Veterinary Compliance Assistance
Back to the
Regulated Medical Waste Resource Locator































































North Carolina

Regulated Medical Waste

Managing Regulated Medical Wastes
Registration, Permits
Packaging and Storage
Training Requirements
Plans, Recordkeeping and Reporting
Treatment and Disposal of Regulated Medical Waste
On-site Treatment Requirements
OSHA Regulations
Statutes, Regulations and Guidelines
Additional Resources

Managing Regulated Medical Wastes

Requirements, for healthcare facilities that generate regulated medical waste and send it off-site to a treatment/disposal facility

Registration, Permits

Generators of regulated medical waste are not required to register with the state of North Carolina and no RMW generator permits are required by the state of North Carolina.  Also, permits are not required for hospitals and similar facilities that treat only waste generated within the facility. Permits are required for facilities that treat medical waste from off-site.

Packaging and Storage

  • Packaging of Regulated Medical Waste for Off-Site Treatment. There are certain specific rules that healthcare facilities must follow for packaging regulated medical waste. These include:
    • Regulated Medical Waste must be packaged in a plastic bag in a rigid fiberboard box or drum in a manner that prevents leakage of the contents.
    • The outer surface of the box or drum must be labeled with a biohazard symbol; the words "INFECTIOUS WASTE" or "MEDICAL WASTE"; the date of shipment; and the name, address and phone number of the generator, transporter, storage facility and treatment facility.
    • The medical waste management rules do not require a biohazard label on the plastic bag or use of red bags. However, generators should be aware that OSHA rules may require labeling of bags containing some types of medical waste.
  • Storage of Regulated Medical Waste Prior to Shipment Off-Site for Treatment. There are certain specific rules that health care facilities must follow for packaging regulated medical waste. These include:
    • A plan must be maintained at the facility to ensure proper management of regulated medical waste.
    • Areas used to store regulated medical waste must be accessible only to authorized personnel.
    • All medical waste, including regulated medical waste, must be stored in a manner so as not to create a nuisance either by noxious odors or by encouraging the presence of insects or vermin.
    • RMW must not be compacted.
    • Regulated medical waste that will be shipped off-site for treatment must be stored in packaging suitable for transportation and in a manner that maintains the integrity of the packaging, including labels and markings.
    • All floor drains in the storage area must discharge directly to an approved sanitary sewer (sewer or septic system).
    • Ventilation must be provided.
    • There are no maximum time limits for storage of RMW destined for off-site treatment.
  • Packaging Requirements for Regulated Medical Waste Which Will Be Treated On-Site. The packaging requirements only apply to regulated medical waste that is being shipped off site for treatment. There is no packaging requirement for regulated medical waste treated on-site.
  • Storage Requirements for Medical Waste Which Is Not Classified as Regulated Medical Waste. If none of the medical waste being stored is regulated medical waste, the waste is subject to the storage requirements of general solid waste. As with regulated medical waste, non-regulated medical waste must be stored in a non-putrescent state, and vermin and insects must be controlled.

Training Requirements

  • All employees involved with the on-site management of RMW must be trained in accordance with the requirements of the OSHA Exposure to Bloodborne Pathogens regulations (29 CFR 1910.1030).

Plans, Recordkeeping and Reporting

These rules apply to facilities that generate 50 pounds or more regulated medical waste per month.

Generators must prepare a plan to ensure proper management of regulated medical waste. The plan must be maintained at the generating facility. Generators must maintain records for each shipment of RMW. The records must include:

  • Amount of waste by number of packages,
  • Date shipped off-site,
  • Name of transporter, and
  • Name of storage or treatment facility.

There are no reporting requirements. However, these records must be maintained at the generatorÕs facility for at least three years.

Treatment and Disposal of Regulated Medical Waste

In this section, you will find information on the proper final disposition of the Regulated Medical Waste (RMW) stream, including RMW sent off-site and RMW treated on-site.

Regulated medical waste may be treated on-site or at a facility that is an integrated part of the generating facility (e.g., one or more healthcare facilities located in a single county or two contiguous counties, facilities affiliated with a university, or facilities that serve a single service area).

On-site Treatment Requirements

The following are acceptable methods for treating regulated medical wastes:

    • Blood and body fluids in individual containers in volumes greater than 20 ml: Incineration or sanitary sewage systems provided the sewage treatment authority is notified.
    • Microbiological waste: Incineration, steam sterilization, microwave treatment, or chemical treatment.
    • Pathological wastes: Incineration.

Other methods of treatment shall require approval by the NC Division of Waste Management (see Alternative Medical Waste Treatment Technologies.

The following general rules apply to healthcare facilities that treat regulated medical waste:

  • Regulated medical waste may be stored prior to treatment for no more than seven calendar days and may be stored no longer than seven calendar days after treatment.
  • Only authorized personnel may have access to areas used to store RMW.
  • All areas used to store RMW must be kept clean. Vermin and insects shall be controlled.
  • Neither carpets nor floor coverings with seams may be used in storage areas.
  • Prior to treatment, all RMW be confined to the storage area.
  • All floor drains must discharge directly to an approved sanitary sewage system.
  • Ventilation must be provided and must discharge so as not to create nuisance odors
  • A plan shall be prepared, maintained and updated as necessary to ensure continued proper management of Regulated medical waste at the facility.
  • Records or treatment must be maintained for at least three years, including: each shipment and shall include the following information: name and address of generator, date received; amount of waste received by number of packages (piece count), date treated, and name and address of ultimate disposal facility.
  • Facilities that treat waste generated off-site shall submit an annual report to the Division of Waste management, by August 1 of each year.
  • Specific operational requirements for steam sterilization, incineration, chemical and microwave treatment requirements can be found in the Medical Waste Management Rules.

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. North Carolina 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. These requirements can be found in the VetCA section entitled OSHA Standards for Regulated Waste.

More Information

In this section, you will find links to points of contacts at the North Carolina agencies responsible for regulating healthcare facility waste, links to the text of the regulations, and additional resources that you might find of interest on this topic.


North Carolina Department of Natural Resources, Division of Waste Management.

Statutes, Regulations and Guidelines

Medical Waste Management Rules: Section 1200

Medical waste is also subject to all general requirements for solid waste found in the solid waste management regulations.

N.C. Hazardous Waste Section - Administers the RCRA Subtitle C program which regulates some types of waste from medical facilities including some chemotherapy waste.

Additional Resources

A guidance document, Look Here First, discusses North Carolina medical waste issues and  regulations.

Alternate (non-incineration) Technologies - Includes a list of approved medical waste treatment systems available for use in North Carolina, information on obtaining state approval, and links to other governmental agencies.

A Guide to Bloodborne Pathogens in the Workplace. A guide published by the N.C. Department of Labor, Division of Occupational Safety and Health.

VetCA Home