United States
Environmental Protection
Agency
Office of Solid Waste
and Emergency Response-
Washington DC 20460
EPA/530-SW-86-014
May 1986
Solid Waste
>EPA
PB86-199130
K -
EPA Guide for
Infectious Waste
Management
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This report is available through the U.S. Department of Commerce,
National Technical Information Service (NTIS), 5285 Port Royal
Road, Springfield, VA 22161
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EPA GUIDE
FOR
INFECTIOUS WASTE MANAGEMENT
a«tal Protection Agency
ironmental rrui
U.S. Environmental Protection Agency
Office of Solid Waste
Washington, D.C. 20460
May 1986
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W-101
PORT DOCUMENTATION
PAGE
EPA/530-SW-86-014
•HI* and Subtitla
EPA Guide for Infectious Waste Management
luthord)
Jacqueline Sales, et. al.
'•rformlng Organization Name and Address
Environmental Protection Agency
Office of Solid Waste
401 M. Street, S.W.
Washington, B.C. 20460
Sponsoring Organization Name and Address
Same as above
3. Recipient's Accession No.
5. Report Date
6.
8. Performing Organization Rept. No.
10. Project/Task/Work Unit No.
11. Contract(C) or Grant(G) No.
(C)
(G)
13. Type of Report & Period Covered
14.
Supplementary Notes
Prepared in cooperation with the infectious waste ad hoc working group.
The infectious waste document provides guidance An the management
of infectious waste. The document presents the EPA perspective on
acceptable infectious waste management practices. Topics include the
definition o-f infectious waste and recommended practices for packaging,
treatment, transportation, storage, and disposal of these wastes.
The document also contains an updated summary of State requirements
and regulations.
Document Analysis a. Descriptors
b. Identifiers/Open-Ended Term*
e. COSATI Reid/Group
Availability Statement
Release Unlimited
19. Security Class (This Report)
20. Security Class (This Page)
ANSI-Z39.18) _ See /nstructlon. on Reverse '• -J
21. No. of Pages
22. Price
OPTIONAL FOKM 272 (4-77)
(Formerly NTIS-35)
Department of Commerce
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ACKNOWLEDGEMENTS
This document was prepared by the Office of Solid Waste of
the U.S. Environmental Protection Agency (EPA) with coordination
conducted by Jacqueline W. Sales. The production of this document
was facilitated by the assistance of Rosemary Workman and Lisa
Ratcliff (EPA). The document was reviewed by EPA. The following
participants of the ad hoc infectious waste working group
provided invaluable expertise and assistance:
John Bleckman, ABAX Incorporated
Linda Brooks, American Hospital Association
Barry Davis, Centers for Disease Control, Department of Health and
Human Services
Mary A. Ficht, American Society for Hospital Engineering, American
Hospital Association
Judith G. Gordon, Consultant to the Environmental Protection Agency
John Keene, Dr.P.H., American Biological Safety Association
Daniel F. Liberman, Ph.D., Massachusetts Institute of Technology
Richard Parker, D.V.M., American Veterinary Medicine Association
Harvey Rogers, National Institutes of Health
William Rutala, Ph.D., Association for Practitioners in Infection
Control
Nelson Slavik, Ph.D., University of Illinois
Bob Spurgin, W.D. Bingham, Inc.
Steve Wittmer, Pharmaceutical Manufacturer's Association
Initial review was also conducted by Franklin Pearce, Memorial
Sloan-Kettering Cancer Center, and Dr. Byron Tepper, Johns
Hopkins Medical Institutions. Finally, Tonya L. Barnett spent
long hours patiently typing all drafts.
NOTICE
The mention of trade names or commercial products in this
publication is for illustration purposes and does not
constitute endorsement or recommendation for use by the
U.S. Environmental Protection Agency.
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TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS i
FOREWORD v
EXECUTIVE SUMMARY viii
Chapters
1. Introduction 1-1
1.1 Purpose and Scope 1-1
1.2 State Regulations Pertaining to 1-3
Infectious Waste
2. Infectious Waste Characterization 2-1
2.1 Definition of Infectious Waste 2-1
2.2 Types of Infectious Waste 2-3
2.2.1 Isolation Wastes 2-3
2.2.2 Cultures and Stocks of Infectious 2-3
Agents and Associated Biologicals
2.2.3 Human Blood and Blood Products 2-4
2.2.4 Pathological Wastes 2-4
2.2.5 Contaminated Sharps 2-4
2.2.6 Contaminated Animal Carcasses, Body 2-5
Parts, and Bedding
2.3 Miscellaneous Contaminated Wastes 2-5
3. Infectious Waste Management 3-1
3.1 Introduction 3-1
3.2 Selection of Waste Management Options 3-2
3.3 Infectious Waste Management Plan 3-5
3.3.1 Designation of Infectious Waste 3-5
3.3.2 Segregation of Infectious Waste 3-5
11
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3.3.3 Packaging of Infectious Waste 3-8
3.3.4 Storage of Infectious Waste 3-12
3.3.5 Transport of Infectious Waste 3-14
3.3.6 Treatment of Infectious Waste 3-14
3.3.7 Disposal of Treated Waste 3-15
3.3.8 Contingency Planning 3-16
3.3.9 Staff Training 3-16
4. Treatment of Infectious Waste 4-1
4.1 Introduction 4-1
4.1.1 Monitoring 4-1
4.2 Steam Sterilization 4-3
4.3 Incineration 4-7
4.4 Thermal Inactivation 4-11
4.4.1 Thermal Inactivation of Liquid 4-11
Infectious Waste
4.4.2 Thermal Inactivation of Solid 4-13
Infectious Waste
4.5 Gas/Vapor Sterilization 4-13
4.6 Chemical Disinfection 4-14
4.7 Sterilization by Irradiation 4-15
4.8 Other Treatment Methods 4-16
5. Suggested Treatment Methods for Each Infectious 5-1
Waste Category
5.1 Introduction 5-1
5.2 Isolation Wastes 5-2
5.3 Cultures and Stocks of Infectious Agents and 5-2
Associated Biologicals
5.4 Human Blood and Blood Products 5-3
5.5 Pathological Wastes 5-3
111
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5.6 Contaminated Sharps 5-4
5.7 Contaminated Animal Carcasses, Body Parts, 5-4
and Bedding
5.8 Miscellaneous Contaminated Wastes 5-5
REFERENCES R-l
APPENDIX State Regulations Pertaining to Infectious A-l
Waste Management (1986)
IV
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FOREWORD
The Resource Conservation and Recovery Act of 1976, as
amended, requires EPA to develop and evaluate environmentally
sound methods for management of solid waste. In addition, the
Act requires EPA to establish a "cradle-to-grave" management
system for solid wastes which are identified as hazardous.
Congress defined hazardous waste generally to mean "a
solid waste, or combination of solid wastes, which because of
its quantity, concentration, or physical, chemical, or infectious
characteristics may (A) cause or significantly contribute to
an increase in mortality or an increase in serious irreversible,
or incapacitating reversible, illness; or (B) pose substantial
present or potential hazard to human health or the environment
when improperly treated, stored, transported, or disposed of,
or otherwise managed." (Solid wastes are defined in the statute
as solids, liquids, and gases.)
As a first step in fulfilling the Congressional mandate to
establish a hazardous waste management system, EPA published
proposed regulations in the Federal Register on December 18, 1978,
which included a proposed definition and treatment methods for
infectious waste. During the public comment period for this
rulemaking, EPA received approximately sixty comments which
specifically addressed the infectious waste provisions of the
proposed regulations.
On May 19, 1980, EPA published the first phase of the hazardous
waste regulations. The Agency stated in the preamble to the
regulations that the sections on infectious waste would be published
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when work on treatment, storage, and disposal standards was
completed. While the Agency has evaluated management techniques
for infectious waste, considerable evidence that these wastes
cause harm to human health and the environment is needed to
support Federal rulemaking.
In response to numerous requests for technical information
and guidance on infectious waste management, EPA published its
findings in September 1982, as a guidance manual, the Draft
Manual for Infectious Waste Management (SW-957). After consideration
of comments on the Draft Manual, the Agency decided to revise
and finalize the manual. An ad hoc working group consisting of
a cross-section of health care professionals from government,
academia, private industry, and trade associations (see
acknowledgements) was convened to provide expertise and
assistance. We believe that this guidance document represents
environmentally sound practices for the handling, treatment, and
disposal of infectious waste, and reflect current thinking and
practices in infectious waste management.
It should be noted that this guidance document addresses
the management of infectious waste solely from the perspective of
problems posed by its infectious characteristics. Additional
hazards which may be posed by these wastes (e.g., toxicity,
ignitability, and radioactivity ) are not within the scope of
this publication. Because EPA is publishing this document only
to refine the draft manual, recent issues such as acquired
immunodeficiency syndrome (AIDS) and antineoplastic agents are
not specifically addressed. We further acknowledge that new
methods and technologies, other than those discussed in
vi
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this document, are available for treating infectious waste.
EPA recommends that persons desiring to use these techniques
make certain that these techniques provide effective treatment.
Requests for copies of this document should be directed to
Superintendent of Documents, U.S. Government Printing Office,
Washington, D.C. 20470, (202) 783-3238.
VI 1
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EXECUTIVE SUMMARY
The purpose of this document is to provide guidance on
the management of infectious waste. The document presents
the EPA perspective on acceptable infectious waste management
practices. Discussions are limited to technologies that are
typically and frequently used for treating and managing
infectious waste; however, the EPA in no way intends to
imply that alternative methods or new technologies are not
available or acceptable.
EPA Recommendations for Infectious Waste Management
The EPA recommends that a responsible person or committee
at the facility prepare an Infectious Waste Management Plan
outlining policies and procedures for the management of
infectious waste. This plan should include the following
elements^
0 Designation
0 Segregation
0 Packaging
0 Storage
0 Transport
0 Treatment
0 Disposal
0 Contingency Planning
0 Staff training
Vlll
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1. Designation of Infectious Waste
EPA recommends that the following categories of waste be
designated as infectious waste:
Waste Category
Isolation wastes
Cultures and stocks of
infectious agents and
associated biologicals
Human blood and blood
products
Pathological waste
Contaminated sharps
Contaminated animal
carcasses, body parts,
and bedding
Examples'
0 refer to Centers for Disease
Control (CDC), Guidelines
for Isolation Precautions in
Hospitals, July 1983
0 specimens from medical and
pathology laboratories
0 cultures and stocks of infectious
agents from clinical, research,
and industrial laboratories;
disposable culture dishes, and
devices used to transfer, inoculate
and mix cultures
0 wastes from production of biologicals
0 discarded live and attenuated
vaccines
0 waste blood, serum, plasma,
and blood products
0 tissues, organs, body parts,
blood, and body fluids removed
during surgery, autopsy, and
biopsy
0 contaminated hypodermic needles,
syringes, scalpel blades, pasteur
pipettes, and broken glass
0 contaminated animal carcasses,
body parts, and bedding of animals
that were intentionally exposed
to pathogens
*These materials are examples of wastes covered by each category.
The categories are not limited to these materials.
IX
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The EPA has identified an optional infectious waste
category which consists of miscellaneous contaminated wastes.
While there is not a unanimity of opinion regarding the hazards
posed by these wastes, EPA believes that the decision whether
to handle these wastes as "infectious" should be made by a
responsible authorized person or committee at the individual
facility. However, the Agency recommends that wastes from
patients known to be infected with blood-borne diseases
should be managed as infectious waste (for example, dialysis
waste from known hepatitis B patients).
