Medical waste is an overall umbrella term that includes many categories, including biohazardous waste. Medical waste is considered to be any form of waste that is the result of medical treatment, research, or diagnosis. Not all medical waste is considered to be dangerous, yet some categories, including biohazardous waste is considered to be potentially toxic. Each category and subcategory of medical waste has specific protocols for handling, containment, storage, transport, and disposal. Unregulated medical waste can be treated as standard waste, whereas regulated medical waste (RMW) requires that a generator comply with the local, state, and federal guidelines for treatment and ultimate disposal.
OSHA (Occupational Safety and Health Administration) as well as other agencies involved in establishing laws and guidelines have used the term RMW (regulated medical waste) as a description for any item that contains potentially infectious materials (OPIM), including enough blood that could have bloodborne pathogens that could be potentially infectious. Since each state has created their own laws/guidelines, states may vary on terms of RMW including: regulate medical waste, biomedical waste, or infectious waste.
Medical Waste Types:
The Environmental Protection Agency (EPA) has established specific definitions and categories for solid medical waste:
General Waste: A majority of the medical waste generated that includes office waste and any waste that doesn’t contain potentially infectious materials.
Infectious Waste: All waste that may contain materials that could contain infectious agents that can be transmitted to humans such as: any bodily fluids, human or animal tissues, and blood.
Hazardous Waste: This is waste that may be dangerous but may not be infectious. Examples of hazardous waste can include such items as discarded surgical equipment, sharps, and even some chemical waste.
Radioactive Waste: This is waste that is created from treatments that are radioactive. Examples of radioactive waste can include cancer therapies and any equipment in the medical treatment that makes use of nuclear elements.
WHO (The World Health Organization) has a bit more details when it comes to medical waste categories:
Infectious Waste: Any waste that is considered to be contaminated or infectious.
Sharps: Any medical waste that can pierce the skin such as scalpels, broken glass or plastic, needles, and razors.
Pathological Waste: Any waste that is animal or human tissue, fluids, blood, or body parts.
Pharmaceutical Waste: Any waste that contains expired or unused medicines or drugs such as pills and creams.
Genotoxic Waste: Cytotoxic drugs and other toxic waste that is hazardous that are carcinogenic, teratogenic, or mutagenic.
Radioactive Waste: Any waste that contains radioactive materials.
Chemical Waste: Any liquid waste that is considered to be a contaminant such as waste from disinfectants, batteries, and machines.
Other/General Waste: All other waste that is considered to be non-hazardous.
There are quite a few medical waste materials that surprisingly fall into the non-regulated category. These are typically items that are used in treatment but don’t contain enough or any potentially infectious agents. Even items containing urine, feces, sweat, and saliva do not fall into the OPIM category.
Each state has specific definitions and protocols for the handling and destruction of RMW and non-regulated medical waste, and some states may differ. Some examples of non-regulated medical waste can include but are not limited to:
Empty IV bags
Empty urine or stool containers
Unused medical supplies and products (with the exception of sharps)
Regulated Medical Waste Categories
Most states recognize the seven types of regulated medical waste (RMW) with specific guidelines for handling, labeling, storing, and destruction of the waste:
Sharps Waste that had Been Contaminated: Sharps are defined as any item used in medical treatment or research that may contain infectious materials. Sharps are particularly dangerous as they can injure individuals due to mishandling. Sharps can include but are not limited to broken glass or plastic that may contain blood, bacteria, or viruses, scalpels, knives, syringes, and needles. Due to the extreme hazard of sharps, specific guidelines have been designed to label, contain, store, transport, and destroy sharps to reduce the potential of injury or contamination.
Anatomical and Pathological Waste: This is any type of waste that is made up of organs, body parts, and tissues that may have been removed during surgical procedures and/or tissues removed for research/study. Anatomical waste is specific to body parts and organs that are recognized as human. Some states have specific laws regarding packaging, labeling and transport of this type of waste as well as regulations for disposal.
Microbiological Waste: This form of waste is usually generated in research laboratories and may include but is not limited to microorganisms, stocks, cultures, and microbiological waste. Due to the potential for infection transmission, those that generate microbiological waste are required to process via autoclave before they are transported off-site for eventual treatment and disposal. Depending upon state requirements, this type of waste may also require additional labeling.
Blood Products, Blood, and OPIM: This form of waste can include but is not limited to blood, blood in tubes, and OPIM that is in suction canisters. Many states allow OPIM and liquid blood to be placed in the sanitary sewer, however, larger volumes may require checking with the local waste management company and state regulations.
Items that are Contaminated that, when pressed, would release OPIM or blood in a semi-liquid or liquid state: These items may be blood-soaked or even have dried caked on blood that can exude when pressed due to absorption. Examples of this type of waste can include gauze that is blood-soaked or blood that may flake off from PPE gloves.
Isolation Waste: This type of waste is from highly infectious patients and can include any discarded materials or biological waste that is contaminated with blood, exudates, excretions, or secretions from either animals or humans that are in isolation for the protection of others from diseases that are communicable. Only patients that are in isolation from the communicable deadly diseases have isolation waste. Other infectious diseases such as MRSA or VRE are not considered to have isolation waste but need to follow the CDC Isolation Precautions.
