Medical Waste in 2020, Definitions, Storage, Regulation & Destruction

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Medical Waste Disposal

medical waste examples

 

Medical waste is a major challenge for hospitals and clinics. U.S. healthcare facilities create 6 million tons of it each day. That’s 33 pounds of waste for every filled bed in our medical system. But what’s the difference between regulated and non-regulated waste? Who can dispose of it, and how?

Who can transport medical waste? What regulations govern its destruction? How does RCRA fit in, and do pandemics like the COVID-19 coronavirus change best practices? Let’s look at the key points around biohazardous waste so you and your staff can become the best healthcare providers you can be.

What is medical waste?

Medical waste is healthcare trash that contains infectious or potentially infectious items. It can come from hospitals, medical clinics, veterinary offices, dental clinics, research facilities, or medical laboratories. It can contain blood or other bodily fluids, or it can appear benign, like gloves or gowns.

According to the Medical Waste Tracking Act of 1988, it’s defined as any waste created during treatment, testing, immunization, research, or diagnosis of human beings and animals. Examples include sharps like scalpels or needles, tissue, fluids, glassware, swabs, culture dishes, or bandages.

Medical waste examples

  • Expired vaccines
  • Tissue from humans or animals
  • Gowns, gloves, or gauze that may have blood on them
  • Waste from rooms of patients with infectious diseases
  • Needles, scalpels, and broken glass used in procedures
  • Laboratory cultures, stocks, and contaminated culture paraphernalia
  • Bedding from infected animals

Names for medical waste

Medical waste goes by many names, such as hospital waste, biohazardous waste, biomedical waste, and infectious medical waste. There’s also healthcare waste, clinical waste, and regulated medical waste (RMW). Even hospital office paper is medical waste, though it’s not regulated.

Names for medical waste

 

Who generates medical waste?

You know hospitals and doctor’s offices create medical waste. But blood banks, dental clinics, and urgent care clinics create it too. Pharmacies, veterinary clinics, medical testing labs, research labs, nursing homes, hotels where patients stay, and funeral homes also create regulated waste.

Even an office building can generate biohazardous waste. Why? Because if someone gets a nosebleed at work and uses a tissue to stop it, they’ve created regulated waste. The Wyndham hotel in Boston, next door to Mass General Hospital, was fined twice for medical waste violations from hotel guests.

Medical Waste Sources

  • Hospitals and clinics
  • Veterinary clinics
  • Nursing homes
  • Blood banks
  • Hotels and office buildings
  • Funeral homes
  • Pharmacies
  • Urgent care
  • Research and testing labs

Types of medical waste

The WHO identifies the 8 categories of medical waste as infectious waste, sharps waste, pathological waste, chemical waste, cytotoxic waste, radioactive waste, and nonhazardous general waste. Those types cover all the potential varieties and sources of regulated and non-regulated healthcare waste.

  • Can pierce the skin. Includes needles, razors, scalpels, lancets, staples, broken glass, and wires.
  • Tissue, fluids, organs, body parts, and animal carcasses.
  • Infectious waste. Potentially infectious swabs, lab cultures, equipment, samples, bandages, and excreta.
  • Unused or expired drugs or vaccines, including pills and injectables.
  • Radiotherapy liquid, lab research liquid, or glassware or supplies contaminated with the liquids.
  • Genotoxic waste. Carcinogenic, mutagenic, or teratogenic medical waste, including cytotoxic cancer drugs.
  • Solvents or disinfectants used in laboratories, or batteries or heavy metals from equipment—like mercury from thermometers.
  • General non-hazardous medical waste. Waste from medical facilities that poses no chemical, physical, biological, or radioactive threat.

 

medical waste facts

 

Who regulates medical waste?

The maze of medical waste regulations can be a tangle to sort out. Historically, biohazardous waste was regulated by the Federal Government and the EPA. In 2020, state laws control hospital waste handling and disposal instead, but several federal agencies maintain lists of rules and guidelines.

The U.S. Centers for Disease Control (CDC), the Occupational Safety and Health Administration (OSHA), the Drug Enforcement Administration (DEA), the Department of Transportation (DOT), the USPS, and the Food and Drug Administration (FDA) all regulate different parts of the medical waste picture.

For instance, DOT regulation 49 CFR 173.22 assigns all responsibility for the safe conduct of all regulated waste to the shipper. That means if a hospital or clinic ships waste to a disposal facility and there’s an accident en route, the hospital assumes all liability and damages.

To learn the regulations governing the collection, storage, transport, and disposal in your state, see the EPA’s medical waste disposal state laws map. Also, contact your state’s health and environmental services agency. Finally, visit the federal agency pages shown in the links above.