Miscellaneous Contaminated
Wastes
Examples
Wastes from surgery and autopsy
Miscellaneous laboratory wastes
Dialysis unit wastes
Contaminated equipment
0 soiled dressings, sponges,
drapes, lavage tubes,
drainage sets, underpads,
and surgical gloves
0 specimen containers, slides,
and cover slips; disposable
gloves, lab coats, and aprons
0 tubing, filters, disposable
sheets, towels, gloves,
aprons, and lab coats
equipment used in patient
care, medical laboratories,
research, and in the production
and testing of certain
Pharmaceuticals
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II. Segregation of Infectious Waste
EPA recommends:
0 segregation of infectious waste at the point of origin
0 segregation of infectious waste with multiple hazards
as necessary for management and treatment
0 use of distinctive, clearly marked containers or plastic bags
for infectious waste
0 use of the universal biological hazard symbol on infectious
waste containers, as appropriate
III. Packaging of Infectious Waste
EPA recommends:
0 selection of packaging materials that are appropriate for
the type of waste:
- plastic bags for many types of solid or semi-solid
infectious waste
- puncture-resistant containers for sharps
- bottles, flasks, or tanks for liquids
0 use of packaging that maintains its integrity during storage
and transport
0 use of plastic bags that are impervious, tear resistant, and
distinctive in color or markings
0 closing the top of each bag by folding or tying as appropriate
for the treatment or transport
0 placement of liquid wastes in capped or tightly stoppered
bottles or flasks
XI
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0 no compaction of infectious waste or packaged infectious waste
before treatment
IV. Storage of Infectious Waste
EPA recommends:
0 minimizing storage time
0 proper packaging that ensures containment of infectious
waste and the exclusion of rodents and vermin
0 limited access to storage area
0 posting of universal biological hazard symbol on storage area
door, waste containers, freezers, or refrigerators
V. Transport of Infectious Waste
EPA recommends:
0 avoidance of mechanical loading devices which may rupture
packaged wastes
0 frequent disinfection of carts used to transfer wastes within
the facility
0 placement of all infectious waste into rigid or semi-rigid
containers before transport off-site
0 transport of infectious waste in closed leak-proof trucks or
dumpsters
XI1
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VI. Treatment of Infectious Waste
For the purposes of this document, EPA defines treatment
as any method, technique or process designed to change the
biological character or composition of waste.
EPA recommends:
0 establishing standard operating procedures for each process
used for treating infectious waste
0 monitoring of all treatment processes to assure efficient and
effective treatment
0 use of biological indicators to monitor treatment (other
indicators may be used provided that their effectiveness
has been successfully demonstrated)
0 the following treatment techniques for each of the six
infectious waste categories (table 1):
Xlll
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TABLE 1
RECOMMENDED TECHNIQUES FOR TREATMENT OF INFECTIOUS WASTE*
Type of Infectious Waste13
Isolation wastes
Cultures and stocks of
infectious agents and
associated biologicals
Human blood and blood
products
Pathological wastes
Contaminated sharps
Contaminated animal carcasses,
body parts, bedding:
0 carcasses and parts
0 bedding
Reccnmended Treatment Techniques
Steam Thermal Chemical
Sterilization Incineration Inactivation Disinfection0 Other
X
X
X
X«
X
xe
X
X
X
X
X
X
X
X
X
X
Xd
xf
X
I-1-
a. The recommended treatment techniques are those that are most appropriate and, generally, in common use;
alternative treatment technique may be used to treat infectious waste, if it provides
effective treatment.
b. See Chapter 2 for descriptions of infectious waste types.
c. Chemical disinfection is most appropriate for liquids.
d. Discharge to sanitary sewer for treatment in municipal sewerage system (provided that secondary treatment
is available)
e. For aesthetic reasons, steam sterilization should be followed by incineration of the treated waste or by grinding
with subsequent flushing to the sewer system in accordance with State and local regulations.
f. Handling by a mortician (burial or cremation).
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Treatment of Infectious Waste (cont'd)
EPA recommends:
0 the following treatment methods for miscellaneous
contaminated wastes (when a decision is made to manage
these wastes as infectious):
- wastes from surgery and autopsy - incineration or steam
sterilization
- miscellaneous laboratory wastes - incineration or
steam sterilization
- dialysis unit wastes - incineration or steam sterilization
- contaminated equipment - incineration, steam sterilization,
or gas/vapor sterilization
VII. Disposal of Treated Infectious Waste
EPA recommends:
° contacting State and local governments to identify approved
disposal options (institutional programs must conform to State
and local requirements)
0 discharge of treated liquids and ground up solids (such as
pathological waste or small animals) to the sewer system
0 land disposal of treated solids and incinerator ash
0 rendering body parts unrecognizable before land disposal (for
aesthetic reasons)
xv
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CHAPTER 1
INTRODUCTION
1.1 Purpose and Scope
This document outlines the EPA perspective on environmentally
acceptable techniques for infectious waste management. Topics
covered include a definition of infectious waste, types of in-
fectious waste, and recommended practices for packaging, trans-
portation, treatment, storage, and disposal of these wastes.
This document is intended to provide guidance to persons
responsible for infectious waste management decisions at the
following types of facilities:
0 hospitals
0 medical laboratories
0 research laboratories
0 commercial diagnostic laboratories
0 animal experimentation units
0 industrial plants and laboratories
0 other facilities which generate infectious waste
(such as biotechnology companies)
This document will be useful to biological safety officers,
environmental and facility engineers, hospital infection control
officers and committees, laboratory supervisors, environmental
services, housekeeping and custodial staff, administrators, and
others involved with infectious waste management. State and
local regulatory agencies may also find this manual useful as
resource material. The EPA strongly urges, however, that such
agencies use this document only as reference material.
1-1
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Described in detail are infectious waste treatment methods
including steam sterilization, incineration, thermal inactivat ion,
gas/vapor sterilization, and chemical disinfection. Included in
the discussion of each treatment method are recommendations for
monitoring and a description of factors that may affect treatment.
The document also contains an up-dated list of State infectious
waste regulations and requirements, as well as a list of State
offices that may be contacted for further information.
The following elements of an overall program for managing
infectious waste are described in this guidance document:
0 Designation of infectious waste
0 Handling infectious waste
Storage (when necessary)
Packaging
Transport (on- and off-site)
0 Selection of appropriate treatment and disposal methods
0 Monitoring of treatment methods
0 Compliance with State and local requirements
Due to factors such as variability of facility size, availability
of treatment alternatives, budgetary constraints, and location,
the elements of an effective program may differ among facilities.
Nevertheless, this document is designed to provide assistance to
persons seeking to meet the challenge of developing an environ-
mentally sound infectious waste management system.
Although the additional hazards (such as toxicity, ignitability,
reactivity, etc) that may be associated with some infectious waste
are not addressed in this document, waste management decisions
1-2
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should take into account all hazards posed by the waste. Persons
responsible for waste management decisions should set management
priorities which take into account the characteristics of the
waste which cause it to be regulated by the State or EPA. For
example, the EPA hazardous waste regulations address the management
of toxic, ignitable, corrosive, and reactive wastes (1,2). The
Nuclear Regulatory Commission regulations address the management
of radioactive wastes (3).
1.2 State Regulations Pertaining to Infectious Waste
Historically, control of infectious waste has been the
responsibility of State health or environmental departments.
Most States have requirements for licensing of hospitals and
nursing homes that may include general requirements for infectious
waste disposal. These general requirements are limited in scope
and do not usually apply to other sources of infectious waste.
Since the passage of the Resource Conservation and Recovery
Act of 1976, many States have passed hazardous waste legislation
to control the treatment, storage, and disposal of infectious
waste (as part of their hazardous waste program). Some States
have already promulgated regulations controlling infectious
waste, while some others are now preparing such regulations.
Since there is no unanimity of opinion on the hazards posed by
infectious waste and appropriate techniques for safe disposal
of these waste, State control varies.
The EPA has conducted a survey of the 50 States and the
District of Columbia to determine their infectious waste management
requirements. The data are presented in the Appendix to this
1-3
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document. The Appendix lists the State agency responsible for in-
fectious waste, the statutory authorities, and infectious waste
management requirements.
1-4
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CHAPTER 2
INFECTIOUS WASTE CHARACTERIZATION
2.1 Definition of Infectious Waste
The definition of infectious waste has been debated for
years. Regulatory agencies, hospitals, and research laboratories
have different perspectives and objectives which influence their
views; therefore, there is no universally accepted definition for
infectious waste. Moreover, there is inconsistency in the
terminology used to define these wastes. For example, the terms
infectious, pathological, biomedical, biohazardous, toxic, and
medically hazardous have all been used to describe infectious
waste.
For purposes of this guidance document, infectious waste
is defined as waste capable of producing an infectious disease.
This definition requires a consideration of certain factors necessary
for induction of disease. These factors include:
a) presence of a pathogen of sufficient virulence
b) dose
c) portal of entry
d) resistance of host
Therefore, for a waste to be infectious, it must contain pathogens
with sufficient virulence and quantity so that exposure to the
waste by a susceptible host could result in an infectious disease.
The six categories listed below are recommended EPA infectious
waste categories:
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0 isolation wastes
0 cultures and stocks of infectious agents and associated
biologicals
0 human blood and blood products
0 pathological wastes
0 contaminated sharps
0 contaminated animal carcasses, body parts, and bedding
There are additional materials which should be evaluated to
determine whether they may pose a health hazard because of po-
tential infectiousness. These include, but are not limited to,
contaminated equipment, wastes from surgery and autopsy, mis-
cellaneous laboratory wastes, and dialysis unit wastes. EPA
has not designated these wastes as infectious waste because of a
lack of information on the relative risk of infection or disease.
Therefore, it is recommended that a responsible authorized person
or committee at the individual facility evaluate these wastes to
determine which should be managed as infectious waste.
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2.2 Types of Infectious Waste
2.2.1 Isolation Wastes
Isolation wastes are wastes generated by hospitalized patients
who are isolated to protect others from communicable diseases
(4). At a minimum, wastes from patients with diseases considered
communicable and requiring isolation, as defined by the Centers
for Disease Control (CDC), should be considered infectious wastes
(see Guidelines for Isolation Precautions in Hospitals, July 1983).
It should be noted that the wastes from hospital patients who
are placed in protective isolation (i.e., isolation imposed only
to protect these patients from the diseases of others) are not
necessarily infectious. EPA recommends that isolation wastes be
managed in accordance with the CDC guidelines (5).
2.2.2 Cultures and Stocks of Infectious Agents and
Associated Biologicals
All cultures and stocks of infectious agents should be
designated as infectious wastes because of the high concen-
trations of pathogenic organisms typically present in these
materials. Included in this category are specimen cultures
from medical and pathological laboratories, cultures and
stocks of infectious agents from research and industrial
laboratories, wastes from the production of biologicals, and
discarded live and attenuated vaccines. Also, culture dishes
and devices used to transfer, inoculate, and mix cultures
should be designated as infectious waste.
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2.2.3 Human Blood and Blood Products
All waste human blood and blood products (such as
serum, plasma, and other blood components) should be managed
as infectious waste.
2.2.4 Pathological Wastes
Pathological wastes consist of tissues, organs, body
parts, and body fluids that are removed during surgery and
autopsy. All pathological wastes should be considered infectious
because of the possibility of unknown infection in the
patient or corpse.
2.2.5 Contaminated Sharps
All discarded sharps (e.g., hypodermic needles, syringes,
pasteur pipettes, broken glass, scalpel blades) which have
come into contact with infectious agents during use in
patient care or in medical, research, or industrial labora-
tories present the double hazard of inflicting injury and
inducing disease. These wastes should be managed as infectious
wastes. All sharps used in patient care should be considered
infectious wastes because of the possibility of undiagnosed
blood-borne diseases (e.g., hepatitis B and AIDS).
2-4
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2.2.6 Contaminated Animal Carcasses, Body Parts, and
Bedding
This infectious waste category includes the contaminated
carcasses, body parts, and bedding of animals that were in-
tentionally exposed to pathogens in research, in the produc-
tion of biologicals, or in the in vivo testing of Pharmaceuticals.
2.3 Miscellaneous Contaminated Wastes - (Optional Category)
The following wastes are not designated as infectious
waste by the EPA. But, in light of the potential hazards
posed by these wastes, a determination to manage these
wastes as "infectious" should be made by a responsible
authorized person at the facility. The Agency recommends,
however, that wastes from patients known to be infected with
blood-borne disease be managed as infectious waste.
0 Wastes from surgery and autopsy - all contaminated wastes
from septic ("dirty") cases; some or all wastes from
"clean" cases that were in contact with patient tissues,
blood, body fluids, secretions, and excretions. Examples
of these wastes include soiled dressings, sponges, drapes,
lavage tubes, drainage sets, underpads, and surgical
gloves.
0 Contaminated laboratory wastes - wastes from medical,
pathological, pharmaceutical, or other research, commercial,
or industrial laboratories that were in contact with
infectious agents. Examples of these wastes include
specimen containers, slides and cover slips, disposable
gloves, lab coats, and aprons.
2-5
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0 Dialysis unit wastes - wastes that were in contact with
the blood of patients undergoing hemodialysis.
