 New
Hampshire
Infectious
Waste
Background Information
Definition of Infectious Waste
Managing Infectious Wastes
OSHA Regulations
Statutes, Regulations and Guidelines
Contacts
More Information
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 Waste
“Infectious waste" means
any waste, which because of its infectious nature may cause or significantly
contribute to an increase in mortality or an increase in serious irreversible
or incapacitating reversible illness; or pose a substantial present
or potential hazard to human health or the environment when improperly
treated, stored, transported, disposed of or otherwise managed. Infectious
waste includes:
-
Cultures and stocks
of infectious agents and associated biologicals, including:
-
Cultures and stocks
of infectious agents from research and industrial laboratories;
-
Wastes from the
production of biologicals, discarded live and attenuated vaccines;
and
-
Culture dishes
and devices used to transfer, inoculate and mix cultures;
-
Pathological wastes,
including tissues, organs, and body parts that were removed during
surgery or autopsy;
-
Waste human blood and
products of blood, including:
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Serum, plasma and
other blood components;
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Containers contaminated
with a. above which were used or intended for use in either patient
care, testing and laboratory analysis or the development of pharmaceuticals;
and
-
Items saturated
and/or dripping with human blood or items that were saturated
and/or dripping with human blood that are now caked with dried
human blood or blood components;
- Sharps that have been used in human or animal patient
care or in medical, research, or industrial laboratories, including
hypodermic needles, syringes, pasteur pipettes, broken glass and scalpel
blades;
- Contaminated animal carcasses, body parts, and bedding
of animals that were exposed to infectious agents during research,
production of biologicals, or testing of pharmaceuticals;
- Wastes from human or animal patient care, surgery
or autopsy that were in contact with infectious agents, including soiled
dressings, sponges, drapes, lavage tubes, drainage sets, underpads,
and surgical gloves;
- Laboratory wastes from medical, pathological, pharmaceutical,
or other research, commercial or industrial laboratories that were
in contact with infectious agents, including slides and cover slips,
disposable gloves, laboratory coats, and aprons;
- Dialysis wastes that were in contact with the blood
of patients undergoing hemodialysis, including contaminated disposable
equipment and supplies such as tubing, filters, disposable sheets,
towels, gloves, aprons, and laboratory coats;
- Discarded medical equipment and parts that were
in contact with infectious agents;
- Biological waste and discarded materials contaminated
with blood, excretion, exudates or secretion from humans or animals
who are isolated to protect others from communicable diseases;
- Any discarded preparations made from genetically
altered living organisms and their products; and
- Such other waste material that results from the
administration of medical care to a patient whether human or animal
by a health care provider and is found by the director in consultation
with the division of public health services or state veterinarian to
pose a threat to human health or the environment due to its infectious
nature.
The infectious waste rules
do not apply to the following types of waste:
-
Gloves, gowns, underpads
or any other materials that come in contact with patients, but not
saturated with blood, body fluids or secretions, through routine
examination or patient care;
-
Animal carcasses not
included in the definition of infectious waste; and
-
Household infectious
waste, provided that sharps shall be enclosed inside rigid, puncture-resistant
containers; containers encasing sharps shall be sealed and labeled “not
for recycling”; and the waste shall be disposed at an authorized
facility only.
Managing Infectious Waste
New Hampshire’s infectious
waste regulations apply to the management of infectious waste and treated
infectious waste, which is not ash residue, from the point of origin
to the point of final disposal.
Collection, Storage and Transfer Requirements
The collection, storage
and transfer of infectious waste shall comply with all applicable requirements,
including:
-
The waste shall be
stored in a pre-designated location, protected from water, rain and
wind.
-
Storage containers
and packaging shall be labeled conspicuously in a legible manner
with the words “infectious waste,” or “biohazard waste,” or with
the universal biohazard symbol.
-
Waste stored at generator
facilities shall be maintained in a nonputrescent state, using refrigeration
when necessary.
-
Waste shall not be
stored at room temperatures in excess of 72 hours.
-
Outdoor storage areas
containing the waste, such as dumpsters, sheds, tractor trailers,
or other storage areas, shall be locked to prevent unauthorized access.
-
Access to on-site storage
areas shall be limited to authorized persons.
