Disposal of Filled Blood Bags by Autoclaving - SOP

Document Number: 529

The purpose of this SOP is to standardize the specific procedures to be used for the facility. This
document should be customized to meet your facility’s needs.

1. Purpose
This procedure covers the correct handling, treatment by autoclaving, and disposal of filled
blood bags that have been discarded as waste.

2. Scope
Blood bags are used for collecting blood donated for transfusing patients. Once rejected for use
(contaminated, incorrect typing, in excess of requirements or expired), the bags and any blood
will need to be treated prior to disposal to reduce any potential for infection. Donated blood
that has been checked for infectious agents prior to issue and found safe can be considered safe
for discard to closed sewer for subsequent treatment, such as provided in a wastewater
treatment works, a septic tank or biodigester (Refer to Doc 521: Sanitary Sewer Disposal of
Liquid Laboratory Waste —Guidance).
In some countries, where the blood donor screening and testing is not thorough enough to
ensure that all blood supplied for transfusion or used in health care may be considered
noninfectious, all waste blood products should be considered hazardous and treated as
infectious waste. The discarded filled blood bags will need to be disinfected prior to disposal, to
prevent the spread of disease.
If blood is known to be contaminated, it will require disinfection prior to disposal and
autoclaving is the recommended treatment method.
Because blood bags are usually made from the chlorinated plastic PVC (polyvinyl chloride), they
should not be incinerated, due to the generation of dioxins and furans during the burning
process. These toxic compounds cause cancers even in low concentrations. In addition, where
the incineration devices are basic, the burning bags may leak, which will create a hazard in the
vicinity of the incinerator. Autoclaving is the preferred option for treatment of blood bags.
Another option is discharge to a closed sewer connected to a waste treatment facility (such as
wastewater treatment works, septic tank or biodigester). Small-scale incineration without air
pollution control devices may be considered as an interim solution until suitable alternatives
have been developed.

3. Definitions
Refer to Document 522: On-site Treatment and Disposal of Blood Transfusion Products –
Guidance.

4. Responsibilities
4.1. This SOP refers to all personnel who are trained and authorized to handle discarded
blood bags.
4.2. All training must be documented, updated regularly and filed by the responsible person.

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 4.3. The person using a blood bag with a needle, once the pack is ready to be discarded, must:
 Tie the tube above the needle.
 Ensure any residual blood is pushed back into the bag.
 Cut the needle off the tubing below the knot, discarding it in the sharps container.
 Empty any residual blood down the drain, if the blood has been assessed to be non-
infectious and the drain is closed, discharging to a treatment facility (refer to the
requirements of Doc 521: Sanitary Sewer Disposal of Liquid Laboratory Waste —
Guidance).
4.4. The person authorized to accept waste blood bags for treatment prior to disposal must
ensure that:
 Where present, the needle has been removed – any incidents of nonconformance are
immediately communicated to the department manager for action, to prevent a
recurrence.
 Only residual liquid remains in the bag, unless the blood has been considered
infectious, requiring disinfection in the bag prior to disposal.
 All blood bags (empty or full) are autoclaved and not incinerated.
 The autoclave cycle used has sufficient exposure time to disinfect dense liquids like
blood.
4.5. The department manager is responsible for:
 Ensuring that waste blood bags are responsibly handled and treated, prior to disposal.
 Ensuring that action is taken to solve any reported problems.

5. Materials and Equipment

 Sharp pair of scissors – to cut the needle off the tubing on a waste blood bag.
 Access to the drain for disposal of any residual or expired, clean blood.
 Autoclave – for disinfecting waste blood in bags.
 Labeled containers for storing waste blood bags at the place where they are used.
 Reusable autoclave containers in which to place blood bags or packs, to contain any liquid
that may leak from ruptured bags.
 Appropriate PPE. When handling blood or blood products, always use:
o Eye protection (safety glasses or goggles) to protect against blood splatter.
o A mask to prevent breathing air-borne pathogens.
o Gloves to protect your skin from spills or leaks.
o Laboratory coat or other protective clothing to protect your upper body from spillages.
o Closed shoes.

6. Hazards and Safety Concerns

6.1. Always
 Wear appropriate PPE (see section 5).

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  Use the precautionary principle – if the hazard is unknown, assume the worst - only if
the blood or blood products are shown to be uncontaminated, may you assume that
they are not hazardous.
 Protect cuts or skin abrasions by using a plaster to close the wound.
 Wash your hands with soap after handling blood or blood products.
6.2. Infectious waste
The hazard arises from blood or blood products that may be contaminated by pathogens.
Contaminated blood should not be disposed of to drain unless there is no other option.
Remember that if the drain or sewer becomes blocked, the maintenance personnel or
plumber will have to manually clear the debris, which puts them at risk from exposure to
pathogens too. They will also need to take steps to prevent exposure to infectious
organisms.
6.3. Sharps
If there is a needle present, make sure that it is discarded as sharps waste and not left
attached to the blood bag. In removing the needle from the blood bag, make sure that you
cannot be spattered by blood or allow the blood to leak out and spill.

