 Connecticut
Biomedical
Waste
Background Information
Definition of Biomedical
Waste (BMW)
Managing BMW
Disposal of BMW
Incinerating BMW
Licensed Transporters
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 Biomedical Waste (BMW)
BMW is any infectious, pathological,
and chemotherapy waste generated during the administration of human medical
care or the performance of medical research involving humans or animals.
BMW includes:
Managing
Biomedical Medical Waste (BMW)
A generator of BMW is any person
who owns or operates a facility that produces BMW in any quantity.
This includes, but is not limited to, the following: hospitals, skilled
nursing facilities, laboratories, physicians’ offices, veterinarians,
dental offices, and funeral homes. Where more than one generator of
BMW is located in the same building, each individual business entity
is considered a separate generator.
Generators must prepare a written
management plan for each facility that generates BMW. The BMW plan
must set forth policies and procedures for segregating the waste and
to ensure the below conditions are met:
Follow
these prescribed practices for managing BMW:
-
Segregate
sharps, body fluids and other BMW.
-
Implement
a written BMW Management Plan.
-
Package
in appropriate containers.
-
Label
containers with water-resistant labels.
-
Mark
primary and secondary containers with water-resistant identification
tags.
Identification
and Segregation
Generators must segregate BMW from other solid
waste before placing the BMW into primary containers. BMW must be
segregated into the following groupings:
Packaging
Requirements
Before transporting BMW, generators are required
to package the BMW as follows:
-
Place BMW in containers that
are rigid, leak-resistant, impervious to moisture, sufficiently
strong to prevent tearing or bursting under normal conditions,
and sealed to prevent leakage.
-
Place sharps in containers
that are puncture-resistant.
-
Body fluids in quantities
greater than 20 cm3 must be placed in containers that
are break-resistant and tightly lidded or stoppered.
-
Employees packaging BMW must
wear personal protective equipment.
-
The outside of each container
must be marked with a water-resistant label displaying the universal
biohazard symbol or the words "medical waste" or "infectious
waste."
Storage
Requirements
BMW must be stored in such a way that it avoids
mixing with other materials, and access to it must be limited to
personnel authorized by the generator, transporter, or solid waste
facility operator to handle it. Outdoor storage areas, such as dumpsters,
sheds, or trailers, must be locked. Furthermore, the areas used for
storage must be constructed of finished materials that are impermeable
and capable of being easily maintained in a sanitary condition.
The waste itself should be stored in a manner
and location that protects it from water, precipitation, wind, animals,
and does not provide a breeding place or food source for insects
or rodents. To maintain a non-putrescent state, BMW may be refrigerated
during storage. Finally, a sign displaying the universal biohazard
symbol and/or the words “BIOHAZARD” must be posted wherever BMW is
stored.
Labeling
and Marking Biomedical Waste (BMW) for Off-Site Transport
Before transporting BMW, the
generator must:
-
Place the waste in a red
bag to render it universally recognizable as biomedical.
-
Package it in rigid, leak-resistant
containers that are resistant to moisture.
-
Use a container that is strong
enough to avert tearing or bursting under normal circumstances
and seal it to prevent leakage.
-
Make sure each container
displays the universal biohazard symbol or the words “BIOHAZARD” in
large, easy-to-read lettering.
-
Never reuse a container that
housed BMW for any purpose unless its surfaces were protected from
contamination through the use of a liner or bag that was removed
with the waste, or it has been thoroughly washed and disinfected,
with all visible traces of prior contamination removed.
Disposal
of Biomedical Waste (BMW)
BMW which has been treated in accordance with
BMW regulations and which has been rendered unrecognizable may be
disposed of as municipal solid waste. Solid waste facilities shall
not accept BMW which is not packaged, labeled and marked as required
by regulations, or which is not accompanied by a tracking form that
complies with all applicable law. The methods of disposal are as
follows:
-
Chemotherapy waste by incineration.
-
Pathological waste (i.e.
human tissue, organs, body parts) by incineration or internment.
-
Infectious waste (i.e. body
fluids or items dripping with body fluids, discarded sharps, biological
waste generated from research) either by incineration, discharge
to a sanitary sewer, or treatment by steam sterilization or other
approved alternative treatment technology (ATT). The waste may
be discharged to a sewer given it is liquid or semi-liquid in form,
and that secondary treatment is provided at a private or public
treatment works. In all cases, once the waste has been treated
in accordance with the provisions of the regulations, the end result
must be rendered unrecognizable as biomedical waste. It may then
be disposed of as municipal solid waste. Note: this category includes
ALL infectious waste EXCEPT that which falls under the categories
of “chemotherapy” and “pathological.”
-
Needles which are specifically
used to administer antineoplastic agents shall be handled in accordance
with this section or under regulations adopted for the handling
of chemotherapy waste; and
-
Syringes designed to deliver
drugs into the human body in a manner other than injection shall
be exempted from the disposal requirements of this section.
On-Site Treatment
or Disposal of Biomedical Waste (BMW)
If BMW is treated or disposed of at the site
where it was generated, the generator shall develop written procedures
for each treatment or disposal method in use at such site which methods
shall be consistent with the provisions of this section and shall
ensure compliance with such procedures.
Such procedures shall be incorporated
into the BMW management plan required by law and shall (1) assure the
effectiveness of any treatment method in use and reflect acceptable
standards of practice, (2) provide for and conduct an ongoing program
of staff training on the implementation of such procedures and the
requirements of this section, and (3) provide for a quality assurance
program to assure compliance with the biomedical management plan prepared
as required by law.
