Q&A with Dan Scungio, MT(ASCP), SLS, CQA(ASQ)
Laboratory Safety Officer
Medical Lab Management: As we are now over a year into the COVID-19 pandemic, how has lab waste been impacted over the last 12 months?
Dan Scungio: While there were several new COVID-19 testing platforms (PCR and otherwise), their introduction did not create any new waste streams. Individual laboratories may have had to figure out disposal for new chemicals they did not utilize previously, such as leftover reagents from molecular PCR testing. However, assuming that the facility already had a chemical waste vendor, any new or altered waste would be negotiated through that vendor. Other testing platforms may have introduced more sharps waste due to increased use of pipette tips or other waste items produced through the utilization of existing analyzers.
MLM: Were established waste streams altered by the course of the pandemic?
Scungio: In some locations, lab waste streams were affected, particularly involving personal protective equipment (PPE) (or the lack thereof). Conservation and reuse of some disposable PPE became necessary because of supply shortages, and that may have reduced the biohazard waste output in some labs. Conversely, increases in chemical waste may have occurred due to rapid on-boarding of new testing that included additional reagents and chemicals not previously used. In the latter case, the lab would follow the same process for identifying that waste and routing it appropriately (see FIGURE 1).
MLM: With blood donations down in 2020, have you seen initiatives to conserve blood supplies and blood products, or reduce wasting of these products?
Scungio: In 2021, new process improvement monitors have been put in place in our organization to track blood product waste. This was done in order to establish a baseline so that as we move forward, we can establish goals and metrics for managing this important process. At the onset of the pandemic, blood product usage went into a steep decline, but those numbers rebounded within just a few months. As hospitals began to resume certain operations while co-managing COVID, surgery volumes increased and so did usage, accordingly. However, due to a large decrease in blood product donations throughout the pandemic, there remain certain restrictions from the American Red Cross (a major blood product supplier) as they face challenges to keep up with the demand.
MLM: Has an effort been made to change ordering patterns or other practices to reduce waste?
Scungio: In our organization there is an ongoing, concerted effort to change how physicians order blood. After careful review and with a goal of reducing both blood product need and waste, one initiative was to update our order sets to default to a single unit, instead of two or three, which was traditionally the case. This process change helped reduce the number of units needed in stock and the amount of work needed to prepare blood products for transfusion in the lab.
MLM: How can the different disciplines in the clinical lab work together to mitigate waste and improve safety?
Scungio: The best way to mitigate waste and improve safety is to emphasize and practice proper waste segregation. Mixing wastes is sometimes done in departments for convenience only, not because it is a best practice. However, this “simple” approach is far more expensive and creates an unnecessary environmental burden.
MLM: What are some typical areas in which labs struggle to maintain proper waste streams?
Scungio: Labs typically struggle with the misplacement of waste into incorrect receptacles. Often, this is either because the correct receptacles are not conveniently located, or staff simply has not been properly trained. Thorough monitoring of staff and training can help overcome these issues (see FIGURE 2).
MLM: What resources do laboratory directors have to assist in implementing waste reduction strategies?
Scungio: Lab leaders should update or create a waste management plan to clearly determine the lab’s specific waste streams and apply appropriate risk reduction strategies. There are numerous resources available for guidance from a range of sources such as the US Dept of Labor, OSHA, the US Dept of Transportation, The Joint Commission, and others, including:
MLM: As the pandemic abates, what lessons can laboratories learn from to ensure ongoing, safe waste handling operations?
Scungio: Continued training and monitoring of waste programs will only increase in necessity and as we emerge from the COVID pandemic, new strategies for reduction should be sought. During the pandemic, some services were severely limited, so labs should learn from that experience and formulate a plan in the event that a waste handling vendor were to suddenly become unavailable. This is a solid addition to the laboratory’s overall emergency management plan.
Daniel J. Scungio, MT(ASCP), SLS, CQA(ASQ), has over 25 years’ experience as a certified medical technologist. He worked as a laboratory generalist in hospitals ranging from 75 to 800 beds before becoming a laboratory manager, a position in which he served for 10 years. Dan is now the laboratory safety officer for Sentara Healthcare, a system of more than seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. As “Dan the Lab Safety Man,” he also serves as a professional speaker, trainer, and lab safety consultant. Dan received his BS in medical technology from the State University of New York at Buffalo.