These wastes include contaminated disposable equipment
and supplies such as tubing, filters, disposable sheets,
towels, gloves, aprons, and lab coats.
0 Contaminanted equipment - discarded equipment and parts
that may be contaminated with infectious agents. These
wastes include equipment used in patient care, medical
and industrial laboratories, research, and in the production
and testing of certain Pharmaceuticals.
2-6
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CHAPTER 3
INFECTIOUS WASTE MANAGEMENT
3.1 Introduction
The objectives of an effective infectious waste management
program should be to provide protection to human health and the
environment from hazards posed by the waste. Proper management
ensures that infectious waste is handled in accordance with estab-
lished procedures from the'time of generation through treatment
of the waste (to render it non-infectious) and its ultimate disposal.
An infectious waste management system should include the fol-
lowing elements:
0 Designation of infectious wastes
0 Handling of infectious wastes which includes:
- Segregation
- Packaging
- Storage
- Transport and handling
- Treatment techniques
- Disposal of treated waste
0 Contingency planning
0 Staff training
Various options are available for the development of an in-
fectious waste management system. Management options and the relevant
factors that should be considered in their selection are discussed
in Section 3.2. Management options for an individual facility
3-1
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should be selected on the basis of what is most appropriate for
that particular facility. Factors such as location, size, and
budget should be taken into consideration. The selected options
should be incorporated into a documented infectious waste management
plan (see Section 3.3). An infectious waste management system
cannot be effective unless it is fully implemented. Therefore,
a specific person at the generating facility should be responsible
for implementation of the plan. This person should have the re-
sponsibility as well as the authority to make sure that the
provisions of the management plan are being followed.
3.2 Selection of Waste Management Options
In an infectious waste management system, there are a number
of areas in which alternative options are available (e.g., treatment
techniques for the various types of infectious waste, types of
treatment equipment, treatment sites, various waste handling
practices, etc.). The selection of available options at a facility
depends upon a number of factors such as the nature of the infectious
waste, the quantity of infectious waste generated, the availability
of equipment for treatment on-site and off-site, regulatory
constraints, and cost considerations. These factors are presented
here in order to provide assistance in the development of an
infectious waste management program.
Since treatment methods vary with waste type, the waste
must be evaluated and categorized with regard to its potential
to cause disease. Such characteristics as chemical content,
density, water content, bulk, etc. are known to influence waste
treatment decisions. For example, many facilities use a
3-2
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combination of treatment techniques for the different components of
the infectious waste stream — e.g., steam sterilization for
laboratory cultures and incineration for pathological waste.
The quantity of each category of infectious waste generated
at the facility may also influence the method of treatment. De-
cisions should be made on the basis of the major components of
the infectious waste stream. Generally, it would be desirable
and efficient to handle all infectious waste in the same manner.
However, if a selected option is not suitable for treatment of
all wastes, then other options must be included in the infectious
waste management plan.
Regulation at the Federal, State, and local level may have
impact on the treatment of infectious waste. For example, although
there are no Federal air pollution regulations that apply specifically
to infectious waste incineration, some States regulate hospital
incinerators (6). Furthermore, many localities apply particulate
standards to all incinerators regardless of type. Water quality
regulations may also be applicable. For example, regulations
and standards pertaining to chemical pollutants, thermal discharges,
organic loading (biological oxygen demand), and particulates
(total suspended solids) are relevant to the infectious waste
treatment systems that utilize chemicals, thermal inactivation,
and grinding, respectively, as part of the treatment process.
3-3
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In addition, States have regulations that specify requirements for
the disposal of pathological waste and sharps. Therefore, it is
imperative that State, and local regulations be carefully considered
when developing an infectious waste treatment plan.
Another important factor in the selection of options for in-
fectious waste management is the availability of on-site and off-
site treatment. On-site treatment of infectious waste provides
the advantage of a single facility or generator maintaining control
of the waste. For some facilities, however, off-site treatment
may offer the most cost effective option. Off-site treatment
alternatives include such options as morticians (for pathological
wastes), a shared treatment unit at another institution, and
commercial or community treatment facilities. With off-site
treatment, precautions should be taken in packaging and transporting
to ensure containment of the infectious waste. In addition,
generators should comply with all State and local regulations
pertaining to the transport of infectious waste, and ensure that
the waste is being handled and treated properly at the off-site
treatment facility.
It is also important to consider prevailing community attitudes
in such matters as site selection for off-site treatment facilities.
These include local laws, ordinances, and zoning restrictions as
well as unofficial public attitudes which may result in changes
in local laws.
Cost considerations are also important in the selection of
infectious waste management options. Cost factors include
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personnel, equipment cost (capital expense, annual operating,
and maintenance), hauling costs (for infectious waste and the
residue from treatment), and, if applicable, service fees for the
off-site treatment option.
3.3 Infectious Waste Management Plan
EPA recommends that each facility establish an infectious
waste management plan. A responsible person at the facility
should prepare a comprehensive document that outlines policies
and procedures for the management of infectious waste (in-
cluding infectious wastes with multiple hazards). This recom-
mendation is consistent with the standard of the Joint Commission
on Accreditation of Hospitals (JCAH) which specifies a system
"to safely manage hazardous materials and wastes" (7).
In addition to the overall infectious waste management
plan, it is appropriate to specify detailed instructions for
research and clinical laboratories within the facility where
infectious waste is generated.
3.3.1 Designation of Infectious Waste
The first element of an infectious waste management plan
is to specify which wastes are to be managed as infectious waste.
EPA has designated six categories of wastes as infectious; however,
as stated earlier, other potentially contaminated wastes should
be evaluated on an individual basis by an authorized responsible
person or committee.
3.3.2 Segregation of Infectious Waste
Infectious waste should be separated from the general waste
stream to assure that these wastes will receive appropriate
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handling and treatment. Also, segregation of the waste assures that
the added costs of special handling will not be applied to non-
infectious waste (8). Infectious waste should be segregated
from the general waste stream at the point of generation (i.e.,
the point at which the material becomes a waste). It is best
accomplished by those who generate the waste and, therefore, are
best qualified to assess the hazards associated with the waste.
Provisions should be made for infectious waste with multiple
hazards. These wastes should be segregated from the general
infectious waste stream when additional or alternative treatment
is required, or in cases where the wastes are regulated under
Federal or State rules.
Infectious waste should be discarded directly into containers
or plastic bags which are clearly identifiable and distinguishable
from the general waste stream. Containers should be marked with
the universal biological hazard symbol (Figure 3-1) (9, 10, 11,
12, 13). Plastic bags also should be distinctively colore.d or
marked with the universal biological hazard symbol. Red or
orange colored plastic bags generally are used to identify
infectious waste.
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FIGURE 3-1
THE BIOLOGICAL HAZARD SYMBOL
The symbol is fluorescent orange or orange-red. The
background may be any color that provides sufficient contrast
for the symbol to be clearly defined. For specifications of
dimensions, see p. 114 of reference 9.
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3.3.3. Packaging of Infectious Waste
Infectious waste should be packaged in order to protect
waste handlers and the public from possible injury and disease
that may result from exposure to the waste. Infectious waste
should be contained from the point of origin up to the point at
which it is no longer infectious. Therefore, the integrity of
the packaging must be preserved through handling, storage,
transportation, and treatment.
The following factors should be considered in selecting
appropriate packaging:
0 waste type
0 handling and transport of the packaged waste (before treatment)
0 treatment technique
0 special considerations for plastic bags
0 package identification
Waste Type. To provide adequate waste containment, packaging
should be appropriate for the type of waste. For example,
liquid infectious waste should be placed in capped or tightly
stoppered bottles or flasks. Containment tanks may be used
for large quantities of liquid waste. Solid or semi-solid wastes
such as pathological wastes, animal carcasses, and laboratory
wastes may be placed in plastic bags.
Sharps should be placed directly into impervious, rigid,
and puncture-resistant containers to eliminate the hazard
of physical injury. Clipping of needles is not recommended,
unless the clipping device effectively contains needle parts which
might otherwise become airborne and pose a hazard.
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Suitable containers for sharps are glass, metal, rigid
plastic, wood, and heavy cardboard; containers should be compatible
with selected treatment processes. Sharps containers should be
marked with the universal biohazard symbol and sealed before
handling.
Handling and Transport of Packaged Waste Before Treatment. If
the waste is to be moved within the facility for treatment or
storage, single plastic bags may not effectively contain the
waste. If necessary, additional packaging should be used to
preserve the integrity of the bags and to ensure containment
of the waste. One option is to place single-bagged waste within
a rigid or semi-rigid container such as a bucket, box, or carton.
Plastic bags may be used as liners for such containers. Another
suitable practice is double-bagging, that is, placing the
sealed plastic bag within another bag which is subsequently
sealed. Containers of sharps and liquids may be placed within
other containers (e.g., boxes) for ease of handling. The containers
should be covered with secure lids during transport and storage.
Lids may be opened during the treatment process.
Whenever plastic bags of infectious waste are handled and
especially when they are transferred, care must be exercised
to prevent tearing of the bags. For example, plastic bags
containing infectious waste should not be transported
through a chute or dumb-waiter. In general mechanical devices should
not be used for transport or loading of plastic bags containing
these wastes. Good practices for handling plastic bags include
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loading by hand, transporting the loaded dumpster to minimize
handling, and placing the plastic bags within rigid or semi-rigid
containers before handling and transport.
When infectious waste is transported off-site for treatment,
plastic bags -- single or double — should be placed within rigid
or semi-rigid containers to maintain the integrity of the packaging
and prevent spillage. Depending on the management system, these
containers can be recycled or disposed of. Recycled containers
(such as heavy plastic barrels) which are used repeatedly for
transport and treatment of bagged waste should be disinfected
after each use. Single-use containers (such as strong cartons)
are usually destroyed as part of the treatment process (e.g.,
incineration).
Infectious waste should not be compacted prior to treatment
because compacting may actually disperse the infectious waste by
destroying the integrity of the packaging. In addition, compaction
may interfere with the effectiveness of the treatment process.
Treatment Techniques. Incineration requires that containers
be combustible. Effective steam sterilization, however, requires
that packaging materials allow steam penetration and evacuation
of air. Therefore, a single packaging technique may not be
suitable for all treatment processes. For example, autoclavable
bags which typically are constructed of high-density plastics
may prevent effective treatment by trapping air within the bags
and impeding steam penetration. This prevents the waste from
attaining temperatures necessary for adequate treatment (14,
15). Interference with the treatment process may also result
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from the type of plastic. Substitution with low density plastics
will enhance steam penetration and facilitate air evacuation
from the load. However when low density plastic bags are
used they should be placed within heat-resistant containers to
assure containment of the waste during the steam sterilization
process.
Special Considerations for Plastic Bags. Several types of plastic
bags are available. The quality of a plastic bag and its suit-
ability for use to contain infectious waste are determined by
the raw materials used in its manufacture and the product speci-
fications. Two different criteria are often used to judge the
suitability of a plastic bag: its thickness and its durability,
as evaluated by the ASTM dart test (16). These standards have
been incorporated separately into some State regulations. For
example, Massachusetts regulations specify bag thickness;
California regulations, however, require the dart test. Therefore,
procurement should be based on one or both of these standards.
The important consideration is the selection of tear-resistant
plastic bags that maintain their integrity (at least until the
waste is treated) and, thus, prevent dispersal of infectious
agents into the environment. The incidence of bag tearing can
be reduced somewhat, but not eliminated completely, by measures
such as using tear-resistant plastic bags for infectious waste;
not placing sharps, sharp items, or items with sharp corners in
the bags; not overloading a bag beyond its weight and volume
capacity; and exercising special care during handling in order
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to keep the plastic bags from coming into contact with external
sharp objects. Another helpful technique is the use of
double-bagging rather than a single plastic bag.
For aesthetic reasons, opaque plastic is preferable when
plastic bags are used to contain certain types of infectious
waste (for example, pathological wastes) — with opaque plastic,
the contents of the bag are not visible. Translucent bags are
suitable for infectious waste when aesthetics is not a concern.
Package Identification. Packaged infectious waste should be
easily identifiable. This may be accomplished by the use of
containers with the distinctive red or orange color that indicates
biohazardous material. Another option is the use of the universal
biohazard symbol (Figure 3-1) on all infectious waste packages
and containers. The identification system should include clear
labelling to indicate all hazards that are present in the waste.