What happens to medical waste in the clinic / hospital?

Hospitals and clinics generate medical waste during daily operation. Doctors, nurses, and other healthcare workers collect the waste, and put it into designated biohazard bins. These can be as small as the wall-box you see in your dentist’s office or as big as a 60-gallon color-coded trash can.

By law, the bins are lined with special biohazard bags and labeled clearly as biohazardous. Each type of waste—from animal carcasses to lab waste to sharps has its own packaging and storage rules. For instance, sharps must be placed in puncture-resistant, leakproof, rigid containers.

Medical waste disposal in 2020

Large, deep-pocketed hospitals may dispose of medical waste on-site. However, cost-restrictions and increasingly strict regulations make on-site incineration problematic for most facilities. More commonly, offsite biohazardous waste treatment is the cost-effective solution in today’s healthcare world.

Most hospitals and clinics today use a truck or box service. The first uses designated trucks operated by contractors. But an increasingly common cure for the modern medical waste disposal problem is the mail or box service. These use the U.S. Postal Service to ship waste safely via licensed vendor.

In 2020, regulated waste is neutralized in dedicated treatment facilities. Depending on the type of waste, it may be incinerated, steam autoclaved, or both. Some infectious waste is decontaminated chemically. Irradiated waste is stored in lead boxes and disposed of in designated, specially controlled landfills. Other waste, like mercury or other heavy metals, are separated and recycled.

 

medical waste disposal methods

 

Who can transport medical waste? License, regulations, requirements for transportation

Only licensed medical waste transportation entities can transport healthcare waste. These include large, well-funded hospitals or independent biohazard waste shipping companies. Independent vendors may pick up the waste in trucks, or send approved mail-back containers to ship through the U.S. mail.

To become a vendor—either by truck or mail-back service—a medical waste transportation company must be licensed by their state. Each state has a separate registration process. For instance, Texas issues permits based on a system of forms, deadlines, reporting, contracts, regulations, and fees.

Different states also maintain their own rules for what types of waste can travel through the mail. The regulations are a bit of a tangle, and in the end relying on a trusted, licensed vendor who stays up on local regs is the best path. Packaging must be able to withstand weather, trauma, and heat.

Who can destroy medical waste? Storage, license, regulations requirements by federal or state?

Licensed hospitals and registered medical waste disposal firms are legally allowed to dispose of biohazardous waste. In the 1980s, one of the most common ways to destroy the waste was in an onsite Hospital, Medical, and Infectious Waste Incinerator (HMIWI), but that’s far from common in 2020.

As state, federal, and local regulations tighten, dedicated waste disposal firms neutralize most bio-waste in the U.S. Regulations are governed by state agencies and federal bodies. Regulated waste is often decontaminated by autoclaving, dry heat, or incineration, then disposed of normally.

Before it’s decontaminated, medical waste is stored onsite in color-coded bins. Black is for non-hazardous waste. Yellow or red is for biohazardous waste. Expired medicines go in blue bins and cytotoxic drugs are stored in purple bins. All containers must be clearly marked, documented, and tracked.

best practices medical waste

 

What is RCRA and does it apply to medical waste?

RCRA is the U.S. Resource Conservation and Recovery Act. Enacted in 1976, Section V-9 gave the EPA “cradle-to-grave” authority over all healthcare waste in the country. However, the Medical Waste Tracking Act of 1988 expired in 1991. When that happened, the states took over regulation of the waste.

The RCRA creates a lot of confusion for healthcare officials and staff. That’s because it still contains language about the regulation of hospital waste. The issue? The portion of the act that covers regulated waste is all in the past tense. None of it applies anymore to current healthcare facilities like clinics or hospitals.

Medical waste best practices

All healthcare workers should know and observe the best practices for medical waste collection, storage, transportation, and disposal. Know the laws, classify and separate all waste, and use a clear color-coding system. Don’t overfill containers, and keep non-regulated waste separate to cut costs.

