Alaska

Medical Waste

Background Information
Definition of Regulated Medical Waste
Managing Regulated Medical Waste
OSHA Regulations
Statutes, Regulations and Guidelines
Contacts
More Information

Background Information

Medical waste differs from hazardous waste. Hazardous waste is regulated by the US EPA (and related state rules) under the Resource Conservation and Recovery Act. Medical waste is not covered federal environmental laws or US EPA regulations (with the exception of a medical waste that also meets the definition of hazardous waste). Rather, medical waste is mostly controlled by state law and associated regulations. In addition to state environmental agency laws/rules, aspects of medical waste management are also controlled by the Occupational Safety & Health Administration (federal and/or state) and Department of Transportation (federal and state).

Each of our 50 states have developed rules and implemented regulations for medical waste. The state rules vary to some extent, including terminology. Depending on which state you live in, you may hear the terms regulated medical waste, biohazardous waste or infectious medical waste. In most cases, these terms all refer to the same thing: that portion of the medical waste stream that may be contaminated by blood, body fluids or other potentially infectious materials, thus posing a significant risk of transmitting infection.

Most states have regulations covering packaging, storage, and transportation of medical waste. Some states require health care facilities to register and/or obtain a permit. State rules may also cover the development of contingency plans, on-site treatment, training, waste tracking, recordkeeping, and reporting.

In most states, the environmental protection agency is primarily responsible for developing and enforcing regulations for medical waste management and disposal. Although in some states, the department of health may play an important role or even serve as the primary regulatory agency. Where both agencies are involved, typically the department of health is responsible for on-site management and the environmental agency is responsible for transportation and disposal.

OSHA, whether it is the U.S. Department of Labor Occupational Safety & Health Administration or an OSHA state program (24 states operate their own program), regulates several aspects of medical waste, including management of sharps, requirements for containers that hold or store medical waste, labeling of medical waste bags/containers, and employee training. These standards are designed to protect healthcare workers from the risk of exposure to bloodborne pathogens. However, they also help to systematically manage wastes, which benefit the public and environment.

Regulated medical waste is defined by the US Department of Transportation as a hazardous material. DOT rules mostly apply to transporters rather than healthcare facilities; although, knowledge of these rules is important because of the liability associated with shipping waste off-site.

Definition of Regulated Medical Waste

Regulated medical waste is defined as:

• Cultures and stocks means discarded cultures and stocks of infectious agents and associated microbiologicals, including human and animal cell cultures from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, waste from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, or mix cultures of infectious agents;
• Pathological waste means discarded pathological waste, including human tissues, organs, and body parts removed during surgery, autopsy, or other medical procedure;
• Selected isolation waste means discarded waste material that is contaminated with excretions, exudates, and secretions from patients with highly communicable diseases, and that is treated in isolation, “selected isolation waste” includes blood and blood components, and sharps;
• Sharps means discarded implements or parts of equipment used in animal or human patient care, medical research, or industrial laboratories, including hypodermic needles, syringes, pasteur pipettes, scalpel blades, blood vials, needles with attached tubing, broken or unbroken glassware that has been in contact with an infectious agent, slides, cover slips, and unused, discarded implements or parts of equipment;
• Animal waste means discarded material originating from an animal inoculated with an infectious agent during research, production of biologicals, or pharmaceutical testing; “animal waste” includes the carcass, body parts, blood, and bedding of any animal known to have been in contact with an infectious agent;
• Blood and blood products means discarded waste human blood and blood components, including serum and plasma, and materials containing free-flowing blood and blood components; and
• Other wastes defined as "regulated waste.

• In an autoclave;
• By a decontamination process other than an autoclave; or
• In a medical waste incinerator.