3.3.4 Storage of Infectious Waste
While it is preferrable to treat infectious waste as soon
as possible after generation, same day treatment is not always
possible or practical. For example, treatment equipment may not
be available because of insufficient capacity, malfunction, or
unavailability of personnel. In such cases it may be necessary to
store the waste.
There are four important factors to be considered when
storing infectious waste — the integrity of the packaging,
storage temperature, the duration of storage, and location and
design of the storage area.
The packaging should provide containment of the waste through-
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out the waste management process. In addition, the packaging
should deter rodents and vermin which can be vectors in disease
transmission.
Storage temperature and duration are important considerations.
As temperature increases, the rates of microbial growth and
putrefaction also increase. This results in the unpleasant
odors typically associated with wastes containing decaying
organic matter.
There is no unanimity of opinion on optimum storage time
and temperature. Some States, however, establish storage
requirements as a function of time and temperature. For example,
regulations in California permit storage for a maximum of four
days at temperatures above 32°F. Massachusetts allows infectious
waste to be stored for one day at room temperature (64°-77°F) or
for three days in a refrigerator (34°-45°F). These requirements
are for total storage time prior to treatment, regardless of
whether the waste is stored at the generating facility or at a
separate treatment facility. EPA recommends that storage times
be kept as short as possible.
The storage area should be a specially designated area
located at or near the treatment site. For security reasons,
the storage area should have limited access that restricts the
entry of unauthorized personnel. It should be kept free of rodents
and vermin. In addition, the universal biohazard label should
be posted where appropriate (e.g., doors, waste containers,
refrigerators, and freezers).
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3.3.5 Transport of Infectious Waste (on- and off-site)
There are two factors which should be considered to ensure
safe transport of infectious waste both within the facility and to
an off-site treatment facility. Proper packaging is necessary
to ensure containment of the waste. Mechanical devices should
not be used to transfer or load infectious waste since rupturing
of the packaging and dissemination of the waste may result.
Carts are suitable for moving packaged infectious waste
within the facility. These carts should be disinfected frequently,
Carts used to transport infectious waste should not be used for
other materials prior to decontamination.
The use of appropriate hazard symbols should be in ac-
cordance with municipal, State and Federal regulations. The
waste should be transported in closed and leak-proof dumpsters
or trucks to prevent scattering, spillage, and leakage of the
waste during off-site transport. EPA does not consider the
truck as a rigid containment system; rather it serves only as a
transport mechanism. Therefore, all infectious waste should be
placed in rigid or semi-rigid, leak-proof containers before being
loaded on the truck.
3.3.6 Treatment of Infectious Waste
Since package integrity cannot be ensured during landfilling,
loss of containment may result in dispersal of infectious waste
into the environment. Therefore, to ensure protection from
the potential hazards posed by these wastes, EPA recommends that
all infectious waste be treated prior to disposal.
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"Treatment" for purposes of this document means any method,
technique, or process designed to change the biological character
or composition of waste.
The purpose of treating infectious waste is to reduce
the hazard associated with the presence of infectious agents.
To be effective, treatment must reduce or eliminate pathogens
(present in the waste) so that it no longer poses a hazard to
persons who may be exposed to it. Waste that is effectively
treated may be handled and disposed of as general refuse.
The information presented in Chapter 4 of this document
summarizes methods commonly used to treat infectious waste.
Chapter 5 provides suggested treatment techniques for each type
of infectious waste.
3.3.7 Disposal of Treated Waste
Infectious waste which has been effectively treated is
no longer biologically hazardous and may be mixed with and
disposed of as ordinary waste, provided the waste does not pose
other hazards that are subject to Federal or State regulations.
Treated liquid wastes may be poured down the drain to the
sewer system. Sewer disposal is also an option for certain
treated solid wastes (e.g., pathological waste) that are amenable
to grinding and flushing to the sewer system. Sewer disposal,
however, is subject to the approval of the local sewer authority.
Treated solid wastes and incinerator ash can be disposed of in a
sanitary landfill.
Additional processing of some wastes may be necessary or ad-
visable before disposal. For example, some States require that
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needles and syringes be rendered non-useable before disposal.
Treated sharps can be ground up, incinerated, or compacted.
For aesthetic reasons body parts should not be recognizable when
disposed of.
3.3.8 Contingency Planning
The infectious waste management plan should include a
contingency plan to provide for emergency situations. It is
important that these measures be selected in a timely manner
so that they can be implemented quickly when needed.
This plan should include, but not be limited to, procedures
to be used under the following circumstances:
0 spills of liquid infectious waste — clean-up
procedures, protection of personnel, and disposal of spill
residue,
0 rupture of plastic bags (or other loss of containment) —
clean-up procedures, protection of personnel, and repackaging
of waste,
0 equipment failure — alternative arrangements for
waste storage and treatment (e.g., off-site treatment).
3.3.9 Staff Training
Facilities that generate infectious waste should provide
employees with infectious waste management training. This training
should include an explanation of the infectious waste management
plan and assignment of roles and responsibilities for implementation
of the plan. Such education is important for all employees who
generate or handle infectious wastes regardless of the employee's
role (i.e., supervisor or supervised) or type of work (i.e.,
technical/scientific or housekeeping/maintenance).
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Training programs should be implemented:
0 when the infectious waste management plans are first
developed and instituted,
0 when new employees are hired, and
0 whenever infectious waste management practices are
changed.
Continuing education is also an important part of staff
training. Refresher training aids in maintaining personnel
awareness of the potential hazards posed by infectious wastes.
Training also serves to reinforce waste management policies and
procedures that are detailed in the infectious waste management
plan.
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CHAPTER 4
TREATMENT OF INFECTIOUS WASTE
4.1 Introduction
The purpose of treating infectious waste is to change its
biological character so as to reduce or eliminate its potential
for causing disease. Incineration and steam sterilization are
the most frequently used infectious waste treatment techniques.
However, other processes are effective in treating infectious
waste.
Facilities involved with the treatment of infectious waste
should establish standard operating procedures for each treatment
process. Standardization of procedures should include establishing
acceptable operating limits which take into account all factors
that may effect the treatment process.
The following treatment techniques are discussed in this
chapter:
0 Steam sterilization (autoclaving)
0 Incineration
0 Thermal inactivation
0 Gas/vapor sterilization
0 Chemical disinfection
0 Sterilization by irradiation
4.1.1 Monitoring
A convenient approach for determining treatment effectiveness
is the use of biological indicators (17). Biological indicators
are standardized products that are routinely used to demonstrate
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the effectiveness of the treatment process (18). It is now
current practice to use spores of a resistant strain of a
particular bacterial species for testing each specific treatment
process. The United States Pharmacopeia recommends the use of
biological indicators for monitoring treatment processes such
as steam sterilization, incineration, and thermal inactivation
(19, 20).
There are other indicators that provide an instantaneous
indication -- usually by a chemically induced color change --
of the achievement of a certain temperature. However, these
indicators are not suitable for use in monitoring the sterilization
process because each treatment technique involves a combination
of factors; therefore, no single factor is a valid criterion
for indicating the effectiveness of the sterilization process.
(For example, in steam treatment, the wastes must be exposed
to a certain temperature for at least a minimum period of time
in order to achieve sterilization. Therefore, any indicator
that indicates only the attainment of a particular temperature
is not suitable for monitoring the effectiveness of steam
sterilization).
Other indicators which monitor the treatment process may
be used (21, 22). However, it is recommended that the appro-
priateness and reliability of these indicators be confirmed
before they are used to monitor infectious waste treatment.
It is essential that indicators be properly placed
within the waste load so that they will indicate accurately
the effect of treatment on the entire waste load. Therefore,
to assure accurate monitoring, the biological indicators should
be distributed throughout the waste load.
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Monitoring is essential in development of standard operating
procedures for each treatment technique to verify that the
treatment process is effective. Monitoring also permits refinement
of the operating procedures so that excess processing can be
avoided while savings are realized in expenditures of time,
energy, and/or materials. Subsequent periodic monitoring
serves to demonstrate sterilization, thereby confirming that
proper procedures were used and that the equipment was functioning
properly.
4.2 Steam Sterilization
Steam sterilization of infectious waste utilizes saturated
steam within a pressure vessel (known as steam sterilizer,
autoclave, or retort) at temperatures sufficient to kill
infectious agents present in the waste (17).
There are two general types of steam sterilizers -- the
gravity displacement type, in which the displaced air flows out
the drain through a steam-activated exhaust valve, and the pre-
vacuum type, in which a vacuum is pulled to remove the air
before steam is introduced into the chamber. With both types,
as the air is replaced with pressurized steam, the temperature
of the treatment chamber increases. This results in temperature
increases within the waste load which under most conditions
are sufficient to treat the waste.
Treatment by steam sterilization is time and temperature
dependent; therefore, it is essential that the entire waste
load is exposed to the necessary temperature for a defined
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period of time. (Heating of the containers and the waste usually
lag behind heating of the chamber (17, 23).)
In steam sterilization, decontamination of the waste occurs
primarily from steam penetration. Heat conduction provides a
secondary source of heat transfer. Therefore, for effective
and efficient treatment, the degree of steam penetration is
the critical factor. For steam to penetrate throughout the
waste load, the air must be completely displaced from the
treatment chamber. The presence of residual air within the
sterilizer chamber can prevent effective sterilization by:
reducing the ultimate possible temperature of the steam,
regardless of pressure; causing variations in temperature
throughout the chamber; prolonging the time needed to attain
the maximum temperature; and inhibiting steam penetration
into porous materials (17). Factors that can cause incomplete
displacement of air include: use of heat resistant plastic
bags (which may exclude steam or trap air), use of deep containers
(which may prevent displacement of air from the bottom), and
improper loading (which may prevent free circulation of steam
within the chamber).
The principal factors that should be considered when
treating infectious waste by steam sterilization are:
0 type of waste
0 packaging and containers
0 volume of the waste load and its configuration in the
treatment chamber.
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Types of Waste. Infectious waste with low density (such as
plastics) is more amenable to steam sterilization. High density
wastes such as large body parts, and large quantities of animal
bedding and fluids inhibit direct steam penetration and require
longer sterilization time. Alternative treatment methods
should be considered (e.g. , incineration) for these wastes.
Packaging and Containers. A variety of containers are used in
steam sterilization including plastic bags, metal pans, bottles,
and flasks. One consideration with plastic bags is the type
and thickness of the plastic and its suitability for use in
steam treatment. As discussed earlier, some plastic bags are
marketed as autoclavable (i.e., they are heat resistant and do
not melt). These bags are constructed of high density polyethylene
or polypropylene plastic and, therefore, do not facilitate
steam penetration to the waste load (14, 15). Bags made of
heat-labile plastic have been found to crumble and melt during
steam treatment which allows steam penetration of the waste
but destroys the bag as a container. When heat-labile plastic
bags are used, they should be placed within another heat stable
container which allows steam penetration (e.g., strong paper
bag). It is good policy to place plastic bags within a rigid
container before steam treatment in order to prevent spillage
and drain clogging. To facilitate steam penetration, bags should
be opened and bottle caps and stoppers should be loosened
immediately before placement in the steam sterilizer.
Volume and Configuration of the Waste Load. The volume of the
waste is an important factor in steam sterilization as it can
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be difficult to attain sterilizing temperatures in large loads.
It may be more efficient to autoclave a large quantity of
waste in two small loads rather than one large load (24).
Many infectious wastes that have multiple hazards should
not be steam sterilized because of the potential for exposure
of equipment operators to toxic, radioactive, or other hazardous
chemicals. Infectious wastes that should not be steam sterilized
include those that contain antineoplastic drugs/ toxic chemicals,
or chemicals that would be volatilized by steam.
Persons involved in steam sterilizing infectious waste
should be educated in proper techniques to minimize personal
exposure to the hazards posed by these wastes. These techniques
include use of protective equipment, minimization of aerosol
formation, and prevention of spillage of waste during autoclave
loading.
A recording thermometer should be used to ensure that a
sufficiently high temperature is maintained for an adequate
period of time during the cycle. Failure to attain or maintain
operating temperature may indicate mechanical failure.
