Medical waste guidelines for handling, storage, disposal, and staff/employee training have been set up in the local, state, and federal levels. In the past, many federal agencies once governed the laws, however, in most cases, these have been superseded by state and local guidelines and may be close to the federal guidelines. For the state of Minnesota, they have established the Minnesota Pollution Control Agency that works in conjunction with state-wide environmental regulations in the handling, treatment, and proper disposal of medical waste. The state makes use of federal guidelines in many cases, including medical waste packaging and storage. Those organizations that create medical waste are required to comply with all laws and guidelines to avoid contamination of potentially infectious materials. The industries are held accountable for medical waste in the “cradle-to-grave” concept, which means that they are responsible for the medical waste from the moment that it is generated to the final appropriate disposal process, including all documentation and confirmation.
Minnesota’s Pollution Control Agency covers detailed regulations in all aspects of medical waste, including a PDF document that offers step-by-step instructions on maintaining compliance, handling, and treatment of hazardous waste as well as waste identification, hazardous waste disposal, and waste characteristics.
The state of Minnesota has an additional detailed list of disposal requirements under the state’s Infectious Waste Management guidelines (MR 7035.9100 – 7035.9150)
Minnesota is one of the twenty one states that operate an approved OSHA (Occupational Safety and Health Administration) that has rules and guidelines in the HERC section for the health and safety of staff, patients, storage, containers, and labeling of medical/infectious waste and required employee training to ensure efficacy.
Minnesota identifies medical waste in much the same as other states and the federal government:
Hazardous wastes are wastes that have been classified as hazardous by the federal Environmental Protection Agency (EPA) or the Minnesota Pollution Control Agency (MPCA). A waste is hazardous if it appears on one of four lists of known hazardous wastes (F, P, K or U lists), if it displays a hazardous characteristic or if it contains 50 parts per million or more polychlorobiphenyls (PCBs). A ‘characteristic’ hazardous waste is one that meets the definition in the Minnesota Rules for ignitability, oxidizer, corrosivity, reactivity, lethality or toxicity.
Industrial solid waste is all solid waste generated from an industrial or manufacturing process, nonmanufacturing activities such as service and commercial establishments, construction debris and asbestos. Health care wastes that are not liquids, not gases, not hazardous, not infectious, not pharmaceuticals or radioactive, and not office materials or food preparation waste are industrial solid waste.
Infectious waste is waste that has the potential to transmit disease – regulated body fluids (blood and blood products and amniotic, cerebrospinal, pericardial, peritoneal, pleural and synovial fluids) and items dripping with those fluids, laboratory waste (waste cultures and stocks), infected research animal waste, sharps and pathology waste. Infectious waste is also sometimes called biohazardous, red bag or regulated medical waste. Infectious waste is not the same as hazardous waste.
Pharmaceutical waste includes expired drugs, medications left behind when a patient expires or leaves a health care facility, waste materials containing chemotherapy drug residues (syringes, IV bags, tubing, etc.) and drugs that are intended to be discarded.
Radioactive wastes contain radioactive materials. Radioactive materials are used in, and wastes generated by, several areas of a health care facility including nuclear medicine, nuclear cardiology, radiation oncology, blood bank, clinical laboratories, and research laboratories. Although X-rays are a form of radiation, they do not “contaminate” items and therefore, are not a source of radioactive wastes.
Sewerable waste is liquid waste that is usually regulated by the generator’s wastewater treatment plant authority or, in some cases, the MPCA. Most of the metropolitan areas and many of the larger cities within Minnesota have local rules regulating the discharge of wastewater into the sanitary sewer. While rules may vary for different cities, limits are usually set for metals and pH. Some wastes may be prohibited, such as flammables, oils, solids, corrosives, hazardous, ground up solids and infectious wastes. Wastewaters, such as non-contact cooling and storm water, may also be prohibited from the sanitary sewer. If part of an approved infectious waste management plan, blood and body fluids may be allowed to be discharged to the sanitary sewer. Check with your wastewater treatment plant authority. Certain wastes may be discharged after they have been treated, such as acids or caustics after adjusting the pH or x-ray fixer after treating to remove silver.
