Written by David Skinner
16 Sep 2020

A New Normal in Chemotherapy Waste Management

It took the environmental disaster of syringes and medical waste washing up on the shores of Connecticut New Jersey in 1987 to shine a much needed national spotlight on the need for federal governance of regulated medical waste management. In 2020, COVID-19 is the new “syringe-tide”, an awakening to healthcare that current medical waste handling and disposal protocols are not adequate enough for minimum safety, environmental and infection control protocols. In the area of trace chemotherapy waste management, current practices in hospitals and cancer centers across the United States threaten not only the environment, but also our healthcare workers on the front-lines of patient care.   


Risks in the Handling of Trace Chemotherapy waste

Trace Chemo waste continues to grow in terms of volumes across the USA and along with it the risk to healthcare workers who are handling and disposing of it on a day to day basis. Decades ago even when it was acceptable that most medications could be flushed down the drain, waste chemotherapy drugs were categorized as hazardous. Why? Because ultimately most chemotherapy drugs are cytotoxic – i.e. they kill cells! Whether in a bulk liquid aqueous form or trace residue, chemotherapy substances are harmful to humans and the environment and need to be managed with strict clinical oversight.

Methodologies and technology to manage and dispose of the waste have virtually remained unchanged in the last 10 years with the continued adoption of disposable containers and, in some cases, cardboard boxes for the collection, transportation and disposal of the infectious waste stream. Beyond the visual image of a cardboard box collecting waste in our living rooms or, in parallel, in an infusion bay… here’s a few clinical pointers why this is simply “not ok”:

  • Assembly and disassembly of containers puts clinical and EVS staff at risk of infection-transfer  
  • Cardboard boxes are prone to leakage and infection risk
  • Manual tying of bags containing chemotherapy contaminated items incites cross-contamination risk 
  • The lack of distinction between sharps and soft waste disposal puts clinical staff at risk of needlestick injuries
  • In transport, the lack of closure, leakproof seals, and hands-free contact puts downstream service staff at risk


And this is without mentioning environmental impact… one Daniels reusable clinically-designed chemotherapy waste container replaces over 800 disposable plastic containers and 800 yellow plastic bags being sent to landfill!



What does Chemotherapy waste handling look like in the modern clinical era?  

For starters… it approaches waste management from a clinical risk perspective rather than a “waste pickup” perspective… what are the safety and infection risks that clinical staff are exposed to? Let’s start there…


Daniels Health has innovated the world’s first clinically engineered Chemotherapy waste container designed for the clinical environment. And when we say “clinically engineered” we don’t mean that we have taken a mobile garbage bin for household recycling, removed the funky recycling symbol and manufactured it in yellow!!! We mean, a container designed in partnership with clinicians to achieve safety and clinical outcomes in a hospital or cancer center in the disposal of trace chemotherapy waste.

  • The Daniels Health Chemosmart eliminates the double handling and packaging required with old fashioned disposable containers with efficiencies that will reduce clinical staff and EVS staff time in managing and moving the waste through the facility.
  • Infection Control and Healthcare worker safety are key contributors to managing Trace Chemo waste, and the Daniels Health Chemosmart system provides benefits in both areas,
  • Handsfree operation reducing any potential infection transfer risk
  • Mobile systems allow the containers to be as close as possible to the point of generation
  • Reusability eliminates labor required to assemble and package for transportation
  • Dual containers provide on the spot segregation of PPE and Sharps, reducing risk for staff handling the waste



Let’s Deep Dive… What Clinical Outcomes does the Chemosmart deliver to a healthcare facility?
The Daniels Chemosmart provides a safe and efficient method for disposing of waste, enabling not only a “no-touch” design that eliminates infection transfer risk but also:

  • No bags, no leakage, no cross-contamination
  • Secure, tamperproof and lockable container design eliminates unauthorized access to contents
  • No-touch design means no manual touching of the container or lifting a lid
  • Sensitive activated safety tray eliminates needlestick injury risk 
  • Stable design minimizes tipping risk with supporting accessories that mount the container in place
  • Clear color-coded segregation of trace vs bulk chemotherapy waste improves compliance
  • Substantial cost savings from the removal of 33% upwards of plastic from the chemotherapy waste stream
  • After every container fill, the Chemosmart undergoes an 8-stage robotic washing process that achieves a level of deep clean decontamination and sanitization 4 times higher than that required by the CDC


Daniels Health has provided these benefits to a multitude of healthcare facilities across North America with its Chemosmart system implementation and has delivered substantial waste savings through the elimination of disposable waste containers, reduced disposal risk with chemotherapy and sharps waste disposal at the point of waste generation, and segregation-induced compliance and costs optimization.


