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Hawaii

Infectious Waste

Background Information
Definition of Infectious Waste
Managing Infectious 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 Infectious Waste

"Infectious waste" means any waste that may contain pathogens capable of causing an infectious disease in humans and shall include, but not be limited to, the following wastes:

  • Infectious isolation waste;
  • Cultures and stocks of infectious agents;
  • Blood, blood products and body fluids;
  • Pathological waste;
  • Contaminated sharps; and
  • Contaminated animal carcasses, body parts, and bedding.

Managing Infectious Waste

The Hawaii Rules for Management and Disposal of Infectious Waste establish minimum requirements for the management, treatment, transport, storage and disposal of infectious waste and treated infectious waste, to protect the health and safety of persons living in Hawaii.

Prohibitions

No person shall handle, treat, and dispose of, transport, or store infectious waste or treated infectious waste except in accordance with all applicable rules.

Handling and treatment of infectious waste

Infectious waste shall be incinerated, sterilized, or chemically disinfected by the following methods recommended for waste treatment:

  • The Centers for Disease Control's (CDC) "Recommendations for Prevention of HIV transmission in Health-Care Settings, MMWR 1987"; or
  • The CDC's "Update: 'Universal Precautions' for prevention of transmission of HIV immunodeficiency virus, hepatitis B virus and other blood borne pathogens in health-care settings MMWR June 1988"; or
  • The U.S. Environmental Protection Agency's "Guide for Infectious Waste Management", May 1986; or
  • Part 1910 of Title 29 of the Code of Federal Regulations, Subpart Z, before their disposal; or by other methods approved by these agencies or the department.

Infectious waste shall be segregated from all other waste at the point of generation. Infectious waste shall be managed and treated as follows:

  • Infectious isolation waste shall be deposited at the point of generation into containers lined with nonsoluble plastic bags that are clearly marked with the Universal Biological Hazard symbol, or into red plastic bags.
  • All plastic bags shall meet applicable requirements.
  • Bags used for autoclaving shall also be marked with the Universal Biological Hazard Symbol.
  • All bags shall be tightly closed before being transported so as to contain the waste completely, and the waste shall be transported in accordance with all applicable transport requirements.
  • Sterilization shall be by autoclaving or incineration.
  • Cultures and stocks of infectious agents shall be sterilized or incinerated.
  • Blood, blood products and body fluids, all of which are considered infectious, shall be incinerated, sterilized, disinfected, or disposed of via a wastewater disposal system approved by the department.
  • Pathological waste shall be incinerated, sterilized, or disinfected; sterilized or disinfected material may be finely ground and flushed into a drain leading to a wastewater disposal system approved by the department.
  • Recognizable human body parts shall be disposed of in accordance with applicable requirements.
  • Contaminated sharps shall be deposited at the point of generation into rigid puncture resistant and leak-proof containers, red in color or clearly marked with the Universal Biological Hazard symbol.
  • Needles shall not be recapped, purposely bent, broken, or otherwise manipulated.
  • Containers shall be located in the immediate area where sharps are used and shall not be allowed to overfill.
  • Prior to transport containers shall be closed securely to contain sharps completely and shall remain closed throughout transport, storage, and disposal.
  • Sharps shall be sterilized, incinerated, or undergo chemical disinfection prior to disposal.
  • Contaminated animal carcasses, body parts and bedding shall be sterilized, incinerated or undergo chemical disinfection in accordance with the regulations.

Transportation of infectious waste within a facility

  • Untreated infectious waste shall be placed in containers sufficient to contain the waste completely as follows:
    • Nonsoluble plastic bags either red in color or clearly labeled with the Universal Biological Hazard symbol; or
    • Sharps containers; or
    • Sturdy leak-proof containers clearly marked with the Universal Biological Hazard symbol.
  • The number of plastic bags and the thickness of bags shall be sufficient to contain the waste completely from generation through treatment and storage.
  • Bags and other containers of untreated infectious waste shall be tightly closed before transport. The bags and containers of waste shall be transported in leak-proof rigid or semi-rigid portable containment systems or carts, clearly marked with the Universal Biological Hazard symbol.
  • Untreated infectious waste shall be transported manually to minimize rupturing and dissemination or aerosolization.
  • Reusable carts bins and other containment systems used to transport waste must be cleaned after each use and disinfected daily when in use.