All steam sterilizers should be routinely inspected and
serviced. Monitoring the steam sterilization process is required
to ensure effective treatment. The process should be monitored
periodically to check that proper procedures are being followed
and that the equipment is functioning properly. Bacillus
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stearothermophilus is recommended by The United States Pharmacopeia
(19, 20) as the biological indicator for monitoring steam
sterilization. There are other indicators that may effectively
monitor the treatment process; however, because steam sterilization
is both time and temperature dependent, any indicator that is
used should effectively monitor both these factors.
4.3 Incineration
Incineration is a process which converts combustible
materials into noncombustible residue or ash. The product
gases are vented to the atmosphere through the incinerator
stack while the treatment residue may be disposed of in a
sanitary landfill. Incineration provides the advantage of
greatly reducing the mass and volume of the waste — often by
more than 95 percent -- which, in turn, substantially reduces
transport and disposal costs.
Incineration can be a suitable treatment technique for all
types of infectious waste. Incineration is especially advantageous
with pathological waste and contaminated sharps because it renders
body part unrecognizable and sharps unuseable. Incinerators
that are properly designed, maintained, and operated are effective
in killing organisms that are present in infectious waste.
However, if the incinerator is not operating properly, viable
pathogenic organisms can be released to the environment in
stack emissions, residue ash, or wastewater (25, 19, 26, 27).
The principal factors that should be considered when
incinerating infectious waste are:
0 variation in waste composition
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0 waste feed rate
0 combustion temperature
Variations in Waste Composition. Waste composition affects
combustion conditions due to variations in moisture content and
heating value. It is important to adjust loading rate and com-
bustion temperature/ as needed, to maintain proper incinerating
conditions.
Waste Feed Rate. The rate at which waste is fed into the incin-
erator also affects the efficacy and efficiency of treatment.
It is important to avoid overloading which often results in
incomplete combustion and unsatisfactory treatment of infectious
waste.
Combustion Temperature. An optimum temperature must be maintained
during combustion to ensure proper treatment of infectious waste.
The combustion temperature can be maintained, as necessary, by
adjustments in the amount of combustion air and fuel.
With pathological incinerators, in particular, it is essential
that operating temperatures be attained before loading the waste.
The amount of air and fuel should be adjusted to maintain the
combustion temperature at the necessary level. Adjustments should
be made as the composition of the waste changes.
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For infectious waste with multiple hazards, special
considerations are appropriate. For example, infectious waste
that contains or is contaminated with antineoplastic drugs
should be incinerated only in an incinerator that provides the
high temperature and long residence (dwell) time that are
necessary for the complete destruction of these compounds.
The plastic content of the waste also should be considered
before incineration is selected as a treatment technique. Many
incinerators can be damaged by temperature surges caused by
combustion of large quantities of plastic (such as contaminated
disposables). Another factor to be considered is the chlorine
content of polyvinyl chloride and other chlorinated plastics
that may be present in the waste. The combustion products of these
plastics include hydrochloric acid which is corrosive to the in-
cinerator and may damage the refractory (lining of the chamber)
and the stack. Limiting the plastic content of waste loads
burned in incinerators will extend the life of these units.
Since infectious waste must be exposed to a sufficiently
high temperture for an adequate period of time to ensure
destruction of all pathogenic organisms, specific standards
should be established to define minimum operating temperatures.
For example, the Massachusetts policy for incineration of
infectious waste specifies that all new incinerators must
operate at a minimum temperature of 1600°F in the secondary
combustion chamber and a minimum residence time of one second.
In addition to operating procedures, design features can
also affect the incineration process (25). For example,
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mechanical controls can help ensure that infectious waste is
exposed to the appropriate combustion temperature. Lock-out
devices can be installed to prevent ignition of the primary
chamber until the secondary chamber is at operating temperature.
Shut-down devices will keep the secondary chamber at operating
temperature for a certain period of time after the primary
chamber is shut off or until it cools to a certain temperature.
Monitors which provide continuous information on combustion
temperature, waste feed rate, fuel feed rate, and air feed
rate are essential for monitoring the process.
Pathological incinerators have traditionally been used by
hospitals to incinerate pathological and other infectious
waste. These incinerators have relatively small capacity, and
generally are operated intermittently. Some larger facilities
have considered installation of resource recovery incinerators
(i.e., heat recovery from incineration of all wastes -- including
infectious wastes). However, these incinerators may be subject
to regulation under the Federal Clean Air Act, or the Resource
Conservation and Recovery Act (hazardous waste regulations) if
certain hazardous waste are burned (28, 29). At present,
pathological incinerators are not subject to Federal regulations
promulgated under either the Clean Air Act or Resource Conservation
and Recovery Act. However, many States and localities have
frequently applied emission standards, in particular, standards
for particulate emissions and carbon monoxide, to all incinerators
(including pathological) within their jurisdictions.
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The absence of regulations that apply to hospital in-
cinerators does not relieve a hospital of responsibility for
meeting the criteria for proper incineration of infectious waste.
Therefore, even though infectious waste incinerators may not be
regulated, hospitals and other facilities treating infectious waste
by this method should ensure that the waste is being properly
incinerated.
4.4 Thermal Inactivation
Thermal inactivation includes treatment methods that
utilize heat transfer to provide conditions that reduce the
presence of infectious agents in waste. Generally this method
is used for treating larger volumes of infectious wastes (such
as industrial applications). Different thermal inactivation
techniques are used for treatment of liquid and solid infectious
wastes.
4.4.1 Thermal Inactivation of Liquid Infectious Waste
Batch-type liquid waste treatment units consist of a vessel
of sufficient size to contain the liquid waste generated during
a specific operating period (e.g., 24 hours). The system may
include a second vessel that provides continuous collection of
waste without interruption of activities that generate the
waste.
The waste may be pre-heated by heat exhangers, or heat may
be applied by a steam jacket that envelopes the vessel. Heating
is continued until a pre-determined temperature (usually measured
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by a thermocouple) is achieved and maintained for a designated
period of time (analogous to steam sterilization). Mixing may
be appropriate to maximize homogeneity of the waste and temperature
during the loading and heat application steps of the treatment
cycle.
The temperature and holding time depends on the nature of
the pathogens present in the waste. Since this treatment method
is used most often in industrial applications, the identity of
the pathogens are usually known. Time and temperature requirements
can be selected on the basis of the resistance of either the
pathogen present in the waste or of a pathogen that is more
resistant than those being treated.
After the treatment cycle is complete, the contents of the
vessel/tank are discharged. These discharges, which are normally
to the sewer, must comply with the local, State, or Federal
requirements. Since these requirements usually include temperature
restrictions, a second heat exchanger may be necessary to remove excess
heat from the effluent.
The continuous treatment process for treating liquid
infectious waste is actually a semi-continuous process. The system
can provide on demand thermal inactivation without the need for
a large vessel or tank. A typical system consists of a small feed
tank, an elaborate steam-based heat exchanger, a control and
monitoring system, and associated piping.
Liquid waste is introduced into the small feed tank, pumped
across the heat exchanger at a constant fixed rate of flow, and
then recirculated through the feed tank and the rest of the system
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until the required temperature has been achieved. Because of
the relatively shorter contact time, the treatment temperature may
be higher than those in a batch-type system. The treated waste
may be cooled by a second heat exchanger before discharge to the
sanitary sewer of the facility.
4.4.2 Thermal Inactivation of Solid Infectious Waste
Dry heat treatment may be applied to solid infectious
waste. In this technique, the waste is heated in an oven
which is usually operated by electricity. Dry heat is a less
efficient treatment agent than steam and, therefore, higher
temperatures or longer treatment cycles are necessary. A
typical cycle for dry heat sterilization is treatment at 320° to
338°F for two to four hours.
The extensive time and energy requirements of thermal in-
activation preclude common use of this technique for treatment
of solid infectious waste.
4.5 Gas/Vapor Sterilization
Gas/vapor sterilization is an option that may be used for
treating certain infectious waste. In this method, the sterilizing
agent is a gaseous or vaporized chemical. The two most commonly
used chemicals are ethylene oxide and formaldehyde. There is
substantial evidence that these chemicals are probable human
carcinogens (30,31), and caution must be exercised when they
are used. Therefore, when the use of gas/vapor sterilization
is considered, the relative hazard of the treatment itself
4-13
-------
should be weighed against the benefits resulting from the
treatment.
Ethylene oxide gas is often used to sterilize thermolabile
supplies but, because of its toxicity and because other options
are available, ethylene oxide is not recommended for treating
infectious waste.
Formaldehyde gas is used to sterilize certain disposable
items which may be contaminated (e.g., HEPA filters from biological
safety cabinets). Formaldehyde sterilization procedures should
be performed only by persons trained in the use of formaldehyde
as a gaseous sterilant.
With both ethylene oxide and formaldehyde, there is the
potential for additional exposure after treatment has been completed,
Ethylene oxide is absorbed by porous materials, and formaldehyde
frequently forms a residue. Both of these phenomena result in
continued release of the gases from the treated waste for
substantial periods of time after treatment.
4.6 Chemical Disinfection
Chemical treatment is most appropriate for liguid wastes,
however, it also can be used in treating solid infectious waste.
In order to use chemicals effectively, the following factors
should be considered:
0 type of microorganism
0 degree of contamination
0 amount of proteinaceous material present
0 type of disinfectant
4-14
-------
0 concentration and quantity of disinfectant
0 contact time
0 other relevant factors (e.g., temperature, pH, mixing
requirements, biology of microorganism)
The disposal of chemically treated waste should be in
accordance with State and local requirements.
4.7 Sterilization by Irradiation
An emerging technology for treating infectious waste
involves the use of ionizing radiation. Experience being
gained from irradiation of medical supplies, medical components,
food, and other consumer products is providing a basis for the
development of practical applications for treatment of infectious
waste.
The advantages of ionizing radiation sterilization for
treatment of infectious waste relative to other available
treatment methods include:
0 nominal electricity requirements
0 no steam requirements
0 no residual heat in treated waste
0 performance of the system
The principal disadvantages of a radiation sterilization
facility are:
0 high capital cost
0 requirement for highly trained operating and support
personnel
0 large space requirement
0 problem of ultimate disposal of the decayed radiation
source
4-15
-------
When properly used and monitored, ionizing radiation may
provide an effective method of treating infectious waste.
4.8 Other Treatment Methods
Other methods of treating infectious waste should be
demonstrated as effective before being used routinely. Efficacy
of the method should be demonstrated by the development of an
biological testing program. Monitoring should be conducted on a
periodic basis using appropriate indicators.
4-16
-------
CHAPTER 5
SUGGESTED TREATMENT METHODS FOR EACH
INFECTIOUS WASTE CATEGORY
5.1 Introduction
Suggested treatment methods for each infectious waste
category presented in Chapter 4 are outlined in this chapter.
These recommendations reflect current practices as well as the
opinions of the work group cited in the acknowledgement section
of this guidance document.
These recommendations are based solely on the efficacy and
feasibility of treatment. It should be emphasized that these
recommended treatment techniques do not preclude use of alternative
effective treatment methods.
In general, the EPA believes that treated liquid infectious
waste or ground up solids may be discharged directly to the
sanitary sewer. It is recommended, however, that personnel
handling these wastes use discretion to avoid possible clogging
of drains. In some States, the landfilling of infectious waste
is allowed, in others it is prohibited. EPA recommends that
only treated infectious waste be landfilled. It must be noted
that if treated waste is no longer infectious, it may be handled
as ordinary waste provided it poses no hazard otherwise subject
to regulation. If landfilling of infectious waste is allowed by
the State, EPA recommends that only well controlled sanitary
landfills be used. Persons desiring to landfill untreated
infectious waste should consult with State officials and the land-
fill operator prior to shipping these wastes to the facility.
5-1
-------
5.2 Isolation Wastes
Patients placed in isolation (other than protective or reverse
isolation) generally have diseases of such severity and con-
tagiousness to require special precautions. To protect the
general population from pathogens present in wastes from these
patients, it is recommended that these wastes be steam sterilized
or incinerated. Feces, urine, and other body fluids may be
discharged to the sanitary sewer. However, it is recommended
that such waste be discarded in the patient care area, if possible.
5.3 Cultures and Stocks of Infectious Agents and Associated
Biologicals
Cultures and stocks of infectious agents, culture dishes, and
devices used to transfer, inoculate and mix cultures constitute a
particular hazard because pathogenic organisms are present at
high concentrations. Therefore, these wastes should be treated
prior to disposal (32). Steam sterilization is the preferred
treatment method because it is the simplest and most effective.
