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Arkansas

Regulated
Medical Waste


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

Medical waste is waste from a generator or a health care related facility which, if improperly treated, handled, or disposed of may serve to transmit an infectious disease and which includes the following:

  • Pathological waste. All human unfixed tissues, organs and anatomical parts, other than intact skin, which emanate from surgeries, obstetrical procedures, dental procedures, autopsies and laboratories. Such waste shall be exclusive of bulk formaldehyde and other preservative agents.
  • Liquid or semi-liquid blood such as human blood, human blood components and/or products made from human blood (e.g., serum, plasma) and other potentially infectious materials, to include regulated human body fluids such as semen, vaginal secretions, cerebrospinal fluid, pleural fluid, pericardial fluid, synovial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood and all body fluids where it is difficult or impossible to differentiate between body fluids, not to include urine or feces, which cannot be discharged into the collection system of a publicly owned treatment works (POTW) within the generating facility.
  • Contaminated items to include dressings, bandages, packings, gauze, sponges, wipes, personal protective equipment, cotton rolls and balls, etc., which cannot be laundered or disinfected and from which blood, blood components, or regulated body fluids drip freely, or that would release blood or regulated body fluids in a liquid or semi-liquid state if compressed or are caked with dried blood or regulated body fluids and all capable of releasing these materials during handling.
    • Contaminated disposable, single-use gloves such as surgical or examination gloves shall not be washed or decontaminated for reuse and are to be handled as a contaminated item.
    • Protective coverings such as plastic wrap and aluminum foil used to cover equipment and environmental surfaces when removed following their contamination are considered a contaminated item.
    • All patient care items from hospital isolation rooms and end-stage renal dialysis units, or from patients with communicable diseases, which cannot be laundered and which are contaminated with regulated body fluids or blood or potential infectious material, must be considered a contaminated item.
  • Microbiological waste which includes, but is not limited to, cells and tissue cultures, culture medium or other solutions and stocks of infectious agents, organ cultures, culture dishes, devices used to transfer, inoculate and mix cultures, paper and cloth which has come in contact with specimens or cultures and discarded live vaccines
  • Contaminated sharps which includes, but is not limited to, any contaminated object that can penetrate the skin, e.g., hypodermic needles, intravenous tubing with needles attached, syringes with attached needles, razor blades used in surgery, scalpel blades, Pasteur pipettes, capillary tubes, broken glass from laboratories, and dental wires. (Potential breakable container(s) of blood, regulated body fluid, microbiological waste, or infectious material must be treated as contaminated sharps when disposed of.

Managing Infectious Medical Waste

Identification of Medical Waste

A person who generates a medical waste shall determine if that waste is a medical waste. Any wastes that contain medical waste mixed with general solid waste shall be managed as medical waste if the solid waste has been contaminated by pathological waste, blood or body fluids, contaminated items and/or microbiological waste. Any medical wastes which meet the definition of "hazardous waste", or which are mixed with hazardous wastes shall be managed as hazardous waste.

Segregation of Medical Waste

  • Medical waste must be segregated from other regular waste at the point of its generation in the producing facility.
  • Segregation of medical waste must be made into containers in compliance with the OSHA Bloodborne Pathogen Standard. Containers meeting this standard must be closable and constructed to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipment.
  • A non-sharps container of medical waste shall be closed at all times except when actively receiving medical waste. A sharps container with openings large enough to allow entry of any human hand shall be subject to any additional physical and/or administration controls necessary to prevent access by the public during normal conditions of use.

Packaging and Labeling of Medical Waste

Medical waste, except for sharps capable of cutting or puncturing, shall be contained for reprocessing at the site of generation in collection containers impervious to moisture, which are leak resistant and have a sufficient strength to preclude ripping, tearing or bursting under normal conditions of usage.

  • Full containers shall be securely closed (fastened, taped or tied) to prevent leakage or loss of solid or liquid wastes.
  • Contaminated sharps shall be packaged for reprocessing at the site of generation in containers that are leak resistant on the bottom and sides, rigid, closable, and puncture resistant. Sharps containers shall be assembled and utilized at all times as intended by the manufacturer. Sharps that have been treated and are still capable of cutting or puncturing must also meet this packaging requirement unless they have been rendered unrecognizable and are no longer capable of cutting or puncturing.
  • Warning labels shall be affixed to all bags and containers used for medical waste or affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal. Labels must be water resistant and legible, colored fluorescent orange or orange-red (or predominantly so), with lettering or symbols in a contrasting color, and include the universal biohazard legend.
  • When medical waste leaves the facility where it was generated, the name and address of the generator must clearly be marked on the outside of the container. If the waste has been treated using an approved method, then it must also be labeled on the container with the words "TREATED" and "BIOHAZARDOUS WASTE" or "INFECTIOUS SUBSTANCE" or "MEDICAL WASTE" or the universal biohazard legend.
  • Medical waste that has been treated by an approved method and determined by the Department as rendered unrecognizable, is not required to have special packaging or labeling when transported or disposed. The handling and disposal of incinerator ash is regulated by the ADEQ.
  • Treated medical waste cannot be disposed of if it is in a red or orange-red bag or container and it must be further overpacked in a different color container and then labeled.
  • If medical waste requires labeling, packaging or management under federal regulations, then the generator shall comply with the labeling and other applicable requirements specified in those regulations.
  • Mechanical compaction of medical waste shall not be conducted prior to treatment and/or disposal, unless the mechanical compaction and treatment are part of a single, self-contained process that does not place employees or the public at risk of exposure to untreated medical waste.

