&EPA
United States Solid Waste and
Environmental Protection Emergency Response
Agency (OS-305)
EPA/530-S W-90-051B
May 1990
Medical Waste
Management in the
United States
First Interim Report to Congress
Executive Summary
Printed on Recycled Paper
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EPA/530-SW-90-051B
Fkst Interim Report to Congress
Executive Summary
Medical Waste Management
In the United States
May 1990
United States Environmental Protection Agency
Office of Solid Waste
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EXECUTIVE SUMMARY
Under Subtitle J of the Resource Conservation arid Recovery
.1 ' . ; ' •= .
Act (RCRA), EPA is to report to Congress on several aspects of
medical waste management and the demonstration program for
tracking medical wastes. This report is the first in a series of
three reports which are required by, and address the topics
specified in, RCRA Section 11008(a).
Medical wastes that are subject to the demonstration program
regulations are generated primarily by hospitals, and comprise
approximately 0.3 percent (by weight) of the municipal solid
waste stream. Wastes from home health care, which are not
"medical wastes" under the definition in RCRA 1004(40), are
likely to contain a significant number of syringes-—one of the
medical items of concern to Congress when it enacted the Medical
Waste Tracking Act of 1988 (MWTA) ..'•.'
The health and environmental threat posed by medical waste
or its incineration is a complex question. Chapter 2 outlines
EPA's planned approach to conducting this assessment, by
responding to the Congressional mandate to evaluate health
hazards posed by routine management of medical waste. The
following topics are addressed in Chapter 2:
coordination with the Agency for Toxic Substances and
Disease Registry (ATSDR) . .,
• definitions and terms . > ,. .
;„.«,.. ;vscope of -the. health,, hazard .assessment .
. , .....,,«»-• , general approach, to evaluating present and potential
" health hazards from exposure to medical waste
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• evaluation of health hazards posed by incineration of
medical™ waste
evaluation of health hazards posed by the landfilling
of medical waste
• evaluation of the health hazards posed by the disposal
of medical waste in sewage systems
data gaps and research heeds ;
The regulations which implement the two-year demonstration
program are estimated to have a cost of $24 million .
(undiscounted); a very preliminary estimate of loss of value in
three states (Connecticut, New York, and New Jersey) due to
mismanaged medical wastes is ih
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to determine the appropriateness of penalties imposed in Subtitle
*<','-. '
J enforcement actions.
Several states have enacted laws and regulatoryprograms, in
response to the public's concerns over the AIDS epidemic,, to
address medical, waste management; although not all of the state ,
programs EPA is aware of require tracking, they typically.require
certain packaging and labeling techniques and treatment before
land disposal. As part of an evaluation of existing state and
local requirements, EPA plans to assess the appropriateness ,pf
these state requirements and the Subtitle C requirements, to
monitor and control .medical waste. s^ ; v
,r Current medical waste management practices range from
handling the waste as npnhazardous municipal solid waste,, to
strict segregation, packaging; labeling, and tracking (using
paper manifests) imposed either by state requirements or through
private agreement by transporters or disposal facilities. Common
treatment techniques include steam sterilization and
incineration. Certain medical wastes are commonly stored in
refrigerators, while others are typically stored indoors or
outdoors in various receptacles or containers. A number of
recycling and reuse techniques are also used.
This report outlines in more detail the topics mentioned
. above, and explains EPA's planned activities to address these
.topics.*--;-.-•./._,,.. ",•>•,,'..'•'•,.- ..•-." •.'.••'.-.- .-' .-:.'. -'•• •'*' , .,•-'
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INTRODUCTION
In response to increased public concern about improperly
managed medical wastes, the Medical Waste Tracking Act of 1988
(MWTA) was enacted. Through the MWTA, Congress amended the
Resource Conservatioh and Recovery Act (RCRA) to add a new
Subtitle J, which establishes a two-year demonstration program
for tracking medical waste. Under Subtitle J, EPA must establish
tracking and management standards for certain medical wastes. ;
These standards apply to medical wastes generated in certain
states. The MWTA also requires EPA to submit a series of reports
to Congress on a .number of topics related to medical waste.
Section 11002 of RCRA required EPA to promulgate regulations
by May 1, 1989, listing the types of medical wastes required to
be tracked in the demonstration program. Section 11003 required
EPA to promulgate regulations by May 1, 1989, for segregation,
packaging, labeling, and tracking those designated medical
wastes. EPA met these statutory requirements by issuing
regulations on March 24, 1989 (54 FR 12326). The regulations,
found at 40 CFR Part 259, list the medical wastes required to be
tracked. These wastes are a subset of all medical waste, and are
defined as "regulated medical waste" at 40 CFR 259.30. In
addition, the regulations set up the segregation, packaging,
labeling, and tracking requirements authorized by RCRA Section;
11003, and a requirement for generators who incinerate medical
waste on-site to report to EPA.
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Following publication of the regulations, several states
that were designated to participate in the program elected to .
"opt out," while others petitioned EPA to be included in the
program. RCRA Section 11001 set up this "opt out" and "petition,..
in" procedure to allow the states' governors to determine whether
they wanted to participate in a program that is not nationwide, in
scope. As a result of the states' actions, five states
(Connecticut, New Jersey, New York, Puerto Rico, and Rhode
Island.) are participants in the demonstration program, ,
The demonstration program is of limited duration; for
Connecticut, New Jersey, and .New York, the program went into
effect June 22, 1989v ; The other states were given 30 days longer
to; prepare their respective regulated communities for:compliance,
and to enable the states to coordinate their implementation
activities. The, program will expire, in all States on June 22j
1991.
-This report fulfills part of the requirement of RCRA • Section
11008(b), which requires EPA to prepare interim reports
containing the information on several medical waste topics
available at the time of submission. This report is structured>
according to the topics outlined in Section 11008(a)(1) through
(12). Chapter 1 addresses the information required by Section
11008(a)(1); Chapter 2 addresses Section 11008(a)(2), etc. To
the extent that information items overlap, the chapters explain -
where the required information is found. Generally, -the
information presented in this first interim report reflects;EPAls
planned inf ormationr-gathering,«ctivitiesr to the .;extent that data
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available, they are included here. Chapters 4 and 9 are
noteworthy in that they present EPA's criteria for determining
the success of the demonstration program, outline available
tracking methods, and assess the appropriateness of federal \
hazardous waste requirements and state/local requirements as
nationwide medical waste controls.
Certain terms are used in a different manner in the statute
than they are used in the regulations or in this report; where;
needed, these terms have been defined specifically for each
chapter. For instance, the term "medical waste" in RCRA Section
1004(40) is more inclusive than the medical waste types .listed .in
Section 11002(a). In some chapters, the broadly defined term of
Section 1004(40) is used. In others, the medical waste types in
Section 11002 or in 40 CFR 259.30 are the wastes that are
discussed. Where possible, the term "regulated medical waste" is
used to refer to the medical waste items listed in 40 CFR 259.30.
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