• Purpose. The purpose of the medical waste disposal policy is to protect workers, the public and the environment from exposure to pathogens, which could cause diseases. The policy applies to any private or public medical, dental or veterinary clinic, office, facility, laboratory, hospital or service within the Municipality of Anchorage that generates, collects or processes medical waste with the intent of disposing the waste at the Anchorage Regional Landfill (ARL).
• Disposal. Medical wastes shall not be disposed of at the ARL until they have been effectively treated - rendered biologically harmless in accordance with acceptable treatment practices as described in the policy or current industry standards and methods and the wastes do not pose other hazards subject to municipal, state or federal laws or regulations.
• Definition of Medical Waste. For the purpose of this policy, the state definition of medical waste applies.
• Treatment Methods. An acceptable treatment method is any technique or process designed to change the biological character or composition of medical waste so that it is no longer infectious or otherwise biologically hazardous. The most commonly accepted treatment methods are incineration and active steam sterilization. Use of other treatment methods will require case-by-case prior review and written approval by the Anchorage Solid Waste Services (SWS) before such treated waste will be accepted for disposal at the ARL.
• Packaging. No medical waste may be disposed of in the ARL unless the waste has been effectively treated, rendered noninfectious and properly packaged for disposal.
  • The residue or ash from incinerated medical waste shall be contained in leakproof, fully enclosed and tightly lidded or sealed containers. Loose residue and ash will not be accepted or disposed in the ARL.
  • Medical waste to be sterilized by active steam autoclaving shall be processed in opaque polyethylene disposable autoclave bags of a minimum 3 mil thickness. The bags shall have heat sensitive markings that change color when exposed to a sterilization temperature for a given time period. The markings will be easily and clearly discernible. Unless specifically approved for such use by the sterilization unit's manufacturer, compactors, grinders or similar devices may not be used to reduce the volume of medical waste before the waste is to be rendered noninfectious by steam sterilization. The use of these devices to reduce the volume of effectively treated waste is acceptable.
  • Effectively treated medical waste will be disposed of only at the ARL. No medical waste, except that which is generated from within the private home by the individual homeowner, will be accepted at the Central or Girdwood Transfer Stations. The generator of the effectively treated medical waste is ultimately responsible for ensuring it will be disposed of at the ARL.
  • The waste will be transported in a leak proof, tightly sealed, fully enclosed container; the container will not be taken to the Central or Girdwood Transfer Stations for off loading.
• Medical Wastes Generated at a Private Home. Medical wastes generated within the private home are not specifically addressed by the applicable regulatory agencies. It is not the intent of this policy to attempt to regulate all medical wastes generated from within the private home environment. The individual home owner or the assisted living support provider who generates in the home environment certain medical wastes is, however, responsible to ensure that waste is properly handled, containerized and, if required, effectively treated prior to disposal. The wastes of primary interest are sharps, such as lancets, syringes and needles used in the home to control diabetes, allergies or any other medical conditions; home care medical wastes associated with infectious diseases; and medical wastes generated from in-home health care, which is provided by a commercial service.

• Red bags and needle disposal boxes used to collect infectious or biohazardous waste can be a source of cadmium, a heavy metal, when incinerated. Check to be sure that red bags and sharps containers used in the workplace are cadmium-free.
• Reduce the amount of biohazardous waste in the workplace by carefully segregating wastes. Check biohazardous waste container placement. Be sure containers are not located in places where they are likely to be filled with non-infectious, nonbiohazardous wastes.
• Items such as paper towels, product supply packaging, and other solid wastes should be discarded as trash, and not as biohazardous waste.
• Find out where the biohazardous waste (red bags and needle boxes) are being disposed. Are they being incinerated or autoclaved? Are they placed in the dumpster in the parking lot? There are many treatment technologies available for this type of waste, such as incineration, autoclaves, microwaving, and electro-thermal deactivation to name a few. Avoid incineration except for wastes which can only be treated by that technology.
• Minimize pharmaceutical waste by only accepting quantities of medication samples from drug representatives that will be consumed. Encourage drug reps to "take back" expired or unused samples. If that strategy is not successful, discard the actual pharmaceutical product in a needle box or sharps container.
• Do not flush medications down the toilet, especially hormonal medications such as replacement therapy and birth control pills, or narcotics.
• Get involved in the process of acquiring products used in health care. Develop an environmental criterion for products being purchased. Evaluate the type of packaging that products come in: is it excessive, are the components recyclable?
• Specify cadmium-free red bags and needle boxes. Purchase battery operated thermometers and digital or aneroid blood pressure monitoring devices instead of mercury based products. Choose reusable cloth gowns and drapes when possible. Minimize the use of chlorinated plastics (They have been associated with creating dioxin when incinerated).
• When purchasing waste disposal services seek companies that offer alternatives to incineration whenever possible and appropriate. Specify autoclaving or an alternate technology. This is especially important for disposal of wastes containing PVC (polyvinyl chloride), items such as IV bags, IV tubing, and blood bags.