Storage of Medical Waste

Medical waste packaged in disposable containers and shall be placed in disposable or reusable pails, cartons, drums, dumpsters or portable bins. Disposable and reusable systems shall be kept clean and rigid, be designed to prevent leakage of fluids, remain impervious to moisture, and be of sufficient strength to prevent tearing or bursting under normal conditions of use and handling and be kept sealed or closed to prevent leakage. The containers may be of any color and shall be conspicuously labeled

  • Storage of medical waste shall be in a manner and location which affords protection from unauthorized entry, animals, adverse weather conditions such as rain, snow, ice, sleet, hail and wind, does not provide a breeding place or a food source for insects and rodents and minimizes exposure of employees and the public. When waste is not being actively placed in storage, the area must be secured.
  • The location of the medical waste in storage shall be conspicuously marked with signs which shall include the universal biohazard legend.
  • Storage time within the generating facility shall not exceed thirty (30) days once the container has been filled and closed. Storage of medical waste for longer than thirty (30) days must be approved by the Department. Filled containers of medical waste must be held at room temperature or below in a secure location with limited access (unauthorized entry) as specified. If the generating facility is unable to control odor from its stored waste, the Department may require more frequent removal and further limit the storage time.

Transport of Medical Waste

The generator of medical waste may transport such waste to an off-site permitted treatment or disposal facility in a fully enclosed container designed to prevent leakage of fluids as outlined, without having to obtain a transportation permit. Generator's that transport their medical waste shall keep a log of all medical waste transported.

Commercial medical waste transporters must comply with additional requirements for transporting medical waste.

Treatment of Medical Waste

Treatment of medical waste shall be by one of the following methods:

  • Incineration. Burning of medical waste in conformance with the standards prescribed by the ADEQ or the U.S. EPA. A permit must be obtained from the ADEQ before an incinerator can be installed or operated. Inspection of incinerators shall be conducted by the ADEQ.
  • Sterilization Technology: Sterilization is the complete elimination of microbial viability. Procedures utilized must be performed properly and according to the manufacturer's operating instructions, provided the results changes the biological character or composition of the medical waste completely and reliably inactivating bacillus stearothermophilus spores or other appropriate organisms at a 4 Log 10 reduction (99.99%) or greater and meet or exceed the parameters listed below.
  • Disinfection: A potential less lethal process compared to sterilization that eliminates or inactivates many or all pathogenic microorganisms including viruses, fungi, and bacteria (but not necessarily all their endospores) on inanimate surfaces.
  • Discharge into the collection system of a publicly owned treatment works (POTW): Grinding and/or flushing of waste into a POTW within the generating facility, except as prohibited by the Department, the ADEQ or the superintendent/manager of the POTW.
  • Encapsulation: Complete encapsulation of medical waste in a solid matrix which will significantly reduce the possibility of exposure.
  • Other available technology (alternate technology):Technology other than listed above shall be evaluated and approved by the Department.

Disposal of Untreated Medical Waste

Disposal shall be by one of the following methods:

  • Discharged from the health care related facility into a POTW.
  • Interment: The disposition of pathological waste by burial or cremation according to standards and practices of the mortuary industry.
  • Other available technology: If approved by the Department.

*Not all methods of treatment and disposal are approved for all categories of medical waste. Check the regulations for the specific type of waste and approved disposal method.

Medical waste which may no longer serve to transmit an infectious disease and is not recognizable, may be disposed of in the regular solid waste stream and/or in a permitted landfill without any labeling requirements.

Untreated medical waste cannot be disposed of in a landfill.

Disposal of Treated Medical Waste

Treated medical waste may be disposed of in a permitted sanitary landfill. Solid waste landfills cannot accept liquid wastes. Treated medical waste, where applicable, must be packaged and labeled.

  • If the generator of medical waste has treated the waste by an approved method and it is packaged and labeled, then the waste may be included in the facility's normal, solid waste stream.
  • A health care related facility with an ADEQ permitted incinerator or use of an approved technology may accept medical waste for treatment/disposal from physicians and surgeons on staff of the health care facility without obtaining an commercial incinerator or non-incinerator technology permit or operating license. Satellite facilities including additional hospitals, affiliated off-site services and physician offices or other affiliated services owned and managed by the primary generator/treater may accept and treat such medical waste without a non-incineration technology permit or operating license unless the facility is engaged in medical waste disposal for profit.

Requirements for Transporters of Commercial Medical Waste

No person in Arkansas may transport commercial medical waste for a generator, other than the generator themselves, without first obtaining a Commercial Medical Waste Transportation Permit.

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. Arkansas is one of 26 states covered entirely by the federal OSHA 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. These requirements can be found in the HERC section entitled OSHA Standards for Regulated Waste.

Statutes, Regulations and Guidelines

Rules and Regulations Pertaining to the Management of Medical Waste from Generators and Health Care Related Facilities

Contacts

Arkansas Department of Environmental Quality

Arkansas Department of Environmental Quality - Solid Waste Management Division