MedWasteMgmtRulesPresentation

Department of Environmental Quality
Division of Waste Management
Solid Waste Section
November 2019
NCDEQ
DWM -SWS
An introduction to the
North Carolina
Medical Waste Management Rules
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The Healthcare Industry and Solid Waste
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•Most solid waste generated by the healthcare industry [treating patients] is medical waste.
•NCDEQ, DWM –SWS defines what is medical waste [not required to be treated] vs what is regulated medical
waste [required to be treated].
•Healthcare facilities often spend more resources than is necessary to treat medical waste that is not defined as
regulated medical waste. This, in turn, increases the cost of healthcare and does not use resources efficiently.
Medical Waste -Definition
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“Medical waste” means any solid waste which is generated in the diagnosis, treatment, or immunization of
human beings or animals, in research pertaining thereto, or in the production or testing of biologicals, but does
not include any hazardous waste… radioactive waste, household waste…, or those substances excluded from the
definition of solid waste.
The definition does not mention solid waste generated from patient “accommodation.”
*North Carolina General Statutes (NCGS):
130A-290(17a), 130A-309.05, and 130A-309.26
*North Carolina Administrative Code (NCAC):
15A NCAC 13B .1200, “Medical Waste Management”
*North Carolina Administrative Code:
15A NCAC 13B, “Solid Waste Management”
specifically: 13B .0101, “Definitions”
Municipal Solid Waste Landfills -Disposal
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•Medical waste may be disposed of in a [lined] municipal solid waste (MSW) landfill.
•Landfill operators may decline to accept a solid waste type for disposal, even if the state regulations allow the
disposal of that solid waste.
•MSW landfills are engineered, monitored, and regulated. They are ongoing construction projects for the life of
the landfill [construction, operation, and post closure].
•The removal of solid waste from a MSW landfill is prohibited.
•Solid waste is required to be covered with six inches of earthen material by the end of the operating day.
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•“Regulated medical waste” means blood and body fluids in individual containers in volumes greater than
20 ml, microbiological waste, and pathological waste that have not been treated …
•Roughly, up to 15 percent of the medical waste generated at hospitals is regulated medical waste.
•Regulated medical waste must be treated prior to disposal.
Regulated Medical Waste (RMW) -Definition
Blood and Body Fluids
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•“Blood and body fluids” means liquid blood, serum, plasma, other blood products, emulsified human tissue,
spinal fluids and pleural and peritoneal fluids.
•Dialysates, urine, and feces are not considered blood and body fluids if not removed during surgery and
autopsies.
•Method of treatment: blood and body fluids in individual containers in volumes greater than 20 ml –
incineration, steam sterilization (autoclave), or sanitary sewage systems provided the sewage treatment
authority is notified.
Microbiological Waste
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•“Microbiological waste” means and includes cultures and stocks of infectious agents. The term includes
cultures of specimens from medical, pathological, pharmaceutical, research, commercial, and industrial
laboratories.
•Method of treatment: Incineration, steam sterilization, ozonation, microwave or chemical treatment.
Pathological Waste
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•“Pathological waste” means and includes human tissues, organs, body parts, secretions and excretions,
blood and body fluids that are removed during surgery and autopsies; and the carcasses and body parts of all
animals that were exposed to pathogens in research, were used in the production of biologicals or in the in
vivo testing of pharmaceuticals, or that died of known or suspected infectious disease.
•Method of treatment: Incineration or ozonation.
Noninfectious Medical Waste
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Noninfectious medical waste and blood and body fluids in individual containers in volumes of 20 ml or less may
be disposed of in a municipal solid waste landfill or sanitary sewer or treated by a treatment method as described
in 15A NCAC 13B .1202(i).
Unregulated and Regulated Medical Waste
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•Unregulated (aka: medical waste) –does not require treatment before disposal. It contains possible
biohazardous materials [possibly infectious].
•Regulated (aka: regulated medical waste) –requires treatment before disposal. It contains blood and body
fluids, microbiological, and/or pathological materials [infectious].
•Trauma scene cleanup is not, by definition, medical waste but may be biohazardous. Universal precautions
apply.
•The North Carolina medical waste rules (15A NCAC 13B .1200)
apply to medical wastes and regulated medical wastes.
Sharps -Definition
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“Sharps” means needles, syringes, and scalpel blades. [NCGS 130A-309.26(a)(1)]
Sharps and other sharp objects such as syringes with attached needles, capillary tubes, slides and cover slips,
lancets, auto injectors, connection needles and sets, exposed ends of dental wires, and objects that can penetrate
the skin shall be placed in a rigid, leak-proof when in an upright position, and puncture-resistant container. [15A
NCAC 13B .1202(b)]
A sharps container [specifically manufactured meeting the requirements of rigid, leak-proof when in an upright
position, and puncture-resistant] may also be used for sharps.
Sharps Disposal
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A sharps container may be treated prior to disposal or transported directly to a municipal solid waste landfill for
disposal.
Household waste is not, by definition, medical waste and can be disposed of in a municipal solid waste landfill.
Sharps generated at a household should be placed in a container that is rigid, leak-proof when in an upright
position, and puncture-resistant.
Sharps shall not be compacted prior to off-site transportation; unless placed in a sealed compactor unit that is
hauled-off for disposal by the transporter.
The medical waste rules do not require the treatment of sharps prior to disposal.
Pharmaceutical Waste
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It is not acceptable to dispose of unwanted pharmaceutical drugs in the sanitary sewer system.
Most pharmaceutical drugs can be disposed of in a municipal solid waste landfill.
Ensure the pharmaceutical drug is not designated as a hazardous waste and that it does not exhibit the
characteristics of a hazardous waste (corrosivity, toxicity, ignitability, and reactivity).
Pharmaceutical drugs may also be returned to the vendor or collected by an authorized third party.
Did You Know?
Many generators of medical waste choose to have non-regulated medical waste treated prior to disposal.
Medical waste such as dressings, bandages, sponges, disposable instruments, used gloves, and tubing are not
included in the definition of regulated medical waste and may be disposed of in a municipal solid waste landfill.
Healthcare providers are responsible to know what category of medical waste they generate, what disposal
options exist, and if treatment prior to disposal is required.
Additional Information
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Department of Environmental Quality
Did You Know?
Blood and body fluids in individual containers in volumes of 20 ml or less shall be stored in an area accessible only
to the responsible party or their designated representative, and shall not be compacted prior to off-site
transportation. [15A NCAC 13B .1202(c)]
Regulated medical waste shall not be compacted prior to treatment. [15A NCAC 13B .1202(d)]
Medical waste generator and transporter information is not gathered or maintained by the NCDEQ, DWM -SWS.
Additional Information
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Department of Environmental Quality
Medical Waste Management
The Medical Waste Management rules have been updated and adopted. The new rules became effective on
November 1, 2019.
The Medical Waste Management rules adopted November 1, 2019 supersedes the April 1, 1993 version.
Adopted Rules
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Department of Environmental Quality
Contact:
John Patrone
Division of Waste Management -
Solid Waste Section
336.776.9673
[e-mail]
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Department of Environmental Quality