Regulated Medical Waste
- Which waste stream should this waste material
- How do I manage Regulated Medical Waste?
- What will happen with the Regulated Medical Waste
- Where can I get more information?
Which waste stream?
In this section, you will find information that will
help you determine how various types of healthcare facility waste are
classified in North Carolina.
North Carolina classifies wastes generated by health
care facilities into four main categories:
- Hazardous wastes. This refers to a class
of wastes specifically defined in a federal law (the Resource Conservation
and Recovery Act, or RCRA). These wastes contain certain
toxic chemicals or have certain characteristics that cause them to
be a significant risk to the environment and/or human health. Certain
some chemotherapy waste is hazardous waste. In North Carolina, hazardous
waste regulations are enforced by the North Carolina Department of
Environment and Natural Resources (NC DENR).
- Medical waste. Medical waste means any
solid waste which is generated in the diagnosis, treatment, or immunization
of human beings or animals, in research, or in the production or
testing of biologicals. It does not include any hazardous waste,
radioactive waste, or household waste.
- Regulated medical waste (RMW). These are
a special subcategory of medical wastes that present significant
health risks such as the potential for infectious disease transmission,
and special rules apply to them. In North Carolina, RMW is defined
in general as "blood and body fluids in individual containers
in volumes greater than 20 ml, microbiological waste, and pathological
waste that have not been treated pursuant to specific standards.
However, if a waste has been designated as a "hazardous waste" by
the NC DENR, the hazardous waste rules apply. (Refer to the regulation
- Municipal solid waste. These wastes
present fewer environmental or health risks than medical wastes.
Municipal solid waste can be disposed of into dumpsters.
It is important that you categorize your facility's
- Hazardous waste disposed
of as regulated medical waste or municipal solid waste, or regulated
medical waste disposed of as municipal solid waste are violations
of the law and can result in substantial penalties.
- Conversely, most medical
waste may be handled as general solid waste and does not require
special handling or treatment.
- Correctly identifying and segregating your RMW
can reduce the cost of disposal. Regulated medical waste makes up
only a small portion of the total medical waste stream. In North
Carolina, roughly 9 to 15 percent of the waste stream at hospitals
is regulated medical waste. Some facilities, such as long-term care
facilities, generate medical waste, but little or no regulated medical
waste. Use the guidance and references below to accurately categorize
your wastes. For additional help, see Contacts below.
- Regulated medical waste that is treated to specific
standards can be disposed of as municipal solid waste, provided that
no local rules prohibit it.
Definition of Regulated
"Regulated Medical Waste" means blood and
body fluids in individual containers in volumes greater than 20 ml,
microbiological waste, and pathological waste that have not been treated
pursuant to specific rules (treatment requirements are covered under
1207 of the medical waste management rules).
Managing Regulated Medical
Requirements, for healthcare facilities that generate
regulated medical waste and send it off-site to a treatment/disposal
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
- 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
- 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
- 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
- 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
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
- Date shipped off-site,
- Name of transporter, and
- Name of storage or treatment
There are no reporting requirements. However, these
records must be maintained at the generatorÕs facility for at least
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
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
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
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 HERC section
entitled OSHA Standards for Regulated
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.
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
N.C. Hazardous Waste Section - Administers the RCRA Subtitle C program
which regulates some types of waste from medical facilities including
some chemotherapy waste.
Medical Waste Guidance and Interpretations