7. Procedures
7.1. Preparing for treatment
7.1.1. For blood bags with contaminated contents or those considered potentially
infectious, ensure all the liquid and the containers are sent for autoclaving to
disinfect them prior to disposal.
7.1.2. For blood bags with an attached needle, once the blood bag is ready to be
discarded:
 Tie a knot in the tubing above the needle.
 Drain the blood in the tube back into the bag, using a pen or other suitable
device, rolling it along the tube to move the blood.
 Cut the needle off the pack and dispose of it in the waste sharps container.
7.2. Loading the blood bags in the autoclave
7.2.1. Load the blood bags in single layers in reusable, leak-proof secondary containers
to ensure the steam is able to heat the liquids effectively, and to contain any
material that leaks from the bags, which often burst during autoclaving.
7.2.2. Where only a few bags (fewer than five) are required to be autoclaved at any one
time, these may be loaded with other infectious waste for treatment. It is best to
use a “liquid cycle,” which is usually one of the program options on electronically
controlled autoclaves. This has an extended exhaust stage to prevent liquids from
bubbling out of containers as the pressure reduces. This slow exhaust stage will
provide sufficient time to allow the bags to hold the required temperature long
enough for disinfection.
7.2.3. For situations where routinely many blood bags at a time require autoclaving, such
as for blood banks, where contaminated bags have been returned for disinfection,
then

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  Undertake a full validation for this waste stream to determine the correct
parameters required for disinfection of the blood.
 If the majority of the waste to be autoclaved comprises filled bags, then the
autoclave cycle will have to be validated for this waste prior to being treated
for the first time.
 Some of the modifications likely in a successful blood bag cycle include:
o It can be anticipated that each load of filled blood bags may need at least
another 20 minutes at 121°C to ensure effective disinfection. Some
researchers recommend 2 hours autoclaving.
o Use a liquid cycle because the longer cooling down period will allow more
time for the blood bags to be effectively disinfected and minimize boiling of
liquids due to rapid pressure drops.

o Do not vent for at least 20 minutes after the usual disinfection time has
elapsed.
7.2.4. When a lot of blood bags are to be autoclaved, but where this will not be a routine
operation, spread the bags out over many loads to prevent too many from being
autoclaved together. Blood bags generally need a longer holding time at the target
temperature (121°C) required to effectively disinfect the dense liquids. This can be
achieved by:
 Using a liquid cycle as the longer cooling down period will allow more time for
the blood bags to be effectively disinfected and to minimize liquid boiling over
due to rapid pressure drops.
 Not venting for at least 20 minutes after the usual disinfection time has
elapsed.
7.3. Discarding autoclaved blood
7.3.1. Blood usually congeals in the bags, which burst during autoclaving, so do not
discard autoclaved blood to drain, as this semi-solid or gelatinous material may
cause blockages by forming a plug in the pipes and u-bends.
7.3.2. Autoclaved blood can either be:
 Discarded with other solid waste or directly into a placenta pit, septic tank or
biodigester (not if accessed via drains or pipes) or
 Macerated and discharged to a closed drain connected to a treatment system.

8. Reporting and Recordkeeping

8.1. The number or mass of blood bags autoclaved should be included in the autoclave
operation log.
8.2. Any incidents, including needles remaining on waste blood bags must be reported to the
department manager for action.
8.3. Report any incidents or accidents, such as spills and needle stick injuries, according to
standard institutional procedures. Where prescribed by local legal requirements, the
relevant authorities must be notified of any incidents, such as needle stick injuries.

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9. References
9.1. Chitnis V, Chitnis S, Patil S, Chitnis D. Treatment of discarded blood units: Disinfection with
hypochlorite/formalin versus steam sterilization. Indian Journal of Medical Microbiology,
2003;21(4):265.
9.2. United Nations Development Programme‒Global Environment Facility (UNDP‒GEF), Global
Healthcare Waste Project. Guidance on the microbiological challenge testing of healthcare
waste treatment autoclaves. New York (NY): UNDP‒GEF; 2010. 9 p.
[Link]
Testing%20for%20Medical%20Waste%20Autoclaves-%20November%[Link]
9.3. Perkins JJ. Principles and methods of sterilization in health sciences. 2nd ed. Charles C
Thomas Pub Ltd; 2008. P. 477-478.

10. Related Documents

 Doc 309: Incident Log
 Doc 308: Incident Reporting Form
 Doc 532: Autoclave Operation Log
 Doc 522: On-site Treatment And Disposal Of Blood Transfusion Products — Guidance
 Doc 530: Autoclave Operation — SOP

11. Attachments
None

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