Animal Waste: This form of waste includes all carcasses, body parts, and bedding from animals that have been exposed to pathogens during research or are infected with zoonotic diseases. This waste is considered to be infectious waste. Animal remains that are non-infectious are managed using individual state regulations.
Subcategories of Regulated Medical Waste
In addition to the standard seven categories of RMW, there are subcategories that include:
Biohazardous waste: Any waste that may contain infectious waste.
Infectious medical waste: Any liquid, dry, or semi-liquid waste that is capable of causing infectious diseases.
Potentially infectious medical waste (PIMW): Any medical waste that contains dry, semi-dry, or liquid products that could cause potential infection.
Hospital waste: All waste generated in a hospital environment; both regulated and non-regulated.
Healthcare waste: All waste generated in a healthcare environment; both regulated and non-regulated.
Healthcare-related waste (HCW): All waste generated in a healthcare environment that could potentially include the transmission of infectious diseases.
Biological waste: Any materials that have been contaminated or may contain biohazardous agents.
Clinical waste: Any waste that consists partly or wholly of animal or human tissue, body fluids, blood, excretions, medications or pharmaceutical products that may prove hazardous to any individual that comes into contact with it.
Special waste from a healthcare-related facility: Any waste that is generated in a healthcare-related facility such as long term care or nursing facilities that may contain materials hazardous to humans, animals, or the environment.
There is specific criteria established to act as a definition for biohazardous waste. The criteria includes:
1} Waste from laboratories or research facilities that include but are not limited to:
Animal or human specimen cultures from pathology or medical labs.
Research laboratory infectious agents stocks and cultures. Any type of mold, bacteria, virus, parasite, or microorganism that significantly contributes to or normally causes an increase in mortality or morbidity of humans.
Waste that is the result of or production of viruses, spores, bacteria, discarded animal vaccines, discarded attenuated or live vaccines that are used in research or human healthcare, devices and culture dishes that are used to inoculate, mix, or transfer cultures.
2} Tissues or specimens of humans removed during surgery or autopsy that may be contaminated with agents that are infectious or are known to be contagious to humans.
3}Animal carcasses, fluids, body parts, or fluid that is suspected to have contamination with agents that are infectious and are known to be contagious to humans.
4}Waste that is recognizable as fluid blood, products of fluid blood, containers or any equipment that contains blood in fluid or animal blood that is known to be infected with diseases that are highly communicable to human beings.
CDC Levels of Biohazardous Waste
The Center for Disease Control (CDC) has defined four levels of biohazardous waste.
Biohazard Level I: Any agent that has the potential to pose even the most minimal threats to humans or the environment.
Biohazard Level II: Any agent that may cause severe illness in a human such as one that is transmitted through direct contact with infected materials.
Biohazard Level III: Any pathogen that has the potential to become airborne and cause severe illness or disease.
Biohazard Level IV: Any pathogen that has an extremely high risk of producing life-threatening disease for which there is no known treatment.
Examples of Biohazardous Waste
Infectious waste can include blood products, blood, contaminated personal protection equipment (PPE), laboratory cultures and stock that are infectious and referred to as microbiological waste, IV tubing.
Any waste that is generated in the location where a patient has been diagnosed with a communicable disease.
Any vaccines that have been discarded.
Any animal wastes
Any sharps waste which is any item in a medical environment that can pierce the skin and may have been contaminated with an infectious agent.
Pathological wastes that are the result of research, surgery, biopsy, or autopsy that includes but is not limited to tissues, body parts, and organs in animals or humans. This excludes teeth.
Biohazardous Waste Handling
Due to the critical nature of biohazardous waste, each state as well as the federal government has established guidelines and laws for the proper handling, labeling, transport, and disposal of this type of waste. While many states have similar rules, some differ. A licensed, trained and certified medical waste disposal company is knowledgeable of all laws for compliance and will supply certification of destruction to the generator.
Standard procedure for any waste that is soaked with bodily fluids or blood is to separate the materials and discard in the appropriate biohazard container for these items. Containers and red bags are labeled with the universal biohazard label. All bags and containers must have the ability to be completely sealed.
Sharps are any object that can pierce the skin that may have been contaminated with infectious agents. These are disposed of in containers designed for sharps immediately after they are used. Containers are only 2/3 filled to avoid accidents. Containers and bags must be puncture-proof, leak-proof, and spill-proof and be completely sealed.
Biohazardous waste such as specimens and culture media are usually placed into vacuum flasks that are non-breakable and leak-proof. The flasks as listed as overflow flasks as they have HEPA filters.
Solid biohazardous waste can be generated in any part of the healthcare environment including a laboratory, surgery center, or the room of a patient. Solid biohazardous waste is anything that has the potential for contamination with materials that are biologically infectious. This was is placed in a leak-proof, sturdy container with biohazardous bags that are marked with the universal label and completely sealed.