Medical waste

Scope

Medical waste is regulated primarily at the state level. States may regulate medical waste as a solid waste, special waste, hazardous waste, or a combination of all three. However, note that:

• OSHA’s BBP Standard covers “regulated waste,” by definition; however, any waste not covered by that standard is pulled under OSHA’s more general Sanitation Standard.
• DOT hazmat transportation requirements apply to non-exempted “infectous substances.”
• Other federal regulations not covered in this ezExplanation that may apply include the EPA requirement for facilities to identify their waste streams (per 40 CFR 260 and 262) and infectious disease controls from the Centers for Disease Control and Prevention (CDC).

Regulatory citations

• 29 CFR 1910 Subpart I — Personal protective equipment
• 29 CFR 1910.141— Sanitation
• 29 CFR 1910.1030 — Bloodborne pathogens
• 49 CFR 171 to 180 — Hazardous materials regulations

Key definitions

• Bloodborne pathogens: Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).
• Contaminated: The presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.
• Infectious waste (EPA): A waste that contains pathogens with sufficient virulence and quantity so that exposure to the waste by a susceptible host could result in an infectious disease.
• Infectious waste (Generator): A healthcare facility that produces infectious waste.
• Infectious waste (Transportation): The shipment or conveyance of medical waste by air, rail, highway, or water.
• Infectious waste (Transporter): A person engaged in off-site transportation of medical waste.
• Medical waste: A subset of wastes mostly generated at healthcare facilities, such as hospitals, physicians’ offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories. Generally, medical waste is healthcare waste that may be contaminated by blood, body fluids or other potentially infectious materials and is often referred to as regulated medical waste.
• Medical Waste Tracking Act: The expired federal medical waste tracking program run by EPA from 1988 to 1991.
• Occupational exposure (OSHA): Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.
• Other potentially infectious materials (OPIM):
  • The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
  • Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
  • HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.
• Regulated waste (OSHA):
  • Liquid or semi-liquid blood or other potentially infectious materials,
  • Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed;
  • Items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling;
  • Contaminated sharps; and
  • Pathological and microbiological wastes containing blood or other potentially infectious materials.
• Regulated medical waste: Waste generated specifically by the heathcare industry, including infectious and hazardous medical wastes.
• Sharps: Needles, syringes, scalpel blades, pipettes, specimen slides, cover slips, glass petri dishes, and broken glass potentially contaminated with infectious material.
• Universal precautions: An approach to infection control, where all human blood and certain human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

Summary of requirements

Healthcare facilities

• Understand the state medical waste regulations that apply to your waste.
• Understand the medical waste standards to maintain your healthcare accreditation, if applicable.
• Properly identify and manage all the types of wastes you generate.
• Separate, or segregate, medical waste from other waste types.
• Manage medical waste that is also a hazardous waste (certain chemotherapy drugs, disinfectants, sterilants, etc.) as hazardous waste.
• Treat or disinfect medical waste (or send the waste to a facility that will treat or disinfect it) before disposing of it.
• Ensure contaminated sharps are placed in appropriate sharps containers.
• Ensure proper packaging for transportation. (See Shipping and Transportation below.)
• Use a licensed medical waste transporter (if required by the state).
• Provide personal protective clothing and equipment (gloves, masks, aprons, etc.) to workers who manage medical waste.

Non-healthcare facilities

• Determine if OSHA’s BBP Standard applies to your establishment. The BBP Standard applies to general industry employers that have employees with occupational exposure, as defined at 1910.1030(b). Follow the requirements of the BBP Standard at 1910.1030, if applicable.
• Ensure employees take universal precautions when handling medical waste.
• Select and provide employees with (and train them in) the proper personal protective equipment to handle the waste, per 29 CFR 1910 Subpart I and 1910.1030, if applicable.
• Immediately discard and contain contaminated sharps in accordance with 1910.1030(d)(3)(iii)(A). This subparagraph goes over container type, labeling/coloring, accessibility, installation, overfill, closure, movement, leakage, and reuse.
• Immediately discard and contain non-sharp regulated waste in accordance with 1910.1030(d)(3)(iii)(B). This subparagraph goes over container type, labeling/coloring, closure, removal, and outside contamination,
• Discard and contain all other waste in accordance with 1910.141(a)(4). This regulation goes over receptacle construction, cleaning, maintenance, removal, and overall sanitation.
• Ensure proper packaging for shipping the waste. (See Shipping and Transportation below.)
• When 1910.1030 applies, dispose of “regulated waste” according to applicable regulations of the U.S., states and territories, and political subdivisions of states and territories. Generally, this means disposing of the waste per your state/territory and local environmental laws and regulations.

Shipping and transportation

• Review 49 CFR 173.134 to determine if your waste is covered infectious substances or exempted from DOT Hazardous Materials Regulations at 49 CFR 171 to 180. Consider reviewing the DOT publication, “Transporting Infectious Substances Safely,” June 10, 2022.
• Train all “hazmat employees” per 49 CFR 172 Subpart H, if your facility will package, label, and ship covered infectious substances. Drivers will also need training per 49 CFR 177.816.
• Ensure covered infectious substances are properly packaged and labeled to the specifications listed in the DOT’s Hazardous Materials Regulations.
• It is recommended to ship untreated medical waste in refrigerated box trucks.
• States may require transporters to obtain infectious waste, or special waste permits.