Furthermore, because autoclaves are present in most microbiological
laboratories, steam sterilization often can be performed in the
laboratory. Treatment at the point of generation makes it
unnecessary to transport these wastes through the facility to
treatment equipment located elsewhere. If the wastes must be
transported from the lab for treatment, steam sterilization,
incineration, and thermal inactivation are acceptable treatment
alternatives.
5-2
-------
Chemical decontamination also provides an alternative treatment
method for cultures and stocks. However, when large amounts
of liquids are treated by this method,the relatively large volume
of chemical disinfectant required to achieve effective treatment
may pose ultimate disposal problems.
5.4 Human Blood and Blood Products
Because it is impractical to test all blood for the presence
of every possible pathogen, it is prudent to manage all blood
and blood products as infectious waste. It is logical to extend
this practice to the wastes associated with blood specimens and
to handle them as though they were contaminated. Two recommended
treatment methods are steam sterilization and incineration. In
addition, blood and blood products also may be discharged directly
to the sanitary sewer for treatment in the municipal sewerage
treatment system provided that secondary treatment is available.
5.5 Pathological Wastes
In addition to the biohazard of pathological waste, other
circumstances may affect management of these wastes. For
aesthetic reasons, recognizable body parts should not be disposed
of in a landfill; rather, these wastes should be incinerated.
For religious reasons, some patients prefer that body parts (for
example, amputated limbs) be transferred to a mortician for
burial or cremation.
Alternatively, pathological waste (such as small organs
and body parts) may be steam sterilized and ultimately ground
and discharged to the sewer.
5-3
-------
5.6 Contaminated Sharps
Two factors should be considered in establishing procedures
for the handling, treatment, and disposal of contaminated sharps:
the hazard of disease transmission and physical injury. Since
the latter factor also pertains to sharps that are not contaminated,
a single uniform management system for all sharps is recommended.
All sharps upon discard should be placed directly into rigid,
puncture resistant containers to avoid injury. Clipping of
contaminated needles is not recommended since this may result in
the production of an infectious aerosol. However, devices used
to clip needles within a totally enclosed system are acceptable.
Contaminated sharps should be treated to eliminate the
disease potential. Both incineration and steam sterilization
provide effective treatment for contaminated sharps. Treatment
by steam sterilization should be followed by compaction or by
grinding when required by State or local regulations.
5.7 ContaminatedAnimal Carcasses, Body Parts, and Bedding
The management of contaminated carcasses and body parts of
animals that were intentionally exposed to pathogens is similiar
to the management of pathological wastes (See Section 5.5).
Incineration of these wastes serves both to treat and destroy the
carcass.
Steam sterilization in a retort followed by grinding and
flushing to the sewer system is another suitable method for treatment
and disposal of these wastes; however, long cycles are necessary.
Steam sterilization in autoclaves has only limited use in treatment
5-4
-------
of animal carcasses because of size constraints and long treatment
times necessary to achieve sterilization. Nevertheless, auto-
claving can be useful in two applications: to decontaminate the
surface of a carcass before it is transported through a facility
to an incinerator, and to treat small carcasses and body parts
before they are ground up and flushed to the sewer.
Contaminated animal bedding is best treated by incineration.
Steam sterilization may not effectively treat these wastes.
5.8 Miscellaneous Contaminated Waste (Optional Category)
The following treatment methods are recommended whenever
one or more of these contaminated wastes are designated as
infectious waste:
0 contaminated wastes from surgery and autopsy should be
treated by incineration or steam sterilization
0 contaminated laboratory wastes should be treated by
incineration or steam sterilization; thermal inactivation
may be appropriate
0 dialysis unit wastes should be treated by steam steri-
lization or incineration
0 contaminated equipment and equipment parts should be treated
by steam sterilization or incineration; in some situations,
gas or vapor sterilization in situ is the best treatment
alternative (e.g. , HEPA filters, large items).
5-5
-------
REFERENCES
1. U.S. Environmental Protection Agency. Regulations for
Hazardous Waste Management. In Code of Federal Regu-
lations, 40 CFR 260-271 and 122-124. Washington, D.C.,
U.S. Government Printing Office, 1985.
2. U.S. Environmental Protection Agency. Title 40, Subchapter
K--Regulations under Toxic Substances Control Act.
I_n_ Code of Federal Regulations, 40 CFR 761 and 762,
Washington, D.C. U.S. Government Printing Office, 1984.
3. Nuclear Regulatory Commission. Biomedical Waste Disposal:
Final Rule. In Federal Register, 46 FR 16230-16234,
March 11, 1981.
4. U.S. Department of Health and Human Services, Centers for
Disease Control (CDC), Isolation Techniques for Use in
Hospitals. 2nd edition. HEW Publication No. (CDC) 78-8314,
Atlanta, Georgia, CDC, 1978. 104 pp.
5. Garner, J.S. and B.P. Simmons. CDC Guidelines for Isolation
Precautions in Hospitals. Infection Control, 4 (Suppl.):
245-325, July/August 1983.
Also: American Journal of Infectious Control, 12(2):
103-163, April 1984.
6. Commonwealth of Massachusetts, Department of Environmental
Quality Engineering, Division of Air Quality Control.
Policy for Commercial, Industrial, and Infectious
Waste Incinerators. Boston, Massachusetts. June 1984.
7. Joint Commission on Accreditation of Hospitals. Plant,
Technology, and Safety Management — Standard VI. In
Accreditation Manual for Hospitals, 1985 Edition- Chicago,
Illinois, Joint Commission on Accreditation of Hospitals,
1985. pp. 133-134.
8. Silvagni, R., et al. A Waste Reduction Project within the
University of Minnesota Hospitals. Minneapolis,
Minnesota, University of Minnesota Hospitals, Physical
Plant Department, March 15, 1980.
9. U.S. Department of Health and Human Services, National
Institutes of Health (NIH). Laboratory Safety Monograph.
A supplement to the NIH Guidelines for Recombinant DNA
Research. Bethesda, Maryland, NIH, Office of Research
Safety, National Cancer Institute, and the Special
Committe of Safety and Health Experts, July 1978.
R-l
-------
iU. U.S. Department of Health and Human Services. Interstate
Shipment of Etiologic Agents: Transportation of
Materials Containing Certain Etiologic Agents; Minimum
Packaging Requirements. In Code of Federal Regulations,
42 CFR 72.3. Washington, D.C., U.S. Government Printing
Office, 1984.
11. U.S. Department of Labor, Occupational Safety and Health
Administration. Specifications for Accident Prevention
Signs and Tags. Biological Hazard Signs. In Code of
Federal Regulations, 29 CFR 1910.145(e)(4).
Washington, D.C., U.S. Government Printing Office, 1979.
12. U.S. Department of Transportation. Etiologic Agent Label.
In Code of Federal Regulations, 49 CFR 172.444.
Washington, D.C., U.S. Government Printing Office, 1984.
13. U.S. Department of Transportation. Labeling of packages
containing etiologic agents. I_n_ Code of Federal Regu-
lations, 49 CFR 173.388. Washington, D.C., U.S.
Government Printing Office, 1984.
14. Everall, P.H. and C.A. Morris. Failure to Sterilize in
Plastic Bags. Journal of Clinical Pathology, 29(12):
1132, December 1976.
15. Dole, M. Warning on autoclavable bags. American Society
for Microbiology, 44(6): 283, June 1978.
16. American Society for Testing and Materials. ASTM Standard
# D 1709-75. Philadelphia, Pennsylvania. 1975.
17. Perkins, J.J. Principles and Methods of Sterilization in
Health Sciences. 2nd edition. Springfield, Charles C.
Thomas, 1969. 560 pp.
18. United States Pharmacopeial Convention, Inc., Sterilization.
Section 1211 In the United States Pharmacopeia. 20th
revision. Rockville, Maryland, United States Phar-
macopeial Convention, Inc., 1980. pp. 1037-1039.
19. Peterson, M.L., and F.J. Stutzenberger. Microbiological
evaluation of incineration operations. Applied Micro-
biology, 18(1): 8-13, July 1969.
20. United States Pharmacopeial Convention, Inc., Sterilization.
In the United States Pharmacopeia. 19th revision.
Rockville, Maryland, United States Pharmacopeia
Convention, Inc., 1975. pp. 709-714
R-2
-------
21. Lee, C. H., T.J. Montville, and A.J. Sinskey. Comparison
of the efficacy of steam sterilization indicators.
Applied and Environmental Microbiology, 37 (6): 113-117,
June 1979.
22. Gillis, J.R. Biological indicators for steam sterilization
process monitoring. Bulletin of the Parenternal Drug
Association, 29(3): 111-121, May - June 1975.
23. Rubbo, S.D., and J.F. Gardner. A Review of sterilization
and Disinfection. London, Lloyd-Luke (medical books)
Ltd., 1965. 250 pp.
24. Karle, D.A. Sterilization of laboratory biological wastes.
Presented at the 22nd Biological Safety Conference,
Bethesda, Maryland, October 1979.
25. Barbeito, M.S., and M. Shapiro. Microbiological safety
evaluation of a solid and liquid pathological incin-
erator. Journal of Medical Primatology, 6(5): 264-
273, 1977.
26. Barbeito, M.S., L.A. Taylor, and R.W. Seiders. Microbiological
evaluation of a large-volume air incinerator. Applied
Microbiology, 16(3): 490-495, March 1968.
27. Robertson, P.G. A Preliminary Evaluation of the Emission
of Viable Microorganisms from an Animal Crematory.
M.Sc. thesis, West Virginia University, Morgantown,
West Virginia, 1968. 20 pp.
28. U.S. Environmental Protection Agency. National Emission
Standards for Hazardous Air Pollutants. In Code of
Federal Regulations, 40 CFR Part 61. Washington, D.C.,
U.S. Government Printing Office, 1984.
29. U.S. Environmental Protection Agency. Incinerator Standards
for Owners and Operators of Hazardous Waste Facilities.
In Code of Federal Regulations, 40 CFR Parts 122, 264,
and 265. Washington, D.C., U.S. Government Printing
Office, 1984.
30. U.S. Environmental Protection Agency, Carcinogen Assessment
Group. List of carcinogens. Washington, D.C.,
April 24, 1980.
31. OSHA regulation, 49 FR 25790, June 22, 1984.
32. Howie, J. Sterilization of discarded cultures. Journal of
Applied Bacteriology, 36(4): i, Dec. 1973.
R-3
-------
Appendix
STATE REGULATIONS PERTAINING TO
INFECTIOUS WASTE MANAGEMENT (1986)
Statutory Authority and
State Regulation Citation
Summary of Requirements
State Agency
>
i
Alabama 1975 Code of Alabama,
Section 22-21-20.
Alabama State Board
of Health Rules and
Regulations for Nursing
Homes and Hospitals.
All infectious waste
generated by nursing
hones and hospitals
must be incinerated
on site.
Bureau of Licensure and Certification
State Health Department
Room 652
State Office Building
Montgomery, Alabama 36130-1701
(205) 261-5105
No regulations.
Policy is to recommend
treatment of infectious
waste prior to disposal.
Alabama Department of Environmental
Management
Land Division
1751 Federal Drive
Montgomery, Alabama 36130
(205) 271-7700
Alaska Laws of Alaska, Title
44, Chapter 46; Title
46, Chapter 3.
All infectious waste
generated by medical
and veterinary
facilities must be
incinerated prior
to final disposal.
Air and Solid Waste Management
Department of Environmental
Conservation
Pouch O
Juneau, Alaska 99811
(907) 465-2666
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
-------
APPENDIX (Continued)
Statutory Authority and
State Regulation Citation
Summary of Requirements State Agency
Arizona
i
to
Arkansas
Arizona Revised
Statutes, Title 36,
Article 2, General
Hospitals.
Regulation R9-10-220,
Environmental Services,
Subsection E.
Act 414 of 1961, as
amended by Act 444
of 1965 and Act 454
of 1965. Rules and
Regulations for
Hospitals and Related
Institutions in Arkansas.
The Solid Waste
Managenent Act (237) of
1971.
Arkansas Hazardous
Waste Management
Act of 1979 (Act
406 of 1979).
All infectious waste
must be either (1)
autoclaved and disposed
of in an approved sanitary
landfill, or (2) incinerated
in an approved incinerator.
Variances are given for
disposal of untreated waste
when there is insufficient
treatment capacity.
All infectious waste
generated by hospitals
and related institutions
must be incinerated or
disposed of by other
approved methods.