Transportation of infectious waste for treatment away from the generating facility

  • Infectious waste shall be placed in containers that are sufficient to contain the waste completely as follows:
    • Nonsoluble plastic bags, red in color or clearly labeled with the Universal Biological Hazard symbol; or
    • Sharps containers as described in section 11-104-5(c) (5); or
    • Sturdy leak-proof containers clearly marked with the Universal Biological Hazard symbol.
  • The number of plastic bags and thickness of plastic bags shall be sufficient to contain the waste completely from the generation through treatment.
  • The bags and other containers of infectious waste shall be tightly closed before transport. The bags and other containers shall be placed in a rigid, or semi-rigid tightly closed, leak-proof containment system, which shall be clearly marked with the Universal Biological Hazard symbol prior to transport.
  • Infectious waste in containment systems shall be transported away from the facility in fully enclosed rigid, leak-proof containers or vehicle compartments that will prevent scattering, spillage, and leakage of the waste during transport. The transport vehicle shall be labeled with a clearly visible Universal Biological Hazard Symbol.
  • Untreated waste shall not be compacted.
  • Containers may be disposable or reusable. Disposable containers that have been in contact with infectious waste shall be sterilized prior to disposal, or incinerated. Reusable containers shall be cleaned after each use and disinfected daily when in use.
  • Untreated infectious waste shall not be transported with noninfectious waste unless all waste in the load is managed as infectious waste.

Storage of infectious waste and treated infectious waste

  • Infectious waste that is being stored while awaiting treatment shall be stored in disposable or reusable sturdy, leak-proof containers that have tight-fitting lids or a leak proof fully enclosed room, which are clearly labeled with the Universal Biological Hazard symbol. These containers shall be kept in fully enclosed and secured locations that are inaccessible to animals and to persons not authorized to handle their treatment, transfer, or disposal.
  • Infectious waste that has been treated and is awaiting transport for disposal shall be stored in fully enclosed and secured areas or containment systems that are accessible only to persons authorized to handle their disposal.

Disposal of infectious waste and treated infectious waste

  • All infectious waste and treated infectious waste shall be disposed of in accordance with the regulations.
  • All infectious waste which is not disposed of via a waste water disposal system approved by the department shall be treated in accordance with the regulations and then disposed of only in state permitted landfills or authorized disposal sites.
  • Treated infectious waste that has not been incinerated shall be in containers, which are clearly, marked as treated waste, which has been rendered noninfectious.
  • Recognizable human body parts shall be incinerated or disposed of in accordance with other applicable state laws governing the disposal of human remains.
  • Incinerator ash shall be disposed of only in state permitted landfills or authorized disposal sites.

Infectious waste management plan

Each infectious waste generator and transporter of untreated infectious waste shall have a written plan that contains policies and detailed procedures for the safe and effective management of infectious waste in accordance with the regulations. A copy of this plan shall be kept in the respective administrative offices of the generator and the transporter.

The plan shall also provide for contingencies in emergency situations. At a minimum, this shall include procedures to be used under the following circumstances:

  • Spills of liquid infectious waste. These procedures shall include provisions for containment, protection of personnel, clean up procedures, disinfection and disposal of the spill residue and of contaminated containers;
  • Rupture of plastic bags or other loss of containment. These procedures shall include provisions for containment, protection of personnel, clean up procedures, disinfection, and repackaging of waste; and
  • Equipment failure. These procedures shall include alternative arrangements for waste storage, transportation, and treatment.

Penalties

Any person, corporation, or agency that violates any of the provisions of the regulations shall be subject to an administrative penalty not to exceed one thousand dollars for each separate offense. Each day of violation may constitute a separate offense. The violator shall also be subject to the other remedies and provisions, including recourse to administrative contested case proceedings

OSHA Regulations

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.  Hawaii is one of 24 states operating an approved occupational safety and health program. This program is operated by the Occupational Safety and Health Administration.  OSHA 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

Hawaii Rules for the Management and Disposal of Infectious Waste (Title 11, Chapter 104)

Contacts

Hawaii Department of Health

More Information

None located.