  • Know the medical waste laws. Waste from healthcare facilities is regulated by the states, the EPA, DEA, OSHA, the DOT, and other federal, state, and local agencies. Be aware of all laws before preparing, storing, or transporting waste.
  • Classify all healthcare waste. About 85% of medical waste is non-hazardous, such as sweeping waste or office trash. However, 15% is hazardous. To keep costs low, don’t put non-hazardous waste in with hazardous waste.
  • Separate waste. Separate waste by type, including pathological, sharps, chemical, and pharmaceutical. All regulated biohazardous waste should go in red bags. Sharps go in puncture-proof containers.
  • Use proper medical waste containers. Some waste can go into certified cardboard boxes. Other wastes go into special tubs. Some is even locked for transportation.
  • Prepare waste containers. Package all bags and containers by taping them for shipment. Then follow DOT waste packaging rules and weight restrictions. Store containers in a dry, secure area for shipping or pickup. Properly label all biohazardous waste.
  • Attach the right documentation. The correct documentation protects the waste disposal company, the shipper, and the healthcare provider. Completed paperwork must accompany every bag or container during transit.
  • Color code all waste. The WHO suggests a color coding system that many facilities adopt. Black containers are for general, non-hazardous healthcare waste. Yellow containers are for used sharps boxes and potentially infected waste bags. Some facilities use red bins for biohazards, and blue for expired medicines.Radioactive wastes like Iodine-131 go into shielded lead containers marked with a radiation symbol.
  • Don’t overfill. Bags should be ¾ full at the most to reduce the chance of spillage. Keep containers covered, and seal them once they’re filled.
  • Keep a strict collection or shipping schedule. Waste shouldn’t be allowed to sit too long, especially in heat. Store medical waste in a cool, dry place out of the way of normal operations.
  • Use a trusted waste disposal company. The thicket of regulations, types of waste, and many methods of transporting and disposal create a frightening hassle for healthcare employees. Partner with a dependable vendor to avoid a potential catastrophe.

 

color coding system medical waste

 

Medical waste violations in 2020

OSHA recommends fines for hospital waste violations ranging from $5,000 to over $70,000 per violation. State and federal bodies carry their own fines. The most common sources of medical waste fines stem from improper employee training, incorrect container management, and mishaps during transportation.

Poor containering, improper labeling, incorrect or incomplete documentation, and illegal storage are other main sources of fines and arrests. Some vehicles may need onboard refrigeration. Even a lost record or an inadequately disinfected truck can lead to hefty financial penalties.

Medical waste during pandemics

What changes about medical waste disposal during a pandemic like the H1N1 Swine Flu? What about the COVID-19 coronavirus outbreak? Some healthcare workers are surprised to find out nothing changes. Biohazardous waste regulations and best practices are designed to handle a pandemic.

That said, there’s a lot more waste generated when patient traffic increases. However, employees should redouble gloving, gowning, and hand-washing habits. During a regular flu season, face masks and disposable tissues used by flu patients are classified as regular, routine, unregulated solid waste.

Medical Waste in 2020

Medical waste is one of the biggest challenges faced by today’s healthcare system. We create 6 million tons of it per year. Though 85% of that waste is harmless, 15% is hazardous. Biohazardous waste can be disposed of through steam autoclaving or incineration. But waste that contains mercury or other contaminants must be dealt with according to strict state and federal laws. Increasingly, offsite dedicated medical waste companies transport, receive, and neutralize the bulk of our regulated healthcare waste.

 

 

 

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What is Medical Waste?

Medical waste is healthcare trash that contains infectious or potentially infectious items. It can come from hospitals, medical clinics, veterinary offices, dental clinics, research facilities, or medical laboratories. It can contain blood or other bodily fluids, or it can appear benign, like gloves or gowns.

According to the Medical Waste Tracking Act of 1988, it’s defined as any waste created during treatment, testing, immunization, research, or diagnosis of human beings and animals. Examples include sharps like scalpels or needles, tissue, fluids, glassware, swabs, culture dishes, or bandages.

 

What are some Examples of Medical Waste?
  • Expired vaccines
  • Tissue from humans or animals
  • Gowns, gloves, or gauze that may have blood on them
  • Waste from rooms of patients with infectious diseases
  • Needles, scalpels, and broken glass used in procedures
  • Laboratory cultures, stocks, and contaminated culture paraphernalia
  • Bedding from infected animals 
What are the types of medical waste?

The WHO identifies the 8 categories of medical waste as:

  • Infectious waste
  • Sharps waste
  • Pathological waste
  • Chemical waste
  • Cytotoxic waste
  • Pharmaceutical waste
  • Radioactive waste
  • Nonhazardous general waste

Those types cover all the potential varieties and sources of regulated and non-regulated healthcare waste.

Who generates medical waste?

You know hospitals and doctor’s offices create medical waste. But blood banks, dental clinics, and urgent care clinics create it too. Pharmacies, veterinary clinics, medical testing labs, research labs, nursing homes, hotels where patients stay, and funeral homes also create regulated waste.

Even an office building can generate biohazardous waste. Why? Because if someone gets a nosebleed at work and uses a tissue to stop it, they’ve created regulated waste. There was a hotel in Boston, next door to Mass General Hospital, was fined twice for medical waste violations from hotel guests.