceptor: <hands on hips>”Please tell me what are you doing.”
Katelin : <meekly> “Um, well, this leak-proof, sealed red bag is full. I’m taking it down to the soiled utility room for disposal?”
Preceptor: <incredulously>”You mean to tell me you are just going to walk out of the room and down the hall Carrying. A. Red. Bag?
Katelin: <hides red bag behind her body>”Um, yes? I mean, no. No. I would never do such a thing.”
Preceptor: <enunciates slowly>”You cannot just carry a sealed, outwardly clean, impervious red bag down the hall. Please. Think of the ecosystem.”
“You have to put it in a secure, rigid and labeled container for transport to the soiled utility room which is 5 feet away from us down the hall.<sigh> Do they teach you nothing in nursing school nowadays?”
Katelin: “So I need a container to hold a container to walk down the hall?”
Preceptor: “Precisely. And don’t let me catch you wearing gloves outside the patient’s room.”
Scenario: Katelin has administered chemotherapy to her patient. She is double gloved, and is wearing a full face shield, special blue gown, and booties. Katelin has done her homework and knows that the bodily fluids of patients receiving antineoplastic drugs are carcinogenic and must be handled with Special Precautions. She places the used IV tubing and empty IV bag in the yellow waste container.
Preceptor: <nods approval> “Good job. IV tubing is trace chemotherapy waste. Trace chemotherapy waste goes in the yellow container.”
“Unless of course, it’s greater than 3% in volume, in which case it’s bulk chemotherapy waste, which is RCRA waste. Remember, we talked about that.”
“Let’s not ever confuse hazardous non-RCRA pharmaceutical waste with hazardous pharmaceutical RCRA waste, alrite?”
“Because then we’re talking black container, not yellow. Whole different ball game.”
Katelin:<nods, encouraged, and holds up a full urinal from patient receiving chemo Proudly asks preceptor>”How should I best safely dispose of a liter of this poison urine brimming full of carcinogenic metabolites ?”
Preceptor: <looks up and shrugs>”Flush it down the toilet, why?”
Until next time, friend
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