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South Dakota

Medical Waste


Background Information
Waste Categories
Definition of Regulated Medical Waste
Management of Infectious Medical Waste
OSHA Regulations
Statutes, Regulations and Guidelines

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.

Waste Categories

South Dakota 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.  Some certain chemotherapy waste is hazardous waste.

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. 

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 waste accurately.

  • 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 IW can reduce the cost of disposal.  Infectious medical waste makes up only a small portion of the total medical waste stream.  Some facilities, such as long-term care facilities, generate medical waste, but little or no infectious medical waste.  Use the guidance and references below to accurately categorize your wastes.  For additional help, see Contacts below.
  • Infectious 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 Medical Waste

Regulated medical waste is solid waste generated in the diagnosis, treatment, or immunization of human beings or animals, in research pertaining to diseases of humans or animals, in research pertaining to diseases of humans or animals, or in the production or testing of biologicals, as listed below:

  • Cultures and stocks of infectious agents and associated biologicals.
  • Pathological waste.
  • Human blood and blood products.
  • Sharps.
  • Animal waste that are known to be contaminated with human pathogens.
  • Isolation Waste such as biological and discarded materials contaminated wit blood, excretion, exudates, or secretions from humans who are isolated to protect others from certain highly communicable diseases.

Managing Regulated Medical Waste

Regulated medical waste must either be disposed of by incineration in accordance or treated by steam sterilization, chemical disinfectant, or an equally effective treatment method.  Treated regulated medical waste may be disposed of as a solid waste.

Healthcare facilities sending their regulated medical waste off-site for disposal must meet comply with regulations covering packaging, labeling, and storage.  These are discussed below.

Container requirements.  Containers of regulated medical waste for transport off-site must meet the following requirements:

  • Containers must be rigid, leak-resistant, impervious to moisture, resistant to tearing or bursting under normal conditions of use and handling, and sealed to prevent leakage during transport.
  • Treated and untreated sharps and sharps with residual fluids must be placed in packaging that is rigid, leak-resistant, and puncture-resistant.
  • Quantities of fluids greater than 20 cubic centimeters must be placed in packaging that is break-resistant and tightly lidded or stoppered.
  • Oversized regulated medical waste need not be placed into containers, but any special handling instructions must be attached to the waste. Generators may use one or more containers to meet these requirements.

If a healthcare facility plans to reuse containers, they must comply with the following rules:

  • All nonrigid packaging and inner liners must be managed as regulated medical waste and may not be reused.
  • Any container used for the storage or transport, or both, of regulated medical waste and designated for reuse once emptied must be decontaminated if the container shows signs of visible contamination.
  • If any container used for the storage or transport, or both, of regulated medical waste is for any reason not capable of being rendered free of any visible signs of contamination, the container must be managed as regulated medical waste and labeled, marked, and treated or disposed of.

Storage Requirements.  Storage of regulated medical waste before treatment or disposal on-site or transport off-site must comply with the following storage requirements:

  • Must be stored in a manner and location that maintains the integrity of the packaging and provides protection from the elements.
  • Must be maintained in a non-putrescent state, using refrigeration when necessary.
  • Must be stored in a manner that affords protection from animals and does not provide a breeding place or a food source for insects and rodents.
  • All on-site storage of regulated medical waste must be in a designated area away from traffic flow patterns and must be accessible only to authorized personnel.
  • Outdoor storage areas containing regulated medial waste must be locked to prevent unauthorized access.
  • Containment of regulated medical waste must be effected in such a manner that no discharge or release of any waste occurs.

Labeling Requirements.  Before transporting regulated medical waste or offering it for transport off-site, each package of untreated medical wastes must have a water-resistant label affixed to or printed on the outside of the container.  The label must include the words “Medical Waste” or “Infectious Waste” or display the universal biohazard symbol.  Plastic bags used as inner packaging need not display a label.

Healthcare facilities must mark each package of regulated medical waste according to the following marking requirements before the waste is transported off-site:

  • The outermost surface of each package prepared for shipment must be marked with a water-resistant identification tag of sufficient dimension to include the generator’s name and address, the transporter’s name and address, the date of shipment and the identification of contents as medical waste.
  • If the generator has used inner containers, including sharps and fluid containers, each inner container must b e marked with indelible ink or imprinted with water-resistant tags.  The marking must contain the generator’s name and address.
  • If the generator has used inner containers, including sharps and fluid containers each inner container must be marked with indelible ink or imprinted with water-resistant tags.  The marking must contain the generator’s name and address.

Incinerator and Other Treatment Regulations

Health care facilities may operate a medical waste incinerator on-site for the disposal of regulated medical waste.  There are various rules that apply to these facilities, which are found in Article 74:35:11 See Statutes, Regulations and Guidelines below.  Incinerators must be permitted before use.

For treatment methods other than incineration, any process designed to treat or actually treating greater than 200 pounds of regulated medical waste for each treatment cycle may not be constructed or operated unless all appropriate local, state, and federal permits and approvals have been obtained.

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.  South Dakota 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

Rule 74:35 Medical Waste


South Dakota Department of Environment and Natural Resources

More Information

None located.