Revisions are expected
in 1986.
The state has statutory-
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Bureau of Health Care Institution
Licensure
Arizona Department of Health
Services
1740 West Adams Street
Phoenix, Arizona 85007
(602) 255-1115
Department of Health
Division of Health Facilities Services
4815 W. Markham Street
Little Rock, Arkansas 72205-3867
(501) 661-2201
Solid Waste Management Division
Department of Pollution Control and
Ecology
P.O. Box 9583
8001 National Drive
Little Rock, Arkansas 72219
(501) 562-7444
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Suimiary of Requirements
State Agency
i
OJ
California California Health
and Safety Code
Chapter 6.5, Article 2,
Section 25117.5
California Administrative
Code, Title 22.
Division 4, Chapter 30:
Minimum Standards for
Management of Hazardous
and Extremely Hazardous
Waste; Infectious Waste
Regulations, effective
November 16, 1985.
Infectious waste must
be incinerated, steri-
lized or treated by
other approved methods.
California Department of
Health Services
Hazardous Materials Management
Section
714/744 P Street
Sacramento, California 95814
(916) 324-1798
Colorado Colorado Revised Statutes,
1973, as amended; Title 25,
Article 15, Parts 1, 2,
and 3: Hazardous Waste
Management Act.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Waste Management Division
Colorado Department of Health
4210 E. llth Avenue
Denver, Colorado 80220
(303) 320-8333 Ext. 4364
Chapter 4, Regulations
Governing General
Hospitals.
Pathological waste must
be incinerated. Off-site
disposal in approved sites
is possible.
Division of Health Facilities
Regulations
Colorado Department of Health
4210 E. llth Avenue
Denver, Colorado 80220
(303) 320-8333 Ext. 6306
-------
APPENDIX (Continued)
Statutory Authority and
State Regulation Citation
Summary of Requirements State Agency
Connecticut
Connecticut General
Statutes of 1979,
Public Act 79-605.
Code 22A-4483
and 22A-115.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Hazardous Waste Management
Department of Environmental
Protection
State Office Building
165 Capitol Avenue
Hartford, Connecticut 06106
(203) 566-4869 or 566-5712
Delaware Delaware Code, Title 7,
Chapter 60:
Solid Waste Act.
Delaware Solid Waste
Disposal Regulations,
August 1974.
Infectious waste disposal
is approved on a case-by-
case basis. None has been
allowed to go to landfills
untreated since the approval
process was initiated.
Revised regulations have
been proposed.
Waste Management Section
Department of Natural Resources and
Environmental Control
89 King Highway
P.O. Box 1401
Dover, Delaware 19903
(302) 736-4781
-------
APPENDIX (Contirued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
District of District of Columbia
Columbia Hazardous Waste Management
Act of 1977, D.C. Law 2-64.
The District has statutory
authority to regulate in-
fectious waste as a
hazardous waste but has
not yet promulgated regu-
lations
Department of Consumer and
Regulatory Affairs and Enviro-
msntal Control Division
5010 Overlook Avenue, SW
Washington, DC 20032
(202) 767-8414
•f
Florida Florida Resource Recovery
and Management Act (Florida
Statutes Annotated, Title
27, Public Health, Chapter
403, Part IV, Enacted by
the Laws of 1974, Chapter
342/ as amended).
Florida Resource Recovery
and Management Regulations:
Rules of the Department
of Environmental Regulation,
Chapter 17-7.04.
Infectious waste must be
incinerated or treated by
an approved treatment
method before being placed
in a landfill.
Solid Waste Management Program
Department of Environmental
Regulation
Twin Towers Office Building, 6th Floor
2600 Blair Stone Road
Tallahassee, Florida 32301
(904) 488-0300
and
Department of Health and
Rehabilitative Services
1317 Winewood Blvd.
Tallahassee, Florida 32301
(904) 488-2905
-------
APPENDIX (Continued)
Statutory Authority and
State Regulation Citation
Summary of Requirements
State Agency
Georgia Code of Georgia, Annotated,
Title 43, Chapter 43-16:
Solid Waste Management Act
of 1972, as amended.
Georgia Department of
Natural Resources Rules
and Regulations for Solid
Waste Management, Chapter
391-3-4, 1972, as attended
through 1974.
Infectious waste is
considered a special
waste. Policy is to
require incineration
or autoelaving before
land disposal.
land Protection Branch
Environmental Protection Division
Department of Natural Resources
Room 724
270 Washington Street, S.W.
Atlanta, Georgia 30334
(404) 656-2833
Hawaii Hawaii Environmental laws
and Regulations, \fol. I,
Title 19, Chapter 342,
Part V, as amended by
Chapter 230, Laws of 1974.
Title II, Department of
Health, Chapter 58,
Solid Waste Management
Control Regulations,
November 1981.
All infectious waste
must be treated or other-
wise rendered safe before
disposal. Double bagging
is considered a means
of rendering an untreated
waste safe.
Air and Solid Waste Permit Section
Department of Health
Amelco Building, 3rd Floor
645 Halekau Wila Street
Honolulu, Hawaii 96313
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Idaho
Idaho Code, Title 39,
Chapter 1.
Idaho Solid Waste
Management Regulations,
Title I, Chapter 6.
All solid waste must
be managed to prevent
health hazards, public
nuisances, and pollution
of the environment
during treatment,
storage and disposal.
Policy is to recommend
that infectious waste
be double bagged prior
to disposal.
Hazardous Materials Bureau
Department of Health and Welfare
State House
Boise, Idaho 83720
(208) 334-4107
Illinois Illinois Revised Act
101-105, January 1985.
State of Illinois Rules
and Regulations 35,
Subtitle G, Subpart F,
Sections 700.601-700.605
All infectious hospital
waste must be rendered
innocuous by sterili-
zation or incineration
before disposal.
Division of land Pollution Control
Environmental Protection Agency
2200 Churchill Road
Springfield, Illnois 62706
(217) 782-6762 or 782-6760
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Indiana Indiana Code, Title 13,
Article 7, Environmental
Management Act.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations. Regulations
are being drafted.
Division of Land Pollution Control
State Board of Health
1330 West Michigan Street, Rm A304
Indianapolis, Indiana 46206
(317) 243-9100
>
00
Refuse Disposal Act:
recodified as Indiana
Solid Waste Disposal
Law 1C-36-9-30.
Rule 330 IAC 4.
Written approval must
be obtained before
disposal of infectious
waste in a sanitary
landfill.
Iowa
Iowa Code 1985, Section
455B.304.
900—100.3(2) Iowa
Administrative Code (IAC)
Land disposal of in-
fectious waste is
prohibited unless
a special waste authorization
is granted that
requires autoelaving
or formalin treatment
before land disposal.
Air and Waste Permit Branch
Program Operations Division
Iowa Department of Water, Air
and Waste Management
Henry A. Wallace Building
900 East Grand Street
Des Moines, Iowa 50319
(515) 281-8692
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Kansas Kansas Statutes Annotated,
Chapter 65, Article 34,
as amended.
Kansas Administrative
Regulations, Title 28.
Public Health, Article 29,
Regulation 27, Effective
May 1984.
Kentucky Kentucky Revised Statutes,
224.005(227)(a).
Certificate of Need and
Licensure Law, as revised,
(originally effective
January 1, 1973).
902 Kentucky Administrative
Regulations, 20:009,
Hospital Facility
Regulation.
Infectious waste must be
incinerated, treated
before land disposal,
or ground to the sewer.
Untreated infectious waste
may be sent to a hazardous
waste land disposal facility
or to a sanitary landfill with
authorization from the Department.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Solid Waste Management Section
Department of Health and Environment
Forbes Field, Building 321
Topeka, Kansas 66620
(913) 862-9360, Ext. 309
Division of Waste Management
Cabinet of Natural Resources
and Environmental Protection
18 Re illy Road
Frankfort, Kentucky 40601
(502) 564-6716
Hospitals must have an
incinerator capable of
destroying infectious
waste. Hospitals which
satisfy the treatment,
packaging, and transportation
requirements can secure
waivers to incinerate the
waste in city facilities.
Revised regs effective 6/4/85
require that sharp waste (needles,
glass, etc.) be separated from
other infectious waste. Sharp
waste is to be packaged in rigid
containers for either incineration
or disposal in approved landfills.
Division for Licensing and
Regulation
Department of Human Resources
275 E. Main Street
Frankfort, Kentucky 40601
(502) 564-2800
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Louisiana Louisiana Revised
Statutes, Act 449,
30: 1133, Environmental
Affairs Act.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Policy is to allow disposal
of treated infectious waste
in selected sanitary landfills.
Hazardous Waste Division
Department of Natural Resources
P.O. Box 44066
Baton Rouge, Louisiana 70804
(504) 342-1216
Maine
Title 38 of Maine Revised
Statutes Annotated.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste tut has
not yet promulgated
regulations.
Bureau of Oil and Hazardous Waste
Materials
Department of Environmental
Protection
State House — Station 17
Augusta, Maine 04333
(207) 289-2651
Maryland Annotated Maryland Code,
Health Environment Article,
Sections 9-210(g) and 9-229,
effective July 1, 1984.
Amended Guidelines for the
Disposal of Infectious
Waste, effective July 1, 1984.
Infectious waste cannot
be disposed of in a land-
fill.
Incineration is the pre-
ferred method of treatment.
Air Management Administration
Department of Health and Mental
Hygiene
201 West Preston Street, 2nd Floor
Baltimore, Maryland 21201
(301) 225-5260
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APPENDIX (Cont irued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Massachusetts
>
i
Massachusetts General
Laws, Chapter 111,
Subsections 3 and 51-56,
and Chapter HID.
105 CMR 130.354.
Hazardous Infectious
Waste Disposal Regula-
tions; and 105 CMR
180.275, Regulation
for Disposal of
Infectious Materials
from Independent
Laboratories.
Massachusetts General
Laws, Chapter 21-C.
Massachusetts General
Laws, Chapter 21-C.
Infectious waste must be
incinerated or treated
before disposal.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Massachusetts Department of
Public Health
150 Tremont Street
Boston, Massachusetts 02111
(617) 727-2700
Division of Solid and Hazardous
Waste
1 Winter Street
Boston, Massachusetts 02108
(617) 292-5582
Michigan
As of December 28, 1985,
Michigan deleted its list
of infectious wastes
from the regulations.
Office of Hazardous Waste
Management
Michigan Department of Natural
Resources
P.O. Box 30038
Lansing, Michigan 48909
(517) 373-1220
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APPENDIX (Continued )
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Minnesota Minnesota Statutes
Annotated
Chapters 115A and 116,Enacted
by Laws of 1980, as
amended.
Minnesota Code of
Agency Rules, Title 6,
Part 4, as amended
SW1-12 and SW6-2viii.
Land disposal of in-
fectious waste is
prohibited.
Division of Solid and Hazardous
Waste
Minnesota Pollution Control
1935 West County Road B-2
Roseville, Minnesota 55113
(612) 296-7373
N)
Mississippi
No laws or regulations
pertaining to infectious
waste management.
Division of Solid/Hazardous Waste
Management
Bureau of Pollution Control
Department of Natural Resources
P.O. Box 10385
Jackson, Mississippi 39209
(601) 961-5171
Missouri Missouri Hospital
Licensing Law,
Chapter 197 of
Missouri Revised
Statutes,
Rules and Regulations
for Hospitals.
Infectious waste
generated by hospitals
must be either incinerated
or autoclaved before
being sent to a landfill
permitted to accept the
waste. Waste is required
to be treated on site.
The state expects to revise
regulations later this year.
Missouri Department of Health
Bureau of Hospital Licensing
P.O. Box 570
Jefferson City, Missouri 65102
(314) 751-2713
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APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Missouri
Missouri Hazardous
Waste Management
Law, Chapter 260
of Revised Statutes
of Missouri, 1985,
as amended.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Waste Management Program
Department.of Natural Resources
P.O. Box 176
Jefferson City, Missouri 65102
(314) 751-3241
Missouri Solid Waste
Management Law,
Chapter 260.200
of Revised Statutes
of Missouri, 1975.
Missouri Solid Waste
Management Rules and
Regulations, 10CSR80,
Chapters 1-5.
Sterilized infectious waste
may be disposed of in
any permitted solid
waste landfill.
Montana
Montana Solid Waste
Management Act of 1976.
