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 Infectious Medical Waste

• Blood, blood products and body fluids.
• Infectious sharps waste.
• Laboratory waste including all cultures and stocks of infectious agents, as specimen cultures from medical and pathological laboratories, wastes from the production of medical and pathological laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate and mix cultures.
• Contaminated animal waste.
• Waste identified by infectious waste generators which includes those wastes determined by the infectious waste generator or the infectious waste generator’s infectious control staff to be treated as infectious waste because of the risk of disease.

Managing Infectious Waste

The management of medical waste, which is not infectious, is not specifically addressed in Nebraska Title 132 Integrated Solid Waste Management Regulations.  Most medical or veterinary wastes may be disposed at a permitted municipal solid waste disposal area as long as they have not been contaminated with something that is considered infectious.  These wastes may include dressings, laboratory wastes, animal bedding, waste or carcasses.  The landfill or hauler of medical or veterinary wastes may have additional restrictions or disposal requirements specific to the disposal facility.

Infectious medical waste is specifically restricted by the Nebraska Department of Environmental Quality.  It is the responsibility of the generator of the waste to determine if it is infectious and to handle it properly.  According to Title 132, Chapter 13, “infectious wastes must not be disposed of at any solid waste disposal area unless such wastes are first rendered non-infectious by incineration, autoclaving, or other treatment method”.  This provision does not apply to infectious waste from households.  Prior written approval from the Nebraska Department of Environmental Quality for disposal at a municipal solid waste landfill is not required for infectious wastes that have been rendered non-infectious.

Household medical waste is any waste that is generated as a result of health care activities in the home.  In may include bandages, hypodermic needles and lancets.  Medical waste generated in the home is a health concern when it is infectious waste.  This infectious waste should be treated so the waste is no longer infectious or properly packaged so that the risk of exposing others to possible infection is reduced.  Properly treated or packaged household medical waste can be added to your general household waste or transported to a permitted municipal solid waste landfill.

Packaging of Infectious Medical Waste

NDEQ recommends the following guidelines for packaging and transporting infectious wastes generated in the home:

• Placement of the waste in a rigid or semi-rigid, puncture resistant and leak-proof container;
• Marking the container prominently with the universal Bio-hazard symbol;
• Labeling “Infectious Waste” or “Bio-hazard Waste”;
• Sealing the container; and
• Insuring that the outside of the container is free from contamination.

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.  Nebraska 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. 

Statutes, Regulations and Guidelines

Nebraska Title 132 Integrated Solid Waste Management Regulations

Contacts

For more information, contact NDEQ via MoreInfo@NDEQ.State.NE.US or phone: 402-471-2186.

NDEQ Field Offices.  The Field Office Section consists of 15 employees who conduct compliance inspections, complaint investigations, environmental sampling, project management, and local compliance assistance for the NDEQ’s Air Quality, Waste Management and Water Quality Divisions.

More Information

In this section, you will find links to points of contacts at the Nebraska 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.

Medical Waste Disposal Fact Sheet.