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North Dakota

Medical Waste

Background Information
Definition of Regulated Infectious Waste

Managing Regulated 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 Regulated Infectious Waste

Regulated infectious waste is considered a solid waste and is defined as follows:

  • Cultures and stocks of infectious agents and associated biologicals, including cultures from medical and pathological laboratories; cultures and stocks of infectious agents from research and industrial laboratories; wastes from the production of biologicals; discarded live and attenuated vaccines; and culture dishes and devices used to transfer, inoculate, and mix cultures.
  • Pathological waste. Human pathological waste, including tissues, organs, and body parts and body fluids that are removed during surgery or autopsy, or other medical procedures, and specimens of body fluids and their containers.
  • Human blood and blood products. Liquid waste human blood; products of blood; items saturated or dripping with human blood; or items that were saturated or dripping with human blood that are now caked with dried human blood (including serum, plasma, and other blood components, and their containers).
  • Sharps that have been used in animal or human patient care or treatment or in medical, research, or industrial laboratories, including hypodermic needles, syringes (with or without the attached needle), pasteur pipettes, scalpel blades, blood vials, needles with attached tubing, and culture dishes (regardless of presence of infectious agents). Also included are other types of broken or unbroken glassware that were in contact with infectious agents, such as used slides and cover slips.
  • Animal waste. Contaminated animal carcasses, body parts, and bedding of animals that were known to have been exposed to infectious agents during research (including research in veterinary hospitals), production of biological, or testing of pharmaceuticals.
  • Isolation waste. Biological waste and discarded materials contaminated with blood, excretion, exudates, or secretions from humans who are isolated to protect others from highly communicable diseases, or isolated animals known to be infected with highly communicable diseases.
  • Unused sharps. Unused, discarded sharps, hypodermic needles, suture needles, and scalpel blades.

Ash from incineration and residues from disinfection processes are not infectious waste once the incineration or the disinfection has been completed.

Managing Regulated Infectious Waste

Every person who collects, stores, transports, treats, or disposes of regulated infectious waste shall comply with the following standards of performance.

  • At the point of origin, regulated infectious waste must be separated from other wastes and placed in distinctive containers which do not leak and which are impervious, puncture resistant, and tear resistant and which contain obvious markings (for example, red or orange plastic bags or the biohazard label). Bags and containers holding regulated infectious waste must be tied, closed, or sealed securely to prevent leakage.
  • At the point of origin, sharps must be separated from other regulated infectious waste, disinfected onsite, rendered non-sharp onsite, and then disposed; or, placed in rigid and puncture-resistant biohazard containers and handled as required.
  • The handling and storage of regulated infectious waste, before treatment, must be conducted in a manner that minimizes exposure to employees of the waste generator, the waste transporter, and the public.
  • Recycled containers or devices such as carts used for the handling of wastes must be disinfected after each use.
  • All regulated infectious waste must be incinerated or disinfected and sharps that are not incinerated must be rendered non-sharp before disposal. Incineration and disinfection equipment and facilities shall meet all applicable requirements.
  • Blood and blood products can be discarded without incineration or disinfection through municipal sewage disposal systems that meet applicable requirements.
  • The disposal of nonviable human fetuses shall meet all applicable requirements.
  • An infectious waste that is not regulated may be disposed at a permitted municipal waste landfill.
  • Household waste containing regulated infectious waste in amounts normally found in household waste may be disposed of at a permitted municipal waste landfill.

General Requirements

  • Any person who owns or operates any premises, business establishment, or industry is responsible for infectious waste management activities, such as storage, transportation, resource recovery, or disposal, of infectious waste generated or managed at that person's premises, business establishment, or industry.
  • No infectious waste may be delivered to a facility that is not in compliance or abandoned upon any street, alley, highway, public place, or private premises.
  • Infectious waste must be stored, collected, and transported in a manner that provides for public safety, prevents uncontrolled introduction into the environment, and minimizes harborage for insects, rats, or other vermin.
  • Except in unincorporated areas of this state, household waste must be removed from the premises or containers at regular intervals not to exceed seven days and transported to a solid waste management unit or facility.

Collection and Transportation Vehicles

  • Vehicles used for the commercial collection and transportation of any residue, sludge, agricultural, inert, industrial waste, or special waste must be loaded and moved in such a manner that the contents will not fall, leak, or spill there from. Where spillage does occur, the collector or transporter shall immediately return spilled waste to the vehicle or container and, if necessary, clean and decontaminate the area.
  • Vehicles used for the commercial collection and transportation of regulated infectious waste, household waste, or municipal waste incinerator ash must be fully leak proof and fully enclosed or covered to prevent scattering of material. Regulated infectious waste may not be subject to mechanical stress or compaction during loading, unloading, and transit. Any spilled material must be immediately returned to the transport vehicle or container and, if necessary, the area must be cleaned and decontaminated.
  • The cargo-carrying body of a vehicle used for commercial collection or transportation of solid waste must be maintained in good repair and in sanitary condition.

Permits

Every person who treats or transports solid waste or operates a solid waste management unit or facility is required to have a valid permit issued by the department, unless the activity is an emergency, exemption, or exception.

Permit Exemptions

A solid waste management permit is not required for the following activities or facilities:

  • Onsite incinerators used by hospitals, clinics, laboratories, or other similar facilities solely for incineration of commercial waste or infectious waste generated onsite;
  • Transport solely their own waste to a solid waste management unit or facility; or
  • Transport waste entirely within a regulated facility or entirely on their property.

Treatment and Resource Recovery Facilities

The owner or operator of a facility that conducts treatment or resource recovery other than processing shall comply with the following standards:

  • All liquids must be collected and treated to meet water protection provisions.
  • Surface water must be diverted away from all open storage areas.
  • Solid waste must be confined to storage containers and areas specifically designed to store waste. Waste handling and storage systems must provide sufficient excess capacity to prevent nuisances, environmental impacts, or health hazards in the event of mechanical failure or unusual waste flows.
  • Resource recovery systems or facilities must be operated on first-in, first-out basis. Stored solid waste containing garbage may not be allowed to remain unprocessed for more than forty-eight hours unless adequate provisions are made to control flies, rodents, odors, or other environmental hazards or nuisances.
  • All solid waste, recovered materials, or residues must be controlled and stored in a manner that does not constitute a fire or safety hazard or a sanitary nuisance.
  • All residues from resource recovery systems or facilities must be handled and disposed of according to applicable regulations.
  • All incinerators used for solid waste must be constructed and operated in compliance with applicable regulations.

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.  North Dakota 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

North Dakota Solid Waste Management Rules - Regulated Infectious Waste (Chapter 33-20-12)

Contacts

North Dakota Health Department

North Dakota Waste Management

More Information

North Dakota Regulated Infectious Waste Information

Infectious Waste Guide

ND Solid Waste Management Rules - Regulated Infectious Waste

Infectious Waste Treatment/Disposal Facilities