Infectious Medical Waste Definitions
Regulation of Infectious Medical Waste
Handling, Treatment and Management of Infectious
Infectious Medical Waste Definitions
Infectious medical waste (IMW) is waste capable
of producing an infectious disease because it contains pathogens of sufficient
virulence and quantity so that exposure to the waste by a susceptible
human host could result in an infectious disease. These wastes include
isolation wastes, cultures and stocks of etiologic agents, blood and
blood products, pathological wastes, other contaminated wastes from surgery
and autopsy, contaminated laboratory wastes, sharps, dialysis unit wastes,
discarded biological materials known or suspected to be infectious; provided,
however, infectious waste does not include waste treated to MDNR specifications.
An Infectious medical waste generator is any
single office (doctor’s office, dentist’s office, and the like) or facility
(hospital, nursing home, mortuary, and the like), whose act or process
first causes an infectious waste. A small quantity generator (SQG) of infectious
waste is defined as a generator of 100 kilograms (approximately 220 pounds)
or less of infectious waste per month. A transfer station permitted
as an infectious waste processing facility becomes the generator when
the infectious waste is transported for further processing.
Infectious medical waste includes the following wastes:
- Isolation wastes generated by patients who have
communicable diseases which are capable of being transmitted to others
via those wastes.
- Contaminated surgical, dialysis and laboratory wastes
generated by surgery, dialysis and laboratory departments in the process
of caring for patients who have communicable diseases which are capable
of being transmitted to others via those wastes.
- Cultures and stocks of infectious agents and associated
biologicals when discarded because of the high concentrations of pathogenic
organisms typically present in these materials.
- Blood and blood products including serum, plasma
and other components known or suspected to be contaminated with a transmissible
infectious agent. An exception is that the term “blood products” does
not include patient care waste such as bandages or disposable gowns
that are lightly soiled with blood or other body fluids, unless such
wastes are soiled to the extent that the generator of the wastes determines
that they should be managed as infectious wastes.
- Pathology wastes including tissues, organs, body
parts and body fluids that are removed during surgery and autopsy. All
such wastes must be considered infectious waste and include are animal
carcasses, body parts and bedding from animals contaminated with infectious
agents capable of being transmitted to a human host.
- Sharps including hypodermic needles, syringes and
scalpel blades. Broken glass or other sharp items that have come in
contact with material considered infectious by definition are also
of Infectious Medical Waste
Infectious waste in Missouri
is regulated as a non-hazardous solid waste under the Missouri Waste
Management Law. Missouri law charges the Missouri Department of Natural
Resources (MDNR) and the Missouri Department of Health (MDOH) with the
responsibility for regulation of infectious waste management:
- MDOH is responsible for regulating the on-site management
of infectious waste by Missouri hospitals defining wastes which are
considered infectious when produced by small quantity generators.
- MDNR is responsible for regulating all other aspects
of infectious waste management, including permit requirements, transportation,
In addition, to these state regulations there are some
federal Occupational Safety and Health Administration (OSHA) rules that
apply to infectious medical waste. Missouri is one of 26 states covered
entirely by the federal OSHA program. OSHA rules impact several aspects
of infectious medical waste, including management of sharps, requirements
for containers that hold or store IMW, labeling of IMW bags/containers,
and employee training. These requirements can be found in the HERC OSHA
Standards for Regulated Waste section.
Anyone generating infectious
waste must be aware of the requirements for infectious waste management. Included
in the requirements are the following major points:
- All infectious waste must be treated before disposal
in Missouri, except waste generated at individual residence.
- All sharps must be packaged in a rigid, leak proof
and puncture-resistant container prior to transport and all treated
and untreated sharps must be similarly packaged before disposal.
- If infectious medical waste is going to be transported
to a permitted treatment facility, the generator must prepare a tracking
document that will accompany the waste.
- All treated waste must be certified as having been
treated prior to disposal in a landfill in Missouri. The certification
must be provided to both the hauler and the landfill.
- The only requirement for infectious waste generated
at an individual residence is that it be packaged in rigid, leak proof
and puncture-resistant containers prior to disposal with regular household
Missouri regulatory agencies
set waste minimization and pollution prevention as the first priority
for managing wastes (i.e., maximum feasible reduction of the total volume
of IMW generated; the reduction of the toxicity of the IMW, or both). Practices
that are considered waste minimization and pollution prevention include
recycling, source separation, product substitution, and the use of less
toxic materials. Missouri regulatory agencies prefer that all IMW generators
consider performing a waste minimization and pollution prevention assessment
for their facility.
Management of Infectious Medical Waste
Packaging of Infectious
Prior to transport, all
infectious medical waste must be placed in rigid or semi-rigid, leak-resistant
containers clearly marked with the universal biohazard symbol prominently
displayed and labeled Infectious Waste or Biohazard Waste and sealed. All
containers must be closed in such a manner as to completely contain all
waste and the outside of the container must be kept free of contamination. Leak-resistant
containers are defined as containers that are closable with a tight fitting
lid and are leak proof on the bottom and sides.
