Infectious Medical Waste
Definition of Infectious
There are eight categories of infectious medical wastes
in West Virginia:
- Cultures and stocks of microorganisms and biologicals
- Blood and blood products
- Pathological wastes
- Sharps (Sharps which are rendered noninfectious
and encapsulated in a solid state on-site may be discarded as solid
- Animal waste
- Isolation wastes
- Residue (e.g., soil, water, debris) from clean
up of infectious medical waste
- Waste contaminated or mixed with infectious medical
For the complete definition of infectious medical
waste see Statutes, Regulations, and Guidelines below.
In this section, you will
find the key rules that apply to the management of the Infectious
Medical Waste (IMW) stream inside your facility.
Most hospitals and similar medical facilities are termed
non-commercial infectious medical waste facilities, because they generate
and in some cases treat infectious medical waste (commercial infectious
medical waste facilities are typically facilities that treat and dispose
of infections medical waste). Non-commercial infectious medical waste
facilities that generate less than 50 pounds per month of IMW are termed
small quantity generators and have fewer requirements to meet.
Hospitals and similar healthcare facilities must develop
and follow an infectious medical waste management plan that
addresses various aspects of waste management. The required contents
of the plan are detailed in the Infectious Medical Waste rules (Title
64, Series 56-5). Examples of required elements include: methods
used for handling, storage, separation, volume-reduction, and treatment;
responsibilities of personnel; training; off-site disposal plans; and
It is illegal to transport, treat or dispose of infectious
medical without first obtaining a permit from the Department of Health
and Human Resources. Hospitals and similar healthcare facilities must
provide public notice on intent to apply for a permit and maintain a
public participation file. The application for a permit must be submitted
to Department of Health and Human Resources on prescribed forms. Permits
must be renewed annually. Prior to any major changes (e.g., adding a
new treatment unit) being made, the facility must submit an application
Infectious medical waste must be labeled
prior to being stored on-site or transported off-site. The label must
be securely attached to the outer layer of packaging and must be clearly
legible. The label may be a tag securely affixed to the package. Indelible
ink must be used to complete the information on the label, and the label
must be at least three (3) inches by five (5) inches in size. The following
information shall be included on the label:
- The name, address, business telephone and fax numbers
of the generator;
- The words "infectious medical waste" or "biomedical
waste" or "biohazard" or "regulated medical waste";
- The name, address, business telephone and fax numbers
of all transporters, treatment facilities, or other persons to whose
control the infectious medical waste is being transferred and the permit
numbers of transporters, if applicable; and
- The date on which the infectious medical waste
noninfectious medical waste must be labeled prior to being transported
off-site. Treated medical waste that will pass through a screen with
a one-half inch (2O) grid is considered not recognizable. The label
must be sized and attached in the manner described above. The following
information shall be included on the label:
- The name, address and business telephone and fax
numbers of the generator;
- The name, address, and business telephone and fax
numbers of the facility at which the waste was rendered noninfectious;
- The weight of the treated noninfectious medical
waste and the method of treatment;
- A signed and dated certification by the facility
at which the waste was rendered noninfectious.
All infectious medical
waste must be packaged using specific methods prior to storage, treatment,
or transport. The following summarizes key packaging requirements.
Details can be found in the Infections Medical Waste rules (Title
64, Series 56-6).
- Infectious medical waste must be contained and
sealed on-site in leak-proof plastic bags.
- Free liquids must be contained in break-resistant,
tightly stoppered containers. Heavier materials must be supported in
double-walled corrugated fiberboard boxes or equivalent rigid containers.
- Sharps must be collected at the point of generation
in rigid, leak-proof and puncture-resistant containers clearly marked
as infectious medical waste. If the sharps are to be stored or treated
off-site, the containers must be placed inside a plastic bag. Prior
to storage, the plastic bags must be bound at the gathered open end
with tape or another closing device that prevents leakage of liquids.
- All bags containing infectious medical waste must
be red in color except that infectious medical waste that is to be
steam treated must be contained in orange bags and marked with autoclave
tape or other heat-activated ink which will indicate whether or not
the appropriate temperature has been reached. Both red and orange bags
must be imprinted with the international biohazard symbol and the words "infectious
medical waste" or "biomedical waste" or "biohazard" or "regulated
medical waste" if treatment is to occur off-site.
