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Medical Waste


Background Information
Definition of Regulated Medical Waste
Healthcare Facility RMW Regulations
The Oklahoma State Department of Health: Hospital Standards
Oklahoma Department of Environmental Quality (DEQ)
Occupational Safety and Health (OSHA)
Additional Resources

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 Regulated Medical Waste

Regulated medical waste is defined by the Oklahoma Department of Environmental Quality as a waste or reusable material that contains an “etiologic agent” and is generated in the diagnosis, treatment or immunization of human beings or animals; research pertaining to the diagnosis, treatment or immunization of human beings or disabling or fatal disease.  The term “etiologic agent” is synonymous with the term “infectious substance”.  Examples of RMW include:

  • cultures and stocks of etiologic agents or live vaccines;
  • human blood, blood products, and human body fluids, except urine or feces;
  • pathological wastes consisting of human tissues, organs, and body parts removed during surgery, autopsy, biopsy and other medical procedures;
  • untreated sharps;
  • used blood collection bags, tubes, and vials;
  • contaminated carcasses, body parts and bedding of animals intentionally exposed to pathogens in research, in the production of biologicals or the "in vivo" testing of pharmaceuticals;
  • items contaminated with blood or other human body fluids which drip freely or would release such materials in a liquid or semi-liquid state if compressed or are caked with dried blood or body fluids and are capable of releasing these materials;
  • isolation wastes unless determined to be noninfectious by the infection control committee at the health care facility;
  • HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV;
  • all disposable materials that have come in contact with cytotoxic or antineoplastic agents during the preparation, handling, and administration of such agents. Such wastes include, but are not limited to, masks, gloves, gowns, empty IV tubing and bags, vials, and other contaminated materials; and
  • any other material or equipment which, in the determination of the health care facility staff, infection control committee or other responsible party, presents a significant danger of infection because it is contaminated with, or may reasonably be expected to be contaminated with, etiologic agents.

Healthcare Facility RMW Regulations

Medical waste is regulated by several Oklahoma state agencies.  The applicable regulations of each agency are summarized below.  Links are provided to the full text regulations.

The Oklahoma State Department of Health: Hospital Standards

The Oklahoma State Department of Health hospital standards require that each hospital establish an infection control program to provide a sanitary environment and avoid sources and transmission of infections.  The program must include written policies and procedures for identifying, reporting, evaluating and maintaining records of infections among patients and personnel, for ongoing review and evaluation of all aseptic, isolation and sanitation techniques employed in the hospital, and development and coordination of training programs in infection control for all hospital personnel.  The standards also require that the infection control program include specific policies related to the handling and disposal of biomedical waste.  However, no specific guidance is provided.  For more information, see Subchapter 11: Infection Control in Hospital Standards (Title 310. Oklahoma State Department of Chapter 667).

The same regulation also covers design and construction requirements for hospitals (see Subchapter 49: General Medical Surgical Hospital Construction Requirements).  Incinerators are required for destruction of pathological waste, unless arrangements are made with a licensed service to pick up the waste for disposal.  Incinerators may be shared by two or more nearby hospitals.  Basic design standards for incinerators are contained in the regulation.

Oklahoma Department of Environmental Quality (DEQ)

DEQ Solid waste management regulations are contained in Title 252 Department of Environmental Quality Chapter 515: Management of Solid Waste.  The following summarize the requirements for healthcare facilities with regard to regulated medical wastes. 

Permits.  Healthcare facilities are not required to obtain a DEQ solid waste permit.  However, regulated medical waste processing facilities are required to be permitted (see: Subpart 23 Regulated Medical Waste Management, 252:515-23-1).

Storage of Regulated Medical Waste.  Healthcare facilities are not subject to the storage requirements of Title 252 Chapter 515.  However, OSHA storage requirements do apply to healthcare facilities (see OSHA regulations below).  Regulated medical waste processing facilities must meet the following storage standards for RMW.

  • All waste must be processed or placed into refrigerated storage, at 45 degrees F, within 24 hours of delivery.
  • If processing has not occurred within 96 hours, waste shall be transported to an alternate permitted site.

Disposal of Regulated Medical Waste.  The disposal of the following RMW is prohibited in a municipal solid waste landfill, a municipal solid waste receptacle or a municipal solid waste transfer station:

  • Untreated sharps.
  • Other untreated, regulated medical waste, except that generated by a small quantity regulated medical waste generator (a generator that generates less than sixty (60) pounds of regulated medical waste per month from one physical location).

Liquid regulated medical wastes (except chemical wastes, or antineoplastic or cytotoxic drugs) may be discharged into the collection system of a publicly owned treatment works (POTW) within the generating facility if written approval of the POTW has been obtained and the POTW provides secondary treatment.

Treatment of Regulated Medical Waste.  Regulated medical waste must not be compacted.

It must be treated by one of the following methods:

  • Incineration in an incinerator that is designed for the destruction of regulated medical waste, will consistently achieve microbial inactivation and is permitted by the DEQ’s Air Quality Division and operated in accordance with the permit.
  • Microwave sterilization, or steam sterilization at sufficient temperature and pressure, for sufficient time to consistently achieve microbial inactivation.
  • Chemical disinfection where contact time, concentration and quantity of the disinfectant are sufficient to consistently achieve microbial inactivation.
  • Any other treatment method demonstrated to be effective in consistently achieving microbial inactivation.

Occupational Safety and Health (OSHA)

Oklahoma is one of 26 states covered entirely by the federal OSHA program.  OSHA rules impact several aspects of regulated medical waste, including management of sharps, requirements for containers that hold or store RMW, labeling of RMW bags/containers, and employee training.  These requirements can be found in the HERC OSHA Standards for Regulated Waste section.


Oklahoma Department of Environmental Quality

Oklahoma Department of Health

Additional Resources

DEQ Regulations: Title 252, Chapter 515. Management of Solid Waste.