-
The waste shall be
stored in a manner that shall provide protection from animals and
shall not provide a breeding place or a food source for insects or
rodents.
-
Storage containers
and packaging shall be of sufficient structural integrity to ensure
that the waste shall not be released to the environment during storage.
-
The contents of damaged
or ruptured containers shall be re-packaged.
-
Infectious waste shall
be transferred by the generator to authorized facilities only.
-
Facilities that receive
infectious waste from off-site generators shall not store the waste
in excess of 7 days from date of receipt.
Processing and Treatment
Requirements
-
The generator of infectious
waste shall assure that the waste is treated at an authorized facility
to achieve high-level disinfection plus a 4 log 10 reduction of Bacillus
subtilis or Bacillus stearothermophilus.
-
Facilities that process
or treat infectious waste in New Hampshire, including generator facilities,
shall meet the requirements of all applicable regulations and the
following:
-
All infectious waste
managed by the facility shall be collected and stored as specified
in the regulations, pending required treatment.
-
If the facility processes
or treats infectious waste by methods other than incineration, the
efficacy of the processing or treatment method shall be demonstrated
by testing as specified in the regulations; and if the facility is
an incinerator that treats the infectious waste by combustion, the
facility shall meet all applicable requirements.
-
Infectious waste treated
as required by the regulations shall not be combined or mixed with
other waste prior to disposal, unless authorized by the receiving
disposal facility.
-
Infectious waste shall
not be landfilled in New Hampshire unless treated to achieve the
standard specified in the regulations.
-
Treated infectious
waste shall be disposed at authorized facilities only.
-
Notification shall
be given by the transporter to the receiving facility prior to the
disposal of treated infectious waste.
-
Liquid infectious waste
may be disposed via a sanitary sewer, subject to the provisions of
local sewer ordinances and regulations, only if the receiving wastewater
treatment facility includes secondary treatment.
Reuse Requirements and Limitations
Infectious waste shall
not be reused or certified for distribution, except as provided below:
Materials or equipment
contaminated with infectious waste, for example surgical equipment,
maintenance carts, bedding, waste containers and the like, may be salvaged
and reused in-kind, subject to the following requirements:
-
If reused within the
generating facility, the materials and equipment shall be cleaned
and disinfected prior to reuse to achieve the standards for disinfection
prescribed by the facility’s internal management protocol; and
-
If sent off-site for
reuse, the materials and equipment shall be cleaned and disinfected
prior to leaving the generating facility to achieve at least the
level of treatment specified in the regulations.
Transportation, Packaging and Labeling Requirements
Infectious waste transported
off-site for treatment prior to disposal shall be transported in conformance
with the U.S. Department of Transportation hazardous materials regulations,
or as specified in below:
The transportation of infectious waste not subject
to federal regulations shall be subject to the following:
-
Sharps shall be segregated
and encased inside rigid, puncture-resistant containers;
-
Infectious waste and
sharps containers shall be placed in a sealed nonpermeable 3 mil
polyethylene bag or equivalent, which is itself placed in a second
bag of similar construction and sealed; and
The outermost container or package shall be labeled
with the following:
-
Clear markings indicating
the contents which shall include the words “Infectious waste,” or “Biohazard
waste” or the universal biohazard symbol; and
-
The name, address and
telephone number of the generator and transporter.
Transporters shall notify
the receiving facility prior to delivering infectious waste to a New
Hampshire landfill.
Testing and Reporting
Requirements
Facilities, including generator
facilities, which treat infectious waste by methods other than incineration
shall be subject to the following:
-
Quality assurance/
quality control efficacy testing shall be performed during initial
facility operations to verify facility operating procedures meet
the requirements of the regulations;
-
Following verification,
the facility shall perform quality assurance/quality control efficacy
testing no less than 4 times yearly, to demonstrate compliance; and
-
The facility shall
maintain the records of quality assurance/quality control efficacy
testing for a minimum of 3 years.
Limbs and recognizable
organs, excluding teeth and contiguous gum tissue, shall be disposed
by incineration or interment.
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. New Hampshire
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
Env-Sw 900 Management of Certain Wastes, including Infectious Waste.
Contacts
New Hampshire
Department of Environmental Services, Waste Management Division
More Information
None located.
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