- All infectious medical waste which is to be transported
off-site must also be packaged in double-wall corrugated fiberboard
boxes or equivalent rigid containers. The boxes or containers must
be leak-resistant or lined with a tear-resistant leak-proof plastic
bag. Reusable containers must be leak-proof and vermin- proof, must
have tight-fitting covers, and be kept clean and in good repair.
Storage rules apply at any time after packaging (sealing)
for transport, including time spent during transportation and at all
treatment and disposal sites or facilities. The key storage rules include:
Infectious medical waste other than sharps shall not
be stored for more than thirty (30) days prior to transportation to an
infectious medical waste management facility, even if refrigerated: Provided,
that the total amount of storage time, including transportation to an
infectious medical waste management facility, shall not exceed forty-five
(45) days. Facilities that treat infectious medical waste on-site must
not store the infectious medical waste more than thirty (30) days.
- Infectious medical waste must be stored in a specifically
designated area located at or near the treatment site, or at the pickup
point if it is to be transported off-site for treatment.
- The manner of storage must maintain the integrity
of the containers; prevent the leakage of waste from the container;
provide protection from water, rain and wind, and maintain the waste
in a non-putrescent state.
- All storage areas shall be constructed of materials
which are durable, easily cleanable, impermeable to liquids, and vermin-proof.
- Carpets and floor coverings with open seams in
which water may be entrapped must not be used in storage areas. All
floor drains must discharge directly to a sanitary sewage disposal
system which is in compliance with sewage system rules or a containment
system which prevents any spilled materials from reaching the environment.
- All storage areas must be kept clean and in good
- All storage areas must have access control. The
areas must be posted prominently with the international biohazard symbol
and with warning signs located adjacent to the exterior of entry doors,
gates or lids which indicate the use of the area for storage of infectious
medical waste and that entry to unauthorized persons is denied.
- Compaction of infectious medical waste or subjecting
infectious medical waste to violent mechanical action is prohibited
unless as a part of an approved treatment process.
All hospitals and similar healthcare facilities must
keep a spill containment and cleanup kit within the vicinity of any area
where infectious medical waste is managed on a bulk storage basis. The
location of the kit must provide for rapid and efficient cleanup of spills
anywhere within the area. The kit must contain:
- Absorbent material sufficient to have a rated capacity
of one gallon of liquid for every cubic foot of infectious medical
waste that is normally managed in the area for which the kit is provided
or of ten (10) gallons, whichever is less;
- one gallon of hospital grade disinfectant in a
- enough red plastic bags to enclose 150% of the
maximum quantity stored or transported.
- two (2) new sets of overalls, gloves, boots, caps,
and devices to protect the eyes and respiratory tract, and tape for
sealing wrists and ankles.
- an adequate first aid kit; and
- one hundred (100) yards of boundary marking tape.
Immediately following a spill of infectious medical
waste or its discovery, all individuals present must leave the area until
any aerosol settles. The cleanup crew must implement the following procedures
for cleaning up a spill:
- put on cleanup outfits;
- secure the spill area from entry by unauthorized
- spray all broken containers of infectious medical
waste with disinfectant;
- place broken containers and spillage in the packing
bags in the kit;
- disinfect and take other steps necessary to clean
up the area;
- clean and disinfect non-disposable items and clothing;
- remove cleanup outfits and place disposable items
in a cleanup bag; and
- take prompt steps to initiate procedures for the
replenishment of the containment and cleanup kit.
When a spill involves a single container of infectious
medical waste with a weight of less than fifty (50) lbs. and a volume
of spilled liquid of less than one (1) quart, the individual responsible
for the cleanup may elect to use dress and procedures other than those
described above. Any proposed alternate procedures for small quantity
spills must be specified in the infectious medical waste management plan
and must provide protection to the health of workers and the public equivalent
to that provided by the regulations.