Transportation of Untreated Infectious Waste
Unless a healthcare facility
is a small quantity generator (SQG), untreated infectious medical waste
can only be transported from the healthcare facility by transporters
who are licensed by the Missouri Department of Natural Resources (MDNR).
An SQG has three options for transportation:
- The generator may transport the properly packaged
waste using its own employees and vehicles, provided the vehicles
are closed and secure.
- If the SQG chooses not to transport its own waste,
the waste must be transported by an infectious waste transporter licensed
in Missouri for the transportation of infectious waste.
- In addition, untreated sharps may be transported
for the treatment by the United States Postal Service, as long as the
Postal Service requirements (39CFR111) are followed.
If the waste is transported off the premises of the
generator, it must be taken to a permitted infectious waste processing
facility, a hospital approved by both the MDNR and MDOH to accept such
waste, or out of the state. A tracking document must be prepared by
the generator, which accompanies the waste during transport.
The generator of infectious
waste that is to be transported to a permitted infectious waste processing
facility must prepare tracking documents which must include:
- name, mailing address, location and telephone number
of the generator,
- name and address of the designated facility which is
permitted to process the waste,
- name and address and Missouri Transporter identification
number of the transporter’s company, if other than the generator,
- quantity of waste to be transported,
- name and signature block for the transporter, and
- name and signature block for the receiving facility.
The healthcare facility
retains one copy of the tracking document and gives the transporter the
remaining copies. Within 35 days after the date that a waste shipment
is received by a processing facility, the processing facility must send
a final copy of the tracking document back to the generator.
Treatment of Infectious Waste
The following treatment technologies are approved for
the treatment of infectious waste by permitted facilities:
- Incineration; and
- Steam sterilization.
Chemical sterilization and other types of treatment
may be approved by the department on a case-by-case basis.
Disposal of Infectious Waste
- All sharps shall be packaged in rigid, leak-resistant
and puncture-resistant containers and sealed prior to disposal.
- Infectious waste treated to render it innocuous
may be disposed as a solid waste provided the treater certifies to
the transporter, if other than the generator, and certifies to the
sanitary landfill operator or processing facility operator that the
waste has been rendered innocuous.
- Incinerator residue from a permitted infectious
waste processing facility shall be considered to be a special waste
and handled accordingly.
Healthcare facilities generating infectious waste may
choose to treat that waste on site to render it innocuous and dispose
of it as solid waste. Such on-site treatment of infectious waste does
not require a permit or approval from the MDNR, except that on-site
incineration will require a permit from the Missouri Department of Natural
Resources (MDNR) Air Pollution Control Program or from a local air pollution
control agency. Some treatment methods may result in the discharge of
liquids and may be regulated by the MDNR Water Pollution Control Program
or the local sanitary sewer district.
Hospitals choosing to treat infectious waste on site
must comply with the requirements of the Missouri Department of Health
(MDOH). Acceptable methods for on-site treatment include incineration,
steam sterilization (autoclave) and chemical treatment.
For chemical treatment of sharps, the MDOH recommends
the use of one part common household chlorine bleach mixed with nine
parts water. This solution should be poured into the container of sharps
and allowed to remain for approximately thirty (30) minutes. The solution
must then be carefully poured off so that free liquid does not remain
in the container. The solution may be disposed of in the sanitary sewer
system. The sharps container must then be sealed prior to disposal.
Infectious waste transported off the premises of the
healthcare facility must be taken to a permitted infectious waste processing
facility (for example, a transfer station, incinerator or steam sterilizing
facility permitted to accept infectious waste), or to a hospital approved
by both the MDNR and the MDOH to accept the waste or out of Missouri.
In order for a hospital to be approved to accept infectious
waste from small quantity generators (SQG's), the hospital must submit
a request for approval to both MDNR and MDOH. Requirements for such requests
are specified in 10 CSR 80-7.010 and 19 CSR 30-20.020. Hospitals may
contact the Solid Waste Management Program and the MDOH - Bureau of Hospital
Licensing for information about the approval process.
Infectious waste generated by ambulance services
in the process of caring for and delivering a patient to a hospital
will be considered to be generated by the hospital to which the patient
is delivered. Therefore, hospitals receiving such waste from ambulance
services will not be required to obtain MDNR or MDOH approval for the
acceptance of infectious waste from off-site.
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. Missouri 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. These requirements can be found in the HERC section entitled OSHA Standards for Regulated Waste.
In this section, you will find links to points of
contacts at the Missouri 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. Specific
questions should be addressed to the local Missouri Department of natural
Resources (MDNR) Regional Office or to the Solid Waste Management Program
at (573) 751-5401.
Missouri Department of Natural Resources
Missouri Department of Health
Chapter 260 Environmental Control Section 260.203
Material Recovery, Incinerators, and Composting Facilities
Licensed Infectious Waste Transporters
Management of Infectious Waste by Small Quantity Generators