Administrative Rules
of Montana, Title 16,
Chapter 14, Subchapter
5, Solid Waste
Management/Refuse
Disposal.
Montana Hazardous Waste
Act of 1981.
Policy is to recommend
treatment of infectious
waste before land
disposal.
Solid and Hazardous Waste
Management Bureau
Department of Health and Environ-
mental Sciences
Cogswell Building, Rm B201
Helena, Montana 59620
(406) 444-2821
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Nebraska Nebraska Environmental
Protection Act, Section
81-1501 through 81-1540.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
land Quality Division
Department of Environmental Control
State House Station
P.O. Box 94877
Lincoln, Nebraska 68509
(402) .471-2186
Nevada
Nevada Revised Statutes,
Chapter 459, Hazardous
Waste Disposal and
Solid Waste Disposal.
Regulations Governing
Solid Waste Management,
Effective 1977.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Division of Environmental Protection
Department of Conservation and
Natural Resources
Capital Complex
Carson City, Nevada 89710
(702) 885-4670
Infectious waste generated
by hospitals may be placed
in a land disposal facility
only under approval of the
Department.
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
New Hampshire
New Jersey
New Hampshire Revised
Statutes Annotated
151, 1979.
Health Facilities
Rules and Regulations,
effective February 1984.
General Requirements
For all Facilities,
HEP-801.
New Jersey Statues
Annotated, Title 13:
Conservation and
Development, Chapter 1E-1.
New Jersey Administrative
Code, Title 7, Chapter 26,
as amended. New regulations
dealing with hazardous
wastes expected within the
year.
New Jersey Health Care
Facilities Planning
Act.
New Jersey Administrative
Code 8:43-8-3.6.
Infectious waste generated
by health care facilities
must be incinerated.
Infectious waste must be
rendered non-infectious
in accordance with the
standards of the New Jersey
Department of Health.
All infectious waste
generated by hospitals
must be treated before
land disposal.
Infectious waste that is
not autoclaved or incinerated
can be double-bagged for land
disposal by a method approved
by the Department of Environ-
mental Protection.
Bureau of Health Facilities
Administration
Division of Public Health
Department of Health and Welfare
6 Hazen Drive
Concord, New Hampshire 03301
(603) 271-4592
Division of Waste Management
Department of Environmental
Protection
33 East Hanover Street
Trenton, New Jersey 08625
(609) 292-9877
New Jersey Department
of Health
Division of Health Facilities
Evaluation
CN 370
Trenton, New Jersey 08625
(609) 292-7834
-------
APPENDIX (Continued)
Statutory Authority and
State Regulation Citation
Summary of Requirements
State Agency
New Mexico
Hazardous Waste Act,
Section 74-4-3, as
amended through 1981.
No specific regulations
on infectious waste.
Incineration or steril-
ization of infectious
waste followed by land
disposal is recommended.
Solid and Hazardous Waste Manage-
ment Programs
Health and Environment Department
P.O. Box 968
Santa Fe, New Mexico 87504-0968
(505) 827-5271 or 827-0020
New York Environmental Conservation
Law, Article 27.
Title 6 NCRR part 364.
Collection and Transport
of Industrial, ConTtercial,
and Certain Other Wastes.
Anyone transporting a
hospital waste off-site
(including infectious
waste) must have a waste
transporter's permit.
Division of Solid and Hazardous Waste
Department of Environmental
Conservation
50 Wolf Road, Roan 417
Albany, New York 12233
(518) 457-3254
North North Carolina Solid
Carolina and Hazardous Waste
Act, as revised, July
1983.
10 NCAC 10G, Solid Waste
Management, July 1, 1985
Infectious waste must be
treated by an approved
method prior to disposal
in a landfill.
Solid and Hazardous Waste
Management Branch
Division of Health Services
Department of Human Resources
P.O. Box 2091
Raleigh, North Carolina 27602
(919) 733-2178
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
North No governing statute or
Dakota regulations.
Policy is to require
autoclaving or inciner-
ation of all infectious
waste generated by
hospitals and nursing
homes. No untreated
infectious waste may be
disposed of in a landfill.
Every hospital and nursing
home must have access to a
double-chambered, approved
incinerator in order to be
licensed.
Division of Health Facilities
Department of Health
State Capitol Building
Bismark, North Dakota 58505
(701) 224-2352
Ohio
Ohio Revised Code,
Title 37, Chapter 34,
as amended.
Ohio Administrative
Code, Regulations
3745-27 and 3745-37,
Effective July 29,
1976.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Division of Solid and Hazardous Waste
Management
Ohio Environmental Protection Agency
361 East Broad Street
Columbus, Ohio 43215
(614) 466-7220
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirments
State Agency
Oklahoma Oklahoma Statutes,
Title 63, 1981,
Section 1-2001 et
seq., Oklahoma
Controlled Industrial
Waste Disposal Act.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Current policy is based
on CDC guidelines. In-
fectious waste regulations
are being drafted.
Institutional Services, Medical
Facilities
Department of Health
P.O. 53551
1000 N.E. 10th Street, 4th Floor
Oklahoma City, Oklahoma 73152
(405) 271-6811
i
h-1
00
Oregon
Oregon Revised Statutes,
Chapter 459, as amended.
Oregon Administrative
Rules, Chapter 340,
Division 61.
Land disposal of infectious
waste is controlled
through the permitting
process for land disposal
facilities.
Hazardous and Solid Waste Division
Department of Environmental Quality
P.O. Box 1760
Portland, Oregon 97207
(503) 229-6266
Pennsylvania
Pennsylvania Statutes,
62 PS 901-1059, Public
Welfare Code.
Pennsylvania Code,
Title 28, Chapter 147.74,
Pennsylvania State
Health Department
Regulations: Disposal
of Bacterial and
Pathological Wastes
That Are Generated in
Hospitals and Medical
Care Facilities.
Current policy is to
allow off-site
sterilization of in-
fectious waste. New
regulations are being
drafted.
Bureau of Waste Management
Department of Environmental Resources
Fulton Building 8th Floor
P.O. Box 2063
Harrisburg, Pennsylvania 17120
(717) 787-6239
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Rhode Rhode Island Hazardous
Island Waste Management Act
of 1978.
Hazardous Waste
Rules and Regulations
Effective December 20,
1979.
Rules and Regulations
for Hazardous Waste
Generation, Transportation,
Treatment, Storage and
Disposal - Effective July
18, 1984.
Infectious waste is
regulated as a
hazardous waste.
Division of Air and Hazardous
Materials
Department of Environmental
Management
204 Cannon Building
75 Davis Street
Providence, Rhode Island 02908
(401) 277-2797
South Code of laws of South
Carolina Carolina, 1976, Sections
44-56-10 through
44-56-140, Hazardous
Waste.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations. The state
recommends that infectious
hospital waste be incinerated
or otherwise treated before
land disposal.
Bureau of Solid and Hazardous
Waste
South Carolina Department of
Health and Environmental
Control
2600 Bull Street
Columbia, South Carolina 29201
(803) 758-5681
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
South South Dakota Codified
Dakota Laws, Chapter 34A-6-2,
Solid Waste Disposal
Act.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Office of Air Quality and
Solid Waste
Department of Water and Natural
Resources
Joe Foss Building
523 East Capitol Avenue
Pierre, South Dakota 57501
(605) 773-3153
to
o
Tennessee Tennessee Hazardous
Waste Management
Act of 1977, as
amended.
Tennessee Solid Waste
Disposal Act, as amended.
The state is initiating
rulemaking action.
Division of Solid Waste Management
Tennessee Department of Public
Health and Environment
Customs House, 4th Floor
601 Broadway St.
Nashville, Tennessee 37219-5403
(615) 741-3424
Tennessee Code Annotated,
6811-201 through 217
Minimum Standards and
Regulations for Hospitals,
1974.
All infectious waste
generated by hospitals
must be incinerated in
closed incinerators on
elevated platforms.
Hospital Licensing Board
283 Plus Park
Nashville, Tennessee 37210
(615) 367-6200
-------
APPENDIX (Cont inued)
State
Statutory Authority 'and
Regulation Citation
Summary of Requirements
State Agency
Texas
N)
Revised Civil Statutes
of the State of Texas
Annotated, Article 4477-7
Texas Solid Waste Disposal
Act; and Article 4477-1,
Texas Sanitation and
Health Protection Law,
as amended.
Texas Administrative Code
325.136(b)(l),
Texas Department of Health,
Municipal Solid Waste
Management Regulations,
effective July 1983, as
amended.
Infectious waste is
regulated as a special
waste. Incineration
is the preferred method
of treatment. Uhtreated
waste may be double bagged
and disposed of in a Type I
municipal landfill.
Bureau of Solid Waste Management
Texas Department of Health
1100 West 49th Street, T601A
Austin, Texas 78756 - 3199
(512) 458-7271
Utah
Utah Code Annotated,
Title 26, Chapter 14,
Utah Solid and
Hazardous Waste Act,
Effective June, 1981.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Bureau of Solid and Hazardous
Waste
Department of Health
P.O. Box 45500
Salt Lake City, Utah 84145-0501
(801) 533-4145
-------
APPENDIX (Continued)
Statutory Authority and
State Regulation Citation
Summary of Requirements
State Agency
Vermont \fermont Statutes
Annotated, Title 10,
Chapter 159.
Hazardous Waste
Management Regulations,
as amended September 13,
1984, Section 6602(2)(a)
(14).
Virginia Code of Virginia,
Title 32.1, Chapter 6,
Article 3.
Virginia Regulations
Governing Disposal of
Solid Waste, April, 1971.
Infectious waste is
regulated as a
hazardous waste.
Infectious wastes are not
regulated as hazardous wastes.
Waste generators must have
special permission to dispose
of non-municipal waste.
Rules do not preclude
land disposal of untreated
infectious waste.
Hazardous and Solid Waste
Management Division
Department of Water Resources
and Environmental Engineering
Agency of Environmental
Conservation
State Office Building
Montpelier, ^fermont 05602
(802) 828-3395
Division of Solid and Hazardous
Waste Management
Department of Health
Monroe Building, llth Floor
101 North 14 Street
Richmond, Virginia 23219
(804) 225-2667
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Sunmary of Requirements
State Agency
Washington Revised Code of Vvkshington,
Hazardous Waste Disposal
Chapter 70.105.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet pronulgated
regulations.
Hazardous Waste Section
Department of Ecology
Mail Step PV-11
Olympia, Washington 98504 - 8711
(206) 459-6322
l
N)
oo
Revised Code of Washington,
Hospital Licensing and
Regulation Statute,
Chapter 70.41.
Washington Administrative
Code, 248-18-170,
Hospital Rules and
Regulations.
Infectious waste
generated by hospitals
must be incinerated
or disposed of by
other approved methods.
Approved methods include
autoclaving, retorting,
or double bagging
before land disposal.
Department of Social and
Health Services
Facility Licensing Certification
Section of the Health
Services Division
Mail Stop ET-31
Olympia, Washington
(206) 753-7039
West
Virgina
Code of West Virginia,
Chapter 20, Article
SE, Effective July
7, 1981.
Infectious waste
regulations are
being drafted.
State Health Department
1800 Washington Street East
Charleston, West Virginia 25305
(304) 348-2970
-------
APPENDIX (Continued)
State
Statutory Authority and
Regulation Citation
Summary of Requirements
State Agency
Wisconsin
i
to
Wyoming
Wisconsin Statutes
Annotated, Chapter 144,
as amended.
Chapter MR 181, and
guidance summary
"Handling and Disposal
of Pathological Waste."
No^. regulations pertaining
to infectious waste
management.
The state has statutory
authority to regulate
infectious waste as a
hazardous waste but has
not yet promulgated
regulations.
Policy is to recommend in-
cineration of infectious
waste. Infectious waste
which has been autoelaved
or sterilized may be bagged
and disposed of in an
engineered landfill.
Bureau of Solid Waste Management
Department of Natural Resources
P.O. Box 7921
Madison, Wisconsin 53707
(608) 266-2111
Solid Waste Management Program
State of Wyoming
Department of Environmental Quality
Herschler Building
122 West 25th Street
Cheyenne, Wyoming 82002
(307) 777-7752
Department of Health and
Social Services
Division of Health and
Medical Services
4th Floor Hathaway Bldg.
Cheyenne, Wyoming 82002
(307) 777-7121
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