The specific characteristics of infectious waste in the state of Minnesota is defined as:
Infectious waste means waste originating from the diagnosis, care, or treatment of a person or animal that has been or may have been exposed to a contagious or infectious disease. Unless the materials have been rendered noninfectious by procedures approved by the state commissioner of health, infectious waste includes:
All wastes originating from persons or animals placed in isolation for control and treatment of an infectious disease;
Bandages, dressings, casts, catheters, tubing, and similar disposable items which have been in contact with wounds, burns, anatomical tracts, or surgical incisions and which are suspect of being or have been medically verified as infectious;
All infectious anatomical waste, including human and animal parts or tissues;
Infectious sharps and needles;
Laboratory and pathology waste of an infectious nature; or
Any other waste, as defined by the state commissioner of health, which, because of its infectious nature, requires handling and disposal in a manner prescribed for other types of infectious waste.
Who Generates Medical Waste
Any industry or organization that has contact with human or animal tissue, blood, or body fluids that could potentially be infectious is considered to be a generator of medical waste. While most people might think that these industries would be limited to the medical field, there are a number of organizations that are outside of that definition. Generators of medical waste can include but are not limited to: hospitals, medical clinics, physician offices, veterinarians, dental offices, dentists, tattoo parlors, body piercing businesses, funeral homes, coroner’s offices, pharmacies, independent and university research labs, and biological companies.
A majority of these organizations and business hire licensed and professional medical waste disposal companies that are knowledgeable in local, state, and federal guidelines for the appropriate disposal of all medical waste types.
Medical Waste Storage Requirements
The state of Minnesota does not allow any commercial transporter or facility owner or operator to receive infectious waste for offsite decontamination, storage, or disposal that is not packaged using the state requirements.
Storage of waste by offsite facility owners and operators requires compliance with the following:
Infectious or pathological waste must be segregated from other wastes in a storage area designed to prevent the entry of vermin. Storage areas for infectious or pathological waste must be secured to deny access by unauthorized persons and must be prominently marked with the international biohazard symbol and with the words “Infectious Waste” on or adjacent to the exterior of entry doors and access gates.
Interior surfaces of storage areas must be constructed of materials that are easily cleaned.
Offsite storage areas must be designed to contain spills.
Infectious or pathological waste must not be allowed to become putrescent during storage or at any time.
Storage facility owners and operators must comply with the spill response requirements in the regulations.
Medical Waste Transport Requirements
Minnesota allows for both generator and commercial transportation of medical waste, and both types of transportation require that the transporters comply with the strict guidelines that have been established.
Generator Transport Requirements
Generators who transport their own infectious waste to an offsite decontamination, storage, or disposal facility must comply with required packaging, labeling, and storage requirements.
Generators who provide not-for-compensation or at cost infectious waste collection and transport services for other generators or groups of generators that provide not-for-compensation infectious waste collection and transport service for the group must comply with the packaging, labeling, and storage requirements.
Generator transport vehicles that exceed 7,000 pounds gross vehicle weight must be identified on each side of the vehicle, and on the access doors to any area holding infectious waste, with the name of the transporter and the words “Infectious Waste” in letters six inches high with a stroke width of three-fourths inch or with the international biohazard symbol, eight inches by eight inches. Magnetic placards that meet these specifications are acceptable.
Generators who transport infectious waste in vehicles that exceed 7,000 pounds gross vehicle weight must comply with applicable regulations, in addition to providing the name and title of the individual responsible for the implementation of infectious waste activities
Commercial Transporter Requirements
A commercial transporter must possess a valid transporter registration.
The required commercial transporter’s management plan must be kept at the address identified as the commercial transporter’s principal place of business.
A commercial transporter who transports infectious waste offsite and facilities that receive the waste must be in compliance with the regulations.
A commercial transporter must not accept infectious waste from a generator who does not have a management plan acknowledgment card issued by the Minnesota Department of Health or a storage facility or treatment facility that does not have a required management plan.
Infectious waste must be transported in a fully enclosed vehicle compartment.
Infectious waste must be delivered for decontamination, storage, or disposal only to a facility owner or operator that has an approved management plan onsite or to a facility owner or operator that is exempt from the requirements for a management plan.
A commercial transporter must not deliver infectious waste to a facility owner or operator prohibited from accepting the waste.
