 Types of Regulated Medical Waste (RMW)
Definitions of "Medical
Waste"
Although there is no universally accepted definition
for medical waste, the definitions offered by most regulatory agencies are
similar. Most federal and state agencies differentiate between common medical
waste and those wastes with the potential for causing infection and for which
special precautions are prudent. Depending on the state, these wastes are referred
to as:
- Regulated medical waste (e.g., NY, RI)
- Infectious waste (e.g., CO, NE, NV)
- Biomedical waste (e.g., CT, FL, GA, ME, WA).
Some state regulations use a general definition,
while others list specific wastes and categories of waste that are considered
infectious. Some states have adopted the definition found in federal standards
(e.g., Nevada adopted the DOT definition).
The following six medical wastes are commonly
regulated by states:
- Pathological waste.
Tissues, organs, body parts, and body fluids removed during surgery and
autopsy.
- Human blood and blood
products. Waste blood, serum, plasma and blood products.
- Cultures and stocks of
infectious agents (microbiological waste). Specimens from medical
and pathology laboratories. Includes culture dishes and devices used
to transfer, inoculate, and mix. Also includes discarded live and attenuated
vaccines.
- Contaminated sharps.
Contaminated hypodermic needles, syringes, scalpel blades, Pasteur pipettes,
and broken glass.
- Isolation waste. Generated
by hospitalized patients isolated to protect others from communicable disease.
- Contaminated animal carcasses,
body parts and bedding. From animals intentionally exposed to pathogens
in research, biologicals production, or in vivo pharmaceuticals testing.
Please note that the above medical wastes, with the exception of sharps, may be referred to as "red bag waste" (RBW), because at the point of generation, these wastes are typically placed into a red plastic bag for easy identification. Conversely, sharps are placed into special hard red plastic containers (i.e., sharps container) to prevent accidental "sticks" during handing and disposal.
More detailed discussions of these waste types
are provided in the sections below.
Pathology
and Anatomy Wastes
Definition: All
human anatomical wastes and all wastes that are human tissues, organs, or body
parts removed by trauma, during surgery, autopsy, studies, or another hospital
procedure, which is intended for disposal.
It is important to understand the distinction between anatomical
and pathological waste. While both are wastes derived from the human body,
pathological wastes are unique in that these are typically samples of tissues
that are examined in a laboratory setting to understand the nature of the disease
or affliction from which a patient suffers. For the most part, pathological
waste refers to very small tissues sections and body material derived from
biopsies or surgical procedures that are then examined in the lab. Anatomical
wastes are typically distinguished as recognizable human organs, tissue and
body parts, and may require special treatment under some state regulations.
Some states do not consider hair, teeth and nails to be pathological/anatomical
waste.
Bulk
human blood, blood products, bulk body fluids or other potentially infectious
material (OPIM- as defined by OSHA)
Definition: Bulk
waste human blood, human blood components or products derived from blood
including serum, plasma and other blood components, or bulk human body fluids
as defined by OSHA to include 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 visually contaminated with blood, and all body fluids
in situations where it is difficult or impossible to differentiate between
body fluids.
This category includes sample of these fluids taken
in hematology labs, as well as drainage from surgery, and urine or feces
when visibly contaminated by blood.
Microbiological Waste
Definition: Cultures and stocks of infectious
agents, and associated microorganisms and biologicals. Discarded cultures,
culture dishes and devices used to transfer, inoculate and mix cultures, stocks,
specimens, live and attenuated vaccines and associated items if they are likely
to contain organisms likely to be pathogenic to healthy humans. Discarded etiologic
agents and wastes from the production of biologicals and antibiotics that likely
have been contaminated by organisms likely to be pathogenic to healthy humans.
Waste that originates from clinical or research laboratory procedures involving
communicable infectious agents.
Note: Microbiological waste that is also considered
a ‘sharp' as defined below, should be managed first and foremost
as a ‘sharp'. It is also important to note what materials your
laboratories are working with, as there are special guidelines from CDC on
how to handle infectious microorganisms at biosafety level (BSL) 3 and BSL
4. Recent federal regulations require healthcare facility laboratories to maintain
the capability of destroying discarded cultures and stocks on-site if these
laboratories isolate from a clinical specimen any microorganism or toxin identified
as a ‘select agent' from a clinical specimen (Table 27- CDC Report
on Environmental Infection Control)
References:
- U.S. Department of Health and Human Services, Office
of Inspector General, DC. Possession, use, and transfer of select gents and
toxins, interim final rule (42 CFR part 73) Federal Register, December 13,
2002; 67(240):76885–905.
- U.S. Department of Agriculture, Animal and Plant Health
Inspection Service. Agricultural Bioterrorism Protection Act of 2002; Possession,
use, and transfer of biological agents and toxins: Interim final rule (9
CFR Part 121). Federal Register. December 13, 2002; 667(2240):76907–38.
Definition: Items
that can induce subdermal inoculation of infectious agents or that can easily
penetrate the skin, puncture waste bags and cardboard boxes. Sharps that have
been used or are intended to be used in human or animal patient care or in
medical, research, or industrial laboratories include hypodermic needles,
syringes, Pasteur pipettes, capillary tubes, broken glass from the laboratory
including slides and slide covers, razor blades, and scalpel blades.
Sharps require special handling and packaging under both
OSHA and DOT. Be sure to refer to your state's guidelines when identifying
what items are classified as sharps. There is confusion that often needleless
injection devices, heel lancers and retractable or needles destruction technologies
are considered sharps as well.
Isolation Wastes (Wastes from Highly
Communicable Diseases)
Definition: Biological
waste and discarded materials contaminated with blood, excretion, exudates
or secretion from humans or animals who are isolated to protect others from
highly communicable diseases (Lassa fever virus, Marburg virus, monkey pox
virus, Ebola virus and others (see list in Table 27- CDC).
Animal Waste
Definition: Animal carcasses, body parts, bedding and related wastes that may have been exposed to human infectious agents during research, production of biologicals, or testing of pharmaceuticals.
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