ENS 53564
ENS Event | |
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05:00 Aug 24, 2018 | |
Title | Agreement State Report - Improper Disposal of Radioactive Material |
Event Description | The following information was received via E-mail:
Oklahoma DEQ [Department of Environmental Quality] notified the Kansas Radiation Control Program of a rejected waste shipment from Kansas. Preliminary information is the waste was not generated from licensed work. A patient who had received what is believed to be an I-131 dose at an unaffiliated facility came in for labs. Blood was drawn and needle was disposed in sharps without the knowledge of contamination by the lab personnel. The survey data on the waste was reported as 500 microR/hr on surface of the waste package. See EN 53561.
The following update was provided via E-mail: The originator of the waste has a radioactive material license, however the package containing the contaminated waste was not from the radiology department where licensed activity occurs. Furthermore the licensee does not use I-131 or any isotope with a half-life nearly as long. [Kansas Radiation Control] will visit the site next week to determine what the dose estimates are for those in the waiting room, lab staff (both blood draw and blood testing), waste transporter and waste handlers. [Kansas Radiation Control] also intend to identify where the blood vial and associated potentially contaminated waste is stored/disposed. It will likely prove impossible to discover the licensee who administered the I-131 to the patient as the individual did not report they were recently treated, there was no surveys in their unrestricted portion of their facility that is unaffiliated with their RAM [radioactive material] work, and the waste is mixed in with several other patients over the course of several days.
The following update was provided via E-mail: Oklahoma DEQ notified the Kansas Radiation Control Program of a rejected waste shipment from Kansas on 8/24/2018. This was reported to the HOO by David Lawrenz on the same day. The Cancer Center of Kansas (CCK) was contacted by Stericycle, the company that handles sharps disposal, August 23, 2018. Stericycle stated they had received a radioactive sharps container from CCK. During a phone call with Stericycle, David Lawrenz learned the sharps container had been picked up last week and delivered to the incinerator facility on Monday August 20th. Preliminary information is the waste was not generated from licensed work. A patient who had received what is believed to be an I-131 dose at an unaffiliated facility came in for labs. Blood was drawn, and needle was disposed in sharps without the knowledge of contamination by the lab personnel. The survey data on the waste was reported as 500 microR/hr. on surface of the waste package on 8/24/18 when [redacted] picked up the container from Stericycle. After [redacted] picked up the sharps container on 8/24/18, it was determined the sharps container came from the CCK lab. [redacted] took surveys on the exterior of the container and found 500 microR/hr for the highest reading prior to returning to CCK. The CCK lab is separate from the CCK radiology department and the sharps containers are used separately as well. The CCK lab is not a restricted area and no radioactive material is used there. Consequently, the sharps from the lab were not monitored for radioactive contamination. With the knowledge that the sharps came from a department that does not handle radioactive material and the fact that so much time had passed we determined the radioactive contamination must have originated from outside CCK. CCK only uses Tc99m. CCK is authorized for 35.100 and 35.200 use only. CCK is a cancer specialty clinic so the most likely scenario is that a patient had very recently undergone I-131 therapy at another facility and then came to CCK for lab work. The discarded lab detritus from that patient was then placed in the sharps container that Stericycle collected. On August 27, 2018 [two individuals from the Kansas Department of Health and Environment] arrived at CCK and met with [the Lab Supervisor]. [redacted] took surveys of the sharps container and lab area. This area is separate from the radiology department. No areas were above background. [The Lab Supervisor took Kansas personnel] to the hot lab used under the Adams Diagnostics 12-B880. The rejected waste is now stored for decay in the regulated area. [The Lab Supervisor] surveyed the container at 259 microR/hr on contact. New procedures are being written to include surveys of the labs sharps container to prevent the issue from happening in the future. The licensee was found to not be in violation of any requirements and there will be no enforcement action as a result of this investigation unless new information comes to light. Root cause analysis is a patient failed to follow instructions after the medical procedure." Notified the R4DO (Alexander) and NMSS Events via email. |
Where | |
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Stericycle Stoud, Oklahoma (NRC Region 4) | |
Organization: | Kansas Dept Of Health & Environment |
Reporting | |
Agreement State | |
Time - Person (Reporting Time:+11.58 h0.483 days <br />0.0689 weeks <br />0.0159 months <br />) | |
Opened: | David Lawrenz 16:35 Aug 24, 2018 |
NRC Officer: | Dong Park |
Last Updated: | Sep 24, 2018 |
53564 - NRC Website | |
Stericycle with Agreement State | |
WEEKMONTHYEARENS 535612018-08-24T05:00:00024 August 2018 05:00:00
[Table view]Agreement State Agreement State Report - Improper Disposal of Radioactive Material ENS 535642018-08-24T05:00:00024 August 2018 05:00:00 Agreement State Agreement State Report - Improper Disposal of Radioactive Material ENS 510762015-05-16T01:30:00016 May 2015 01:30:00 Agreement State Agreement State Report - Radioactive Material Disposed in Medical Waste 2018-08-24T05:00:00 | |