Surface areas of equipment used to transport infectious waste must be smooth and easily cleaned.
Infectious waste must not be compacted during transport. Sharps containers, or infectious waste containers that include sharps containers, must never be compacted, whether or not the sharps have been decontaminated. Containers must be secured to prevent movement during transport.
Infectious waste must not be allowed to become putrescent during transportation.
A person must not transport or receive for transport infectious waste that is not properly packaged and labeled.
Commercial transporters must comply with all applicable regulations.
Commercial transporter vehicles must bear labels or placards that comply with the regulations.
Vehicles transporting infectious waste must be identified on each side of the vehicle, and on the access doors to any area holding infectious waste, with the name of the transporter and the words “Infectious Waste” in letters six inches high with a stroke width of three-fourths inch or with the international biohazard symbol, eight inches by eight inches.
The vehicle identification number that is issued by the commissioner must be displayed on the single unit vehicle or trailer to which it is assigned in letters and numbers at least four inches in height with a stroke width of one-half inch.
On-site separation requires that all medical waste be placed in a location that is inaccessible to unauthorized staff members, the general public, and any individuals or companies that are not authorized to add to or pick up the medical waste. Separation and segregation of medical waste, including infectious medical waste in the state of Minnesota must be complied with using the following rules:
Sharps must be in rigid, puncture-resistant containers that have lids or caps that are designed to preclude loss or leakage of the contents.
Sharps must remain packaged throughout collection, storage, decontamination, and any handling processes that precede disposal, unless the sharps have been treated by a process that renders them incapable of inducing subdermal inoculation. This item does not prevent the use of sharps containers that are designed to be reusable if applicable parts of the regulations with.
Sharps containers, or infectious waste containers that include sharps containers, that will be transported to an offsite facility must be labeled, on the outer container, with “Sharps” in letters at least one inch high with a stroke width of one-eighth inch and with either the international biohazard symbol, at least three inches by three inches, or the words “Infectious Waste” in letters at least one inch in height with a stroke width of one-eighth inch.
Infectious waste, except for sharps, must be contained in plastic bags that are impervious to moisture, and of sufficient strength to preclude ripping, tearing, or bursting under normal conditions of use and handling. Each plastic bag must be constructed of material of sufficient single thickness and strength to pass the 165-gram dropped dart impact resistance test as prescribed by ASTM Standard D 1709-75, which is incorporated by reference, and is not subject to frequent change. The bags must be secured to prevent leakage of waste during handling, decontamination, storage, transport, or disposal.
Plastic bags of infectious waste that will be shipped offsite must be packaged for storage or handling by placement in corrugated fiberboard boxes or equivalent rigid containers such as reusable pails, cartons, or portable bins. Containers must have tight-fitting covers and be securely sealed.
Boxes and rigid containers of infectious waste must be conspicuously labeled with the words “Infectious Waste” in letters at least one inch high, with a stroke width of one-eighth inch, or the international biohazard symbol, at least three inches by three inches.
Containers that have been in direct contact with infectious waste must be disinfected as required in the regulations, before further use.
Minnesota requires that both in-house and off-site storage locations have a spill cleanup kit for use in storage, decontamination, or disposal of infectious waste as well as on each transport vehicle. The cleanup kits must include:
Absorbent material for spilled liquids;
One gallon of hospital grade disinfectant or disinfectant made of a formula listed in the regulations;
Packaging and labeling, as required by the regulations.
Scoop shovel, push brooms, and plastic buckets; and
Disposable coveralls, latex and neoprene gloves, surgical type face mask, and goggles.
Response to a spill must include the following minimum procedures:
Access to the spill area by unauthorized personnel must be prevented;
Broken containers and spillage must be packaged and labeled as required by the regulations;
Absorbent material must be applied to surface areas that have been contaminated with infectious waste; and
Reusable items must be cleaned and disinfected using the required procedures.
Procedures for disinfecting contaminated surfaces include, but are not limited to, agitation to remove visible soil and application of one of the following chemical sanitizers for the contact time required by the manufacturer’s label:
Hypochlorite solution (500 ppm available chlorine);
Phenolic solution (500 ppm active ingredient);
Iodoform solution (100 ppm active ingredient); or
Other chemical sanitizer solutions of equivalent disinfectant strength.