Medical waste is generated at facilities that involve exposure to body fluids or tissues that may contain contaminants that are potentially infectious to humans, the community, and the environment. Specific laws and guidelines have been established on local, state, and federal levels to identify, store, transport, and treat medical waste so that it is rendered harmless. The State of Indiana Laws- 410 IAC has adopted regulations that define medical waste that is hazardous and dictates the standards for handling PIMW (potentially infectious medical waste); complimenting existing federal laws and guidelines. The purpose of the regulations is for the reduction of environmental and occupational risks that happen during storage, transfer, transport, treatment, and disposal of PIMW. Dot regulation 49 CFR 173.22 indicates that all responsibilities involving safe conduct of all regulated waste is assigned to the shipper. This is called “cradle to grave,” which means that the organization generating and shipping the medical waste is accountable for insuring that it is stored, handled, documented, and disposed of according to all guidelines.
Medical waste can be generated in any facility that has exposure to human or animal blood or tissues that could have infectious contaminants and pathogens. Facilities can be individual businesses such as: Physician’s offices, veterinary clinics, tattoo parlors, body piercing, dental offices, pharmacies, and mortuaries. Midsized organizations that generate medical waste can include but are not limited to blood banks, university and scientific research and laboratories, the coroner facilities, nursing homes, pharmaceutical laboratories, and multi-physician clinics. Hospitals and pharmaceutical research laboratories are some the largest institution type that generates medical waste.
Indiana State Department of Health; 410 IAC 1-3-24; filed Jan 17, 1989, 3:30 p.m.: 12 IR 1385; readopted filed Jul 11, 2001 has a complete list of definitions of medical waste, packaging and storage requirements. A majority of facilities that generate medical waste coordinate transportation and disposal with a professional and licensed medical waste disposal company. Some of the larger facilities, such as hospitals, may have onsite containment and disposal abilities that comply with state and federal laws. All PIMW which will be shipped, treated and disposed of off-site is required to be placed in containers that are rigid, leak-resistant, impervious to moisture, and strong enough to prevent bursting or tearing under normal use and handling conditions, as well as sealed to keep the containers from leaking at any point. Sharps are those items that can puncture the skin and must be packaged in special puncture-proof containers. Oversized PIMW are required to be packaged or covered so that contact with the public or transport professionals is minimized. Sharps are not allowed to be packaged and transported as oversized PIMW.
Containers are required to be labeled with the international “Biohazard” symbol, the word Biohazard, and sharps will have the distinctive “Sharps” label. Inner packages must have the word “Biohazard” or “Sharps” and must also have the international Biohazard symbol label. All containers need to be stored in a location that is segregated so that only the transport professionals will have access.
“Conditionally exempt small quantity generators (CESQGs) do not have a limited accumulation time, as long as the quantities accumulated are less than 2,200 pounds of non-acute hazardous waste or less than 2.2 pounds of acute hazardous waste. This limit was set so that a small business can accumulate enough hazardous waste to make shipping and disposal more economical. Small quantity generators (SQGs) can accumulate hazardous waste up to 180 days, or 270 days if the distance to the disposal site is over 200 miles. The total waste quantity must not exceed 13,200 pounds of non-acute hazardous waste or 2.2 pounds of acute or severely toxic hazardous waste. Large quantity generators (LQGs) can only accumulate hazardous waste up to 90 days.”
The transportation of untreated and treated medical waste is considered to be infectious waste transport. Indiana State Department of Health rules for labeling and placarding can be found in 410 IAC 1-3. The Indiana Department of Environment Management (IDEM) requires a company to be licensed, trained, and comply with registrations and permits for the transport of medical waste. The hazardous waste transporter is required to have a U.S. EPA/RCRA ID number. Hazardous waste must be properly container, identified and labeled prior to transport according to the U.S. Department of Transportation (U.S. DOT) regulations.
Companies involved in the handling, transport, and disposal of medical waste are required to be licensed and trained professionals according the federal OSHA guidelines. The companies need to have: all staff properly trained, insured, and permitted to handle medical waste, properly trained drivers, understand and comply with both federal and state laws, be able to provide proper paperwork, manifests, and bills of lading, as well as documentation of final treatment and disposal of the medical waste.
The vehicles/trucks/vans for transport are required to be completely self-contained without leaks or gas exposure, well-insulated, well-maintained, enclosed so that putrescence effects are minimized, cannot be accessed by the public, cleaned and sterilized after each use, cannot be used for any other purpose other than PIMW (potentially infectious medical waste) transport, and must be in condition that prevents a breeding place or food source.
Transport requirements include:
Specific destruction methods are required for each type of medical waste. The State of Indian bans any untreated medical waste from being placed in a landfill.
Incineration: The incinerators used for medical waste operate at temperatures around 1800 degrees Fahrenheit, which reduces the medical waste to harmless ash that can be safely placed in a landfill. The State of Indiana currently has no offsite commercial infectious waste incinerators. Infectious waste incinerators that do accept offsite waste are required to have a solid waste processing facility permit from OLQ.
Autoclaving: A method that uses chemicals and/or heat at 300 degrees Fahrenheit to sterilize the medical waste. Some medical waste cannot be autoclaved using chemicals as the addition of the chemicals changes some metallic substances so that they are toxic and/or combustible. In those cases, incineration is the only option for destruction.
Irradiation: A method using gamma rays to disinfect by killing bacteria. It employs radioactive isotope of cobalt and is similar to the same radiation used for cancer treatments.
Pharmaceuticals/Medication: For unused, old, or expired medications, the State of Indiana does have medication take back programs. These programs are at specific locations and are guarded by law enforcement. Liquid medications cannot be accepted for the take back programs. It is unlawful to place any medications in private or public water systems for disposal. Many of the medications do not degrade naturally and contain elements that are hazardous for the environment and can be toxic for individuals and animals.
Parent page – Medical Waste Disposal
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