Identifying and managing medical waste

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What is medical waste?

Medical waste are biohazardous wastes or sharps wastes that have been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents.

Infectious agents in this definition refer to organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health.

Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.

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Who generates medical waste?

A medical waste generator is typically a person or business involved in the following activities:

• diagnosis, treatment, or immunization of human beings or animals
• research pertaining to the aforementioned activities
• production and testing of biological agents

The following are examples of businesses considered to be generators of medical waste:

• clinics and hospitals
• medical and dental offices
• surgery centers
• laboratories and research laboratories
• unlicensed and licensed health facilities
• chronic dialysis clinics
• education and research facilities
• veterinary offices
• trauma scene waste management practitioners

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What is regulated medical waste?

Regulated medical waste is waste that meets both of the following requirements:

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Waste produced as a result of one or more of the following activities:

• Diagnosis, treatment, or immunization of human beings or animals
• Research pertaining to the aforementioned activities
• The production and testing of biological agents
• Accumulated home-generated sharps waste at an approved point of consolidation
• Removal of waste from a trauma scene by a trauma scene waste management practitioner

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And is either biohazardous or sharps waste.

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What is biohazardous waste?

Biohazardous waste includes but is not limited to items such as:

• Fluid blood or fluid blood products
• Infectious secretions
• Microbiology and surgery specimens
• Cultures or stock wastes from medical, pathology, research and industrial laboratories
• Animal parts or animal fluids contaminated with infectious agents known to be contagious to
• humans
• Other related materials contaminated through contact such as gloves, disposable gowns or previously contained chemotherapeutic agents such as intravenous solution bags and tubing

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What is sharps waste?

Sharps waste includes devices with acute rigid corners, edges, or protuberances capable of cutting or piercing. Sharp waste items include:

• Hypodermic needles
• Syringes
• Blades and needles with attached tubing
• Broken glass items
• Syringes contaminated with biohazardous waste
• Acupuncture needles
• Root canal files
• Any other device capable of cutting or piercing

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How should a medical practice dispose of regulated medical waste?

There are several options for disposal of sharps waste:

• Disposal through a registered medical waste hauler
• Treatment onsite by a steam autoclave prior to disposal as medical solid waste
• Mail-in sharps disposal (sharps only)
• Use of an alternative treatment technology approved by the California Department of Health Services, such as encapsulation (this technology is approved for sharps waste only)

There are fewer options for disposal of biohazardous waste:

• Disposal through a registered medical waste hauler
• Treatment onsite by a steam autoclave prior to disposal as medical solid waste
• Use of an alternative treatment technology approved by the California Department of Health Services

Approved alternative technologies are listed on the California Department of Health Services web page.

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How is medical waste to be stored?

Medical waste must be contained separately from other waste at the point of origin. The following describes the different methods of storage for various types of medical waste.

All biohazardous waste must be placed in a red bag labeled with the words "Biohazardous Waste" or with the international biohazard symbol and the word "BIOHAZARD."

A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport.

The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. This red bag must be placed in a rigid and leak resistant container with a tight-fitting lid for storage, handling or transport.

The secondary container must be labeled with the words "Biohazardous Waste" or with the international biohazard symbol and the word "BIOHAZARD" on the lid and on the sides in order to be visible from any lateral direction.

All sharps waste must be placed into a sharps container that is rigid, puncture-resistant, leak- resistant when sealed, and difficult to reopen once sealed. The sharps contained must be labeled with the words "SHARPS WASTE" or with the international biohazard symbol and the word "BIOHAZARD." Sharps containers may be placed in red biohazard bags or in rigid containers with biohazard bags. Sharp containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used.

Needles and syringes shall not be clipped prior to disposal.

Waste such as gloves, disposable gowns, towels, intravenous solution bags and attached tubing which are empty and considered biohazardous waste through contact with, or having previously contained chemotherapeutic agents, must be placed in a secondary container labeled with the words "CHEMOTHERAPY WASTE" or "CHEMO."

Biohazardous waste, which is recognizable human anatomical parts or comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, must be placed in a secondary container labeled with the words "PATHOLOGY WASTE" or "PATH."

Pharmaceutical waste that is either prescription, over-the-counter, or a veterinary drug may be considered biohazardous waste by definition and must be placed in a container labeled with the words "INCINERATION ONLY."

This does not include pharmaceuticals that are listed or defined as hazardous under RCRA or the Radiation Control Law. These pharmaceuticals are regulated under the federal Resource Conservation and Recovery Act of 1976 or the Radiation Control Law (Chapter 8, Part 9). In addition, pharmaceuticals that were not previously hazardous under the California Hazardous Waste Control Law will continue to be regulated as solid waste and may therefore be disposed of in the garbage.

In summary, pharmaceutical waste fall into one of three categories based upon their toxicity: hazardous waste, medical waste, or solid waste.

Any area designated for the accumulation and storage of medical waste containers must be secured to prevent entry by unauthorized persons. The exterior door, gate, or lid must be marked with a warning sign in both English and Spanish and any other appropriate languages. The wording shall read "Caution: Biohazardous Waste Storage Area—Unauthorized Persons Keep Out," and in Spanish "Cuidado-Zona DeResidous-Biologicos Peligrosos-Prohibida La Entrada A Personas No Autorizadas."

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How long may medical waste be stored?

Biohazardous waste may not be stored for more than seven days unless the business generates less than 20 pounds per month. In this case, the waste may be stored up to 30 days. However, if the biohazardous waste is stored at or below 0 degrees centigrade (32 degrees Fahrenheit), it may be stored up to 90 days with approval from this Division.

Full sharps containers ready for disposal may not be stored for more than 30 days. Pharmaceutical waste containers that are full and ready for disposal may not be stored longer than 90 days. Whether the container is full or not, the container may not remain on site for more than a year.

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How do I dispose of medical waste?

The majority of waste is transported to an off-site medical waste treatment facility by a registered hazardous waste hauler or via the postal service using a mail-back system where it is sterilized prior to disposal in a landfill. Some generators transport their own waste to a common storage facility while others may choose to treat their waste on-site prior to disposal.

If untreated medical waste is picked up at the generator’s business by a registered hazardous waste hauler, insure that, at the time of pickup, the hauler provides a copy of the tracking document. Small quantity generators are required to keep tracking documents for two years and large quantity generators for three years.

Only businesses that generate less than 20 pounds of medical waste per week may opt to transport their own waste. A Limited Quantity Hauling Exemption Permit must be approved and obtained by this Division prior to transporting any waste. No more than 20 pounds of medical waste may be transported at any one time. Only the generator or member of his/her staff may transport the waste. A tracking document must be in the driver’s possession while transporting waste and the original tracking document must be provided to the receiving facility (permitted medical waste treatment facility, consolidation point, transfer station, parent organization).

Those generators wishing to treat their own medical waste on-site must be approved for and obtain a treatment permit from HMUPA. Treatment must be done using an approved method, the most common of which is steam sterilization. Those using steam sterilization must establish written operating procedures, check the thermometer during each cycle to verify an attainment of 121degrees centigrade (250 degrees Fahrenheit) for at least 30 minutes, test the thermometer for calibration annually, use indicator heat-sensitive tape on each biohazard bag and sharps container, and conduct monthly biological indicator tests on the autoclave. Records of these procedures noted above must be kept for three years. Once medical waste is treated, it ceases to be regulated under the Medical Waste Management Act and is considered solid waste.

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