Efficiencies of Segregating Chemotherapy waste at Point of Waste Generation

The use of Daniels Health Chemosmart system allows chemotherapy containers (the CT22 for sharps devices and the CT64 for soft-contaminated chemotherapy waste) to be maneuvered to the point of waste generation, thereby providing an infusion-bay appropriate segregation model for waste generated from cancer treatment. Mounted side-by-side on a mobile apparatus, the Daniels suite of Chemotherapy waste containers cater for waste disposal as follows:

  • Sharps with trace amounts (less than 3%) of chemotherapy drug residue to go into a CT22 container
  • Soiled PPE, USP800 classified waste, IV bags and tubing or suction cannisters contaminated with trace amounts of chemotherapy waste to be disposed into a CT64 container

Through the clear point-of-use disposal of both sharps and soft waste into puncture-proof containers at patient bedside or in an infusion bay, the risk of intravenous skin puncture for healthcare workers is dramatically reduced, the temptation to “push more waste into a container” is mitigated via the Chemosmart’s “maxiumum-fill-level” design, and both clinical and EVS staff are protected in the disposal and decanting of waste, and the movement of containers,




How Clinical Container Design supports improved waste segregation

Beyond the aesthetic appeal of having a clinically appropriate container for waste collection in a patient-care setting, Daniels Health has proven time and time again that smart container design can support both compliance and waste segregation goals. Some of the aspects of the Chemosmart container design that encourage more thoughtful waste disposal include:

  • Lid must be activated by foot pedal to open
  • Smaller opening / disposal aperture
  • Ability to position the container at point-of-waste generation
  • Color differentiation and clear labelling on the top and base of the container
  • Container Design differentiation interrupts habitual mentality of ‘bin = trash’
  • Ability to co-mount containers on a mobile trolley for dual-waste-stream segregation


All of these aspects of the container design force the user to think before act. There is no open lid that you could just throw waste into when passing by, you have to consciously activate the container to use, and visually the Chemosmart is a clinically-engineered device that is fit for a specific purpose. Learn how one hospitals’ use of a Daniels container resulted in a 65% decrease in medical waste containers.  


Read the Case Study



A New Minimum Benchmark of Safety and Infection Control in Chemotherapy Waste Containment is Needed

Decontamination protocols, infection control and hygiene in a hospital are largely concentrated on PPE precautions, sterilization of hospital equipment and hand-washing – and all these things are critical to maintaining a minimum standard of infection control in a healthcare setting. What is not looked at however is hygiene considerations around medical waste management:

  • How often are your containers being cleaned?
  • How many times is the waste touched in the waste or bin handling process?
  • If located permanently in a patient setting, who is responsible for cleaning bins?
  • Is there a risk of infection spread through spills and cross-contamination from dirty bins?  


Chemotherapy and medical waste bins are often situated in some of the most critical patient areas of a hospital including the ICU or OR’s and yet while everything else in the environment is routinely sterilized – medical waste bins are overlooked.



An integrated container system designed to reduce spread of infection

Daniels’ Chemosmart is designed not as a “container” but as a system. Daniels’ accessory and logistical solutions ensure the container will never touch the ground (in transport, internal hospital movement or when in position-for-use), each container undergoes a washing and sanitization process after use that achieves a 106 log bacterial kill, and its interchangeable mounting accessories enable the container to be positioned at point-of-waste generation, eliminating cross-contamination risk.

A New Normal requires a level of cleanliness and hygiene around healthcare waste management that is above and beyond the standard today. We at Daniels are passionate about reforming safety and infection control practices around healthcare waste collection, minimizing touches, minimizing patient interruptions and minimizing risk exposure to frontline healthcare workers. To understand how the Chemosmart could take your oncology center or hospital into a new modern era of Trace Chemotherapy waste collection, reach out to us today.


Header Style: 
David Skinner

David Skinner

Executive VP - Sales

With over 20 years experience in healthcare and a genuine passion for reinventing the medical waste model of our era to achieve higher infection control standards, David is a walking almanac or, as we call him, the "skinnerpedia" of clinical knowledge.