Incinerating
Biomedical Waste (BMW)
Biomedical waste incinerator residue shall be
managed as a special waste in accordance with the regulations. A
steam sterilizer used to decontaminate biomedical waste shall be
operated in accordance with the following requirements:
-
In a gravity flow sterilizer,
biomedical waste shall be subjected to a temperature of not less
than two hundred fifty degrees Fahrenheit at fifteen pounds per
square inch of gauge pressure for no less than sixty minutes.
-
In a vacuum type sterilizer,
biomedical waste shall be subjected to a temperature of not less
than two hundred seventy degrees Fahrenheit at twenty-seven pounds
per square inch gauge pressure for no less than forty-five minutes.
-
Notwithstanding subdivisions
(1) and (2) of this subsection, a different combination of operational
time, temperature and pressure may be utilized for steam sterilization
of biomedical waste if such combination is first described in writing
to the commissioner and approved in writing by the commissioner.
The commissioner shall not grant approval unless such combination
is proven on the basis of thorough tests, including tests of its
capacity to kill bacillus stearothermophilus and to completely
and reliably kill all microorganisms in waste at design capacity.
-
Biomedical waste shall be
steam sterilized in its primary container. The primary container
shall be placed in the sterilization chamber so that sufficient
space is provided between the chamber walls and the container to
allow the steam to penetrate the container. The primary container
shall then be unsealed to allow the steam to penetrate the contents
of the container.
-
Unless the steam sterilizer
is equipped to continuously monitor and record temperatures during
the entire length of each sterilization cycle, the operator of
such sterilizer shall affix to the primary container temperature-sensitive
tape which indicates when the desired temperature is reached. Biomedical
waste shall not be considered decontaminated unless the temperature-sensitive
tape indicates that a temperature of at least two hundred fifty
degrees Fahrenheit was reached during the sterilization process.
A steam sterilizer which is used for the first time after July
1, 1994, shall automatically and continuously monitor and record
temperatures throughout the entire length of each steam sterilization
cycle.
-
At least once during every
forty hours of operation, tests shall be conducted to evaluate
the effectiveness of the sterilization process, including tests
of the capacity of such process to kill bacillus stearothermophilus.
A log shall be maintained recording the dates and results of such
test.
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At least once during every
forty hours of operation, a sterilization unit shall be evaluated
to determine whether it is operating properly with respect to temperature
and pressure. A log shall be maintained recording the dates and
results of such evaluations and the dates of calibration.
-
For each sterilization unit
a log shall be maintained recording, for each use, the date, time,
operator, type and approximate amount of biomedical waste treated,
the sterilization pressure reading and the poststerilization reading
on the temperature-sensitive tape.
Sharps shall be physically altered
so as to render them unrecognizable in accordance with the regulations.
Prohibitions
No person shall:
-
Deliver biomedical waste
or cause biomedical waste to be delivered to any incinerator, whether
located inside or outside of this state, unless such incinerator
complies with all applicable law; or
-
Operate an incinerator in
which biomedical waste is burned unless such incinerator complies
with all applicable law.
Licensed
Transporters
Generators must use transporters permitted by
DEP. Connecticut requires separate permits for transporting hazardous
and biomedical waste. Under Connecticut law, ANY person who transports
BMW, regardless of the quantity, needs a permit issued by the Commissioner.
To receive the most current list of licensed BMW transporters, contact
the Waste Engineering and Enforcement Division’s Solid Waste Section
at 860-424-3366.
One exception
to this permit requirement is if you are a BMW Small Quantity Generator
(SQG) and you generate or transport less than 50 lbs in a month
or in any single shipment. SQG’s may self-transport without a permit,
ship certain BMW using the US Postal Service and are exempt from
certain tracking and record keeping requirements. SQG’s may ship
to a solid waste facility or another facility owned by the generator.
Generators may ship from the original generation point to a central
collection point if:
-
The
waste is segregated, packaged, labeled and marked.
-
Written
authorization is provided for employees.
-
The
waste is transported by employer/employees.
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Shipping
logs are maintained at each site.
*Although qualified SQG’s can self-transport
certain BMW, it is recommended that you use a permitted BMW transporter
to ship BMW, to ensure that the waste is being transported in accordance
with applicable law.
Each generator of biomedical waste shall submit
to the Commissioner of Environmental Protection, in writing, the
name of the person said generator has contracted with to dispose
of its biomedical waste, the amount of such waste and the site of
disposal.
Tracking
Forms, Reporting and Recordkeeping
Generators must use the DEP-provided form to
track BMW from cradle to grave. The generator must prepare one copy
for its facility, one copy for the transporter, and two copies for
the solid waste facility where the BMW is being transported.
If
applicable, maintain the following records on-site for three years:
-
Signed
Medical Waste Tracking forms.
-
Original
US Postal Service receipts and return mail receipts.
-
Operating
logs and annual reports.
-
Shipping
logs.
-
Exception
reports.
OSHA
Regulations: HERC OSHA State Page
In addition to the state medical waste environmental regulations there
are some Occupational Safety and Health Administration (OSHA) rules
that apply to medical/infectious waste. Connecticut is one of
24 states operating an approved occupational safety and health program. However,
the Connecticut program only covers the workplace safety and health
of public sector employees only.
Private sector employees in Connecticut are covered by Federal OSHA.
OSHA state and federal rules (Occupational Exposure to Bloodborne Pathogens
Standards) impact various aspects of medical/infectious waste, including
management of sharps, requirements for containers that hold or store
medical/infectious waste, labeling of medical/infectious waste bags/containers,
and employee training.
Statutes,
Regulations and Guidelines
Connecticut
BMW Definitions (Sec. 22a-209b)
Connecticut
BMW Disposal Requirements (Sec. 22a-209c)
Connecticut
BMW Disposal by Generators (Sec. 22a-213a)
Contacts
CT-DEP,
Bureau of Waste Management
More
Information
Biomedical waste frequently asked questions.
Other Resources
Biomedical waste information.
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