Employers must provide training to employees involved
with packaging, labeling, storage, or treatment of infectious medical
All pertinent records required by the Infectious Medical
Waste rules must be retained for a period of not less than three (3)
years. The period of retention extends automatically during the course
of any unresolved enforcement action regarding the regulated activity.
All records must be made available for inspection and
or duplication by the Department of Health and Human Resources upon request.
All generators, except small quantity generators and
those listed in Section 2 of this rule, commercial storage and transfer
facilities and treatment facilities must submit an annual report annually
covering the preceding calendar year to the Health Department by January
Treatment and Disposal of Infectious Medical
In this section, you will find information on the
proper final disposition of the Infectious Medical Waste (IMW) stream,
including IMW sent off-site and IMW treated on-site.
Most hospitals and similar healthcare facilities contract
for the transport of infectious medical waste and therefore, a detailed
description of applicable rules is not presented here. However, some
basic transporter requirements are listed below for informational purposes,
in the event you have questions regarding your transporter or their procedures:
- Infectious medical waste may only be transported
by a permitted transporter (there is an exception of small quantity
generators) and the waste must be delivered to a permitted infectious
medical waste management facility.
- Vehicles used for transporting infectious medical
waste must be prominently with specific markings (e.g., international
- The cargo-carrying portion of the vehicle must
be closed and secured except when loading or unloading infectious medical
waste to prevent unauthorized access and exposure to wind and precipitation.
- The vehicle must be cleaned and disinfected following
leakage or spills.
- The vehicle must be equipped with a spill containment
and cleanup kit.
Manifests: A generator of infectious medical
waste that is to be transported off-site for storage or treatment must
initiate a four-part
manifest, which are available from the Department of Health and Human
Resources. Copy three (3) of the manifest must be retained by the generator
after acceptance by the transporter. Copy two (2) of the manifest must
be retained by the transporter after acceptance by the treatment facility.
Copy one (1) of the manifest must be retained by the treatment facility:
The treatment facility must forward the original to the generator. A
transporter who commingles loads must initiate a new manifest as a generator.
If the generator does not receive the completed manifest
from the treatment facility within fifty (50) days after the date the
medical waste was accepted by the transporter, the generator must report
this fact to the secretary.
There are three approved
methods for infectious waste treatment (incineration, steam treatment,
and discharge liquids to a sanitary sewer system. Also, alternative
methods of treatment can be used if they have been approved in writing
by the Department of Health and Human Resources. The following is a
brief overview of the three approved methods (consult Title
64, Series 56-10 for details):
- All incinerators must be registered with
the Department of Health and Human Resources.
- All the waste must be subjected
to a minimum burn temperature of 1400EF for at least one hour.
- The incinerator must be equipped with certain
controls and monitoring devices to assure proper operation.
- All combustible waste must be into ash that
is not recognizable.
- Steam Treatment.
- The unit must maintain a temperature
of 250EF for 90 minutes at 15 pounds per square inch gauge (psig)
or one of several alternative operational set of conditions.
- Each package of infectious medical waste to be
treated with steam shall have a tape attached that will indicate
if the steam treatment temperature has been reached.
- Steam treatment units shall be evaluated under
full loading for effectiveness with spores of Bacillus stearothermophilus
no less than once per every forty (40) hours of operation.
- An operational log must be kept at each steam
treatment unit that is complete for the preceding three (3) year
- Sanitary Sewer.
- Liquid infectious medical waste may be discharged
to a sanitary sewer through a drainage fixture.
- The use of a grinder to reduce infectious
solid matter to a size or consistency which can be discharged
to a sewer is prohibited.
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. West Virginia 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 West Virginia State 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.
Virginia Infectious Medical Waste Program Contacts
Statutes, Regulations and
Infectious Medical Waste, Legislative Rule Division
of Health, Department of Health and Human Resources, Title
64 Series 56
Infectious Medical Waste Incinerator rule (Title
45, Series 24)
Virginia Infectious Medical Waste Program Home Page
Medical Waste Question and Answer Forum. This page provides you
with an area to submit questions related to infectious medical waste.
WV IMW personnel will respond to the questions. You must check back
in a few days for the answer to your question.
Applications and Forms for Medical Waste Generators