State-by-State
Regulated Medical Waste Resource Locator
Useful
resources:
The
CDC provides guidance
for environmental infection control that impacts medical waste
rules.
Many
state rules are based in some part on OSHA's
Bloodborne Pathogens standard.
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AVMA Policy -- Medical Waste
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Regulated Medical Waste--Overview
What is RMW?
Unlike many environmental regulations that apply to veterinary clinics (e.g., hazardous waste rules), regulations governing medical waste are defined at a state, rather than a federal level. Adding yet a further level of complexity, authority for medical waste rules often comes from multiple agencies at the state level including state departments of health and environmental agencies.
The definitions of medical waste and regulated medical waste vary somewhat from state to state, however, in general:
- Medical waste usually refers to waste products that cannot be considered general waste, produced from healthcare premises, such as hospitals, clinics, doctors/dentists offices, veterinary hospitals and laboratories.
- Regulated medical waste (RMW) (also known as 'biohazardous' waste or 'infectious medical' waste in some states) is typically a subset of medical waste that poses a significant risk of transmitting infection to people.
In most states, RMW generated from veterinary facilities is limited to:
- Sharps waste (all needles, syringes with attached needles, suture needles, scalpels, and similar wastes)
- Animal carcasses, body parts, bedding and related wastes when animals are intentionally infected with organisms likely to be pathogenic to healthy humans for the purposes of research, in vivo testing, production of biological materials or any other reason.
There are several key categories of waste that are typically classified as 'regulated'. Each category typically has special handling requirements that may be state-specific. See the Types of Regulated Medical Waste page for more information on the classification of RMW. Also, use the RMW State Locator to find the definitions that apply in your state. Of course, it is not always clear how overall rules will apply to a specific situation. The RMW State Locator provides contact information for individuals in state agencies who may help resolve questions of interpretation.
Most state laws require RMW to be rendered non-infectious before it can be disposed of as solid waste. (See the RMW Treatment and Disposal page for more information.)
Regulatory
Overview--Past
In the late 1980s, when
the present system of medical waste regulation was being developed, EPA
played a central role. The pattern was similar to other forms of
environmental regulation, such as air emissions and solid waste. A
general framework was developed on a federal level, and was then adopted,
with relatively minor variations, in each state. However, after
that initial phase, the regulatory framework for medical waste developed
differently from the more typical pattern, with considerably more discretion
being left to individual states.
During the 1980's, the public became
aware that used syringes and similar wastes had been found washing up
on several East Coast beaches. In response, Congress enacted the Medical
Waste Tracking Act (MWTA), which required EPA to create a two-year
medical waste demonstration program. The MWTA:
- identified which wastes would be
regulated
- established a cradle-to-grave tracking
system based on a generator-initiated tracking form (similar to RCRA
manifests for hazardous
waste)
- required management standards for
segregation, packaging, labeling, and storage of the waste
- established record-keeping requirements
- defined penalties that could be imposed
for mismanagement
These standards for tracking and management
of medical waste were in effect in four states (New York, New Jersey,
Connecticut, Rhode Island), and in Puerto Rico, from June 1989 to June
1991. During this time, EPA also gathered information and performed
several studies related to medical waste management. The regulations
promulgated under the MWTA expired on June 21, 1999.
From the information gathered during
this period, EPA concluded that the disease-causing potential of medical
waste is greatest at the point of generation and naturally tapers off
after that point. Medical waste could therefore be considered more
of an occupational concern than an environmental concern
affecting the general public: the risk to the general public of
disease caused by exposure to medical waste is likely to be much lower
than the risk for the occupationally exposed individual.
The MWTA, along with EPA's associated
program, served to focus attention on the medical waste issue. It
also provided a model that was subsequently used by some states and by
other federal agencies in developing their own medical waste programs.
Regulatory
Overview--Present
EPA no longer plays a central role in
medical waste regulation; instead, the states and other federal agencies
have taken on that responsibility. The following summarizes the current
regulatory scheme for medical wastes.
State Medical
Waste Regulations. Nearly all 50 states have enacted medical waste
regulations to some extent. However, unlike state hazardous waste regulations,
which are all based on the federal RCRA standards, state medical waste
standards vary diversely. Some state medical waste rules are fashioned
after the Medical Waste Tracking Act, while others have little or no
resemblance to this historical law.
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 (e.g., MO, OK) or even
serve as the primary regulatory agency (e.g., CO). 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 (e.g., LA, MO).
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.
Many states also specifically address the disposal of animal carcasses.
AVMA Resources for Veterinary Practice or Workplace
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OSHA Regulations. 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.
In states with comprehensive medical waste
regulations, there are often overlaps between state environmental/department
of health rules and the OSHA bloodborne pathogens standard; however,
there are few, if any conflicts. Instead, one set of rules may be vague
or general, where the other is highly specific. In such cases, healthcare
facilities are advised to follow the more detailed or stringent regulations.
In states where comprehensive medical waste regulations do not exist,
the OSHA rules fill an important gap.
US EPA Regulations. Although EPA no longer plays a central role with medical waste management, EPA has active regulations governing emissions from Hospital/Medical/Infectious Waste Incinerators as well as requirements under the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) for certain medical waste treatment technologies which use chemicals for treating the waste.
DOT Regulations. The Department of Transportation (DOT) regulates the transport of hazardous materials. Some animal tissues, specimens, and samples along with cultures and other items are classified by DOT as hazardous materials if they meet certain qualifications as stated in 40 CFR 173.134 (Class 6, Division 6.2--Definitions and exceptions). Amputated dog legs, tissues from spays and neuters, enucleated eyes, nail clippings, extracted teeth, neoplastic tissues, and most other animal tissues offered for transport are not regulated as hazardous materials in transport unless they are known to or are reasonably expected to contain certain pathogens or unless they are packaged with amounts of dry ice, formalin, or alcohol above DOT's exemptions granted for small amounts of each of these.
The following are helpful resources:
For additional information on DOT rules, including packaging and shipping, see VetCA's Department of Transportation Regulations section.
What is not RMW?
While states do outline specific categories of regulated
medical waste, it is important that healthcare facilities understand
certain key concepts to avoid improper segregation of wastes.
One common misunderstanding, for example, is the use
of the word 'saturated' to define what material
can be considered solid waste versus RMW. In some states, 'saturated' typically
refers back to the OSHA blood borne pathogen standard,
which qualifies the meaning of 'saturated' as referring to "contaminated
items that would release blood or other potentially infectious
materials in a liquid or semi-liquid state if compressed".
In those cases, it would be a misinterpretation
to assume that any medical product that comes into contact with blood,
body fluids or other potentially infectious materials, no matter how
minor the contact, automatically becomes RMW. The OSHA 'saturation' definition
would allow most items with trace levels of contamination to be placed
in the solid waste stream.
Your state's rules may allow you to handle certain
wastes that you currently handle as medical wastes as part of the general
solid waste stream. Check the RMW State Locator for details on
your state's definitions.
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