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New Hampshire

Infectious Waste

Background Information
Definition of Infectious Waste
Managing Infectious Wastes
OSHA Regulations
Statutes, Regulations and Guidelines
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:
    • Serum, plasma and other blood components;
    • 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.

Disposal Requirements

  • 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.


New Hampshire Department of Environmental Services, Waste Management Division

More Information

None located.