RMW Regulations
A variety of regulations govern how regulated medical waste (RMW) is handled, segregated and subsequently disposed of. The following pages highlight regulatory language pertaining to different aspects of RMW management.
Regulated medical waste management is not primarily governed by the federal government, but is instead regulated state-by-state with different aspects overseen by different agencies. Nearly all 50 states have enacted medical waste regulations to some extent. However, unlike state hazardous waste regulations, which are all based on the federal RCRA standards, state medical waste standards vary diversely. Some state medical waste rules are fashioned after the Medical Waste Tracking Act, while others have little or no resemblance to this historical law.
In most states, the environmental protection agency is primarily responsible for developing and enforcing regulations for medical waste management and disposal. Although in some states, the department of health may play an important role or even serve as the primary regulatory agency. Most states have regulations covering packaging, storage, and transportation of medical waste. Some states require health care facilities to register and/or obtain a permit. State rules may also cover the development of contingency plans, on-site treatment, training, waste tracking, recordkeeping, and reporting.
OSHA, whether it is the U.S. Department of Labor Occupational Safety & Health Administration or an OSHA state program (24 states operate their own program), regulates several aspects of medical waste, including management of sharps, requirements for containers that hold or store medical waste, labeling of medical waste bags/containers, and employee training. These standards are designed to protect healthcare workers from the risk of exposure to bloodborne pathogens. However, they also help to systematically manage wastes, which benefit the public and environment.
In states with comprehensive medical waste regulations, there are often overlaps between state environmental/department of health rules and the
OSHA Bloodborne Pathogens Standard however, there are few, if any conflicts. Instead, one set of rules may be vague or general, where the other is highly specific. In such cases, healthcare facilities are advised to follow the more detailed or stringent regulations. In states where comprehensive medical waste regulations do not exist, the OSHA rules fill an important gap.
U.S. Department of Transportation (DOT)
Regulated medical waste is defined by the Department of Transportation as a hazardous material. The DOT rules mostly apply to transporters rather than healthcare facilities; although, knowledge of these rules is important because of the liability associated with shipping waste off-site.
U.S. Environmental Protection Agency (EPA)
Although EPA no longer plays a central role with medical waste management, EPA has active regulations governing emissions from Hospital/Medical/Infectious Waste Incinerators as well as requirements under the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) for certain medical waste treatment technologies which use chemicals for treating the waste. EPA also interacts with medical waste where some portion of the waste stream may be considered “hazardous”, as deemed by the Resource Conservation and Recovery Act (RCRA). RCRA is relevant to medical waste management where waste products determined to be infectious may be mixed with a hazardous waste. RCRA provides strict interpretation of how these wastes must be handled.
U.S. Centers for Disease Control and Prevention (CDC)
While not strictly acting in a regulatory role, the CDC provides guidelines pertaining to infection control in healthcare facilities. CDC’s 2003 Guidelines for Environmental Infection Control in Healthcare Facilities highlights a number of considerations for medical waste management.
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
The Joint Commission regulates medical waste management as it pertains to the Environment of Care (EOC) Standards, which includes requirements for a management plan for all RMW.
Additional Guidance on RMW Management
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