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Louisiana

Medical/Infectious Waste

Background Information
Definition of Infectious 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 Medical/Infectious Waste

Potentially infectious medical waste is the term used most extensively throughout the state health regulations.  Potentially infectious medical waste includes:

  • Cultures and stocks of infectious agents and associated biologicals, including cultures from medical and pathological laboratories, from research and industrial laboratories.
  • Human pathological wastes including tissue, organs, body parts and fluids that are removed during surgery or autopsy.
  • Human blood, human blood products, blood collection bags, tubes and vials.
  • Sharps used or generated in health care or laboratory settings.
  • Bandages, diapers, "blue pads," and other disposable materials if they have covered infected wounds or have been contaminated by patients isolated to protect others from the spread of infectious diseases.
  • Any other refuse which has been mingled with potentially infectious biomedical waste.

Eating utensils, animal carcasses and bedding, and "very small quantities" (less than 250 grams or 1/2 pound) of human or animal tissue, clean dressings, and clean surgical wastes from persons or animals not known to be infected, are excluded from the definition of potentially infectious biomedical waste. The last two categories of material must be disposed in tightly closed plastic bags or other impervious containers.

Animal carcasses and tissues and wastes from large animals must be disposed either as potentially infectious biomedical waste, or according to regulations of the Livestock Sanitary Board. Carcasses, tissue, and wastes of pets may be buried, rendered [cooked at a minimum temperature of 250 degrees Fahrenheit for at least thirty (30) minutes], incinerated, or disposed either in accordance with these regulations or on the order of a licensed veterinarian.

Regulation of Medical Waste

In Louisiana, there are three (3) sources of regulations for medical wastes:

  • Louisiana Department of Environmental Quality, (DEP)
  • Louisiana Department of Health and Hospitals (DHH), and
  • Occupation Safety and Health Agency (OSHA)

The DEP is authorized to promulgate rules and regulations for the transportation, incineration, and disposal of medical waste.  At this time, DEP rules only regulations only cover disposal aspects of infectious waste.

The DHH rules and regulations for medical waste are far reaching; they cover packaging and labeling, storage, transport, and treatment.

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. 

Managing Regulated Medical Waste

The following is a summary of Louisiana Department of Health and Hospitals Regulations pertaining to medical waste.  This agency has regulations governing the packaging, labeling, storage, transportation, and treatment of medical waste, contained in the Louisiana Sanitary Code, Chapter XXVII.

Packaging and Labeling - Potentially infectious biomedical waste (i.e., medical waste) must be packaged in a manner that prevents exposure to the material. Liquids must be in a sturdy, leak-resistant container. Sharps must be in a closed, rigid, break-resistant, puncture-resistant container. Plastic bags and other containers must be clearly labeled, impervious to moisture, strong enough to prevent tearing or bursting under normal conditions, and closed prior to transport. A second level of containment is necessary if the material is to be stored prior to transport.

All containers of potentially infectious biomedical waste must be labeled "Potentially Infectious Biomedical Waste," "Medical Waste," or "Infectious Waste." Untreated waste must bear the name and address of the generator or transporter when it leaves the generator's premises. Treated waste that is still recognizable must carry a supplemental label to specify the treatment method used, the date of treatment, and the name or initials of the person responsible for treatment. All labels must be clearly visible and legible, and must be water resistant. Note: There are no requirements in the DHH Regulations that state that the bags, boxes, containers, etc., be a certain color.

Storage and Transport - Potentially infectious medical wastes must be stored in a secure manner. Compactors shall not be used for storage. Except for small quantities (defined as a single package containing less than 11 pounds of waste other than sharps or less than 2.2 pounds of sharps), wastes can be transported off the site where they were generated only by transporters permitted by the State Health Officer.

Small quantity generators, including doctors', dentists', and veterinarians' offices and private households, may transport small quantities of properly packaged and labeled wastes to approved large quantity generators, permitted storage facilities, or permitted treatment facilities without meeting the requirements for transport and treatment that large quantity generators must meet.

Transportation of potentially infectious waste (except by small quantity generators, as described above) is governed by Section 27:023 of the regulations. This section contains provisions for transporter permits; written contracts between generators and transporters; vehicles used in transportation; transporter operation plans (including worker safety and decontamination provisions), and delivery of potentially infectious biomedical waste only to properly permitted facilities.

Treatment and Disposal ­ Healthcare facilities may store and treat their own potentially infectious biomedical wastes, if they obtain a proper permit and comply with substantive provisions of the regulations as to packaging, labeling, storage, transportation, and treatment.

Acceptable treatment methods for potentially infectious biomedical waste include:

  • incineration,
  • steam sterilization [generally, autoclaving at least 248 degrees Fahrenheit (120 degrees C.) and a minimum pressure of 15 psi for a minimum of 30 minutes, or longer if necessary,
  • disposal of liquids into a sanitary sewer system that meets the requirements of the sanitary code,
  • thermal inactivation [dry heat of at least 320 degrees F. (160 C.) at atmospheric pressure for at least 2 hours, excluding lag time,
  • chemical disinfection (use of chemical agents that have been approved by the State Health Officer), and
  • irradiation (only with the written approval of the State Health Officer).

Sharps must be incinerated, encased in plaster or other approved substances in a tightly closed container, or treated in some other manner that renders them unrecognizable as medical sharps and practically precludes the release of recognizable needles and syringes if compacted.

Once treated, potentially infectious biomedical waste may be disposed in a permitted sanitary landfill in accordance with the Solid Waste Regulations of the Department of Environmental Quality. As noted above, treated and still recognizable medical waste must carry a supplemental label specifying the treatment method and date, and the name or initials of the person responsible for treatment.

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.  Louisiana 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

Louisiana Part XXVII. Management of Refuse, Infectious Waste, Medical Waste, and Potentially Infectious Biomedical Waste (see pages 292 to 299).

Contacts

Louisiana Department of Environmental Quality

Louisiana Department of Health and Hospitals

More Information

Medical Waste Considerations, detailed information covering the regulations of various Louisiana agencies, published by the Louisiana Department of Environmental Quality.