California
Medical
Waste
Medical
Waste Definition
“Medical
waste” means waste which meets both of the following requirements:
(1) The
waste is composed of waste which is generated or produced
as a result of any of the following actions:
- Diagnosis,
treatment, or immunization of human beings or animals.
- Research
pertaining to the above.
- The
production or testing of biologicals.
- The
accumulation of properly contained home-generated sharps
waste that is brought by a patient, a member of the patient’s
family, or by a person authorized by the enforcement agency,
to a point of consolidation approved by the enforcement
agency.
- Removal
of a regulated waste from a trauma scene by a trauma scene
waste management practitioner.
(2) The
waste is either of the following:
Medical
waste does not include any of the following:
- Waste
generated in food processing or biotechnology that does
not contain an infectious agent.
- Waste
generated in biotechnology that does not contain human
blood or blood products or animal blood or blood products
suspected of being contaminated with infectious agents
known to be communicable to humans.
- Urine,
feces, saliva, sputum, nasal secretions, sweat, tears,
or vomitus, unless it contains fluid blood.
- Waste
which is not biohazardous, such as paper towels, paper
products, articles containing non-fluid blood, and other
medical solid waste products commonly found in the facilities
of medical waste generators.
- Hazardous
waste, radioactive waste, or household waste.
- Waste
generated from normal and legal veterinarian, agricultural,
and animal livestock management practices on a farm or
ranch.
Large vs. Small
Waste Generators
The Medical
Waste Management Act (MWMA) considers any person whose act
or process produces medical waste to be a “medical waste
generator” in California (e.g. a facility or business that
generates, and/or stores medical waste onsite). Medical
waste generators may be either:
- large
quantity generators (LQG = >200lbs/month), or
- small
quantity generators (SQG = <200lbs/month).
Registration
Medical
waste generators must register with their enforcement agency
(click here for a list of enforcement
agencies by county). CA
state map depicting the enforcement agency by county.
Medical
waste generators, whether large quantity generators or small
quantity generators, located in counties where the state
acts as the local enforcement agency (see the CA state map
link above to determine the enforcement agency in each county)
must complete the Generator Registration Application (see
below) and mail it along with the fee page (below) to the
address provided. For those medical waste generators treating
medical waste on-site, an on-site treatment permit application
must also be completed and submitted. Each application, along
with a check made payable to the Medical Waste Management
Fund must be mailed to:
California
Department of Health Services
Medical Waste Management Program
P.O. Box 997413, MS 7405
Sacramento, CA 95899-7413
Management Plan
LQG’s or
SQG with on-site treatment are required to submit a Medical
Waste Management Plan (Plan) with their medical waste enforcement
agency. A Plan Checklist is provided to assist medical waste
generators in developing their Plan.
Segregation and
Storage
Rules for
containerizing and storing medical waste vary depending or
the type of waste. The following rules apply (for complete
rules see Chapter 9 of the Medical Waste Management Act,
below):
- Medical
waste must be contained separately from other waste at
the point of origin in the healthcare facility. Sharps
containers may be placed in biohazard bags or in containers
with biohazard bags.
- Biohazardous
waste must be placed in a red biohazard bag conspicuously
labeled with the words “Biohazardous Waste” or with the
international biohazard symbol and the word “BIOHAZARD.”
- Sharps
waste must be contained in a sharps container.
- Biohazardous
waste that is contaminated through contact with, or having
previously contained, chemo-therapeutic agents, must be
segregated for storage, and, when placed in a secondary
container, that container must be labeled with the words “Chemotherapy
Waste”, “CHEMO”, or other label approved by the department
on the lid and on the sides, so as to be visible from any
lateral direction.
- Biohazardous
waste comprised of human surgery specimens or tissues which
have been fixed in formaldehyde or other fixatives, must
be segregated for storage and, when placed in a secondary
container, that container must be labeled with the words “Pathology
Waste”, “ PATH”, or other label approved by the department
on the lid and on the sides, so as to be visible from any
lateral direction.
To containerize
biohazard bags, a person must do all of the following:
- The
bags must be tied to prevent leakage or expulsion of contents
during all future storage, handling, or transport.
- Biohazardous
waste must be appropriately bagged and placed for storage,
handling, or transport in a rigid container which may be
disposable, reusable, or recyclable.
- Containers
must be leak resistant, have tight-fitting covers, and
be kept clean and in good repair.
- Containers
may be of any color and 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 so as to be
visible from any lateral direction.
- Biohazardous
waste must not be removed from the biohazard bag until
treatment is completed.
- Biohazardous
waste must not be disposed of before being treated.
- If a
facility generates 20 or more pounds of biohazardous waste
per month, the facility must not contain or store biohazardous
or sharps waste above 0 degrees Centigrade (32 degrees
Fahrenheit) at any onsite location for more than seven
days without obtaining prior written approval of the enforcement
agency.
- If a
facility generates less than 20 pounds of biohazardous
waste per month, the person must not contain or store biohazardous
waste above 0 degrees Centigrade (32 degrees Fahrenheit)
at any onsite location for more than 30 days.
- A facility
may store biohazardous or sharps waste at or below 0 degrees
Centigrade (32 degrees Fahrenheit) at an onsite location
for not more than 90 days without obtaining prior written
approval of the enforcement agency.
- A facility
may store biohazardous or sharps waste at a permitted transfer
station at or below 0 degrees Centigrade (32 degrees Fahrenheit)
for not more than 30 days without obtaining prior written
approval of the enforcement agency.
- A facility
must not store biohazardous or sharps waste above 0 degrees
Centigrade (32 degrees Fahrenheit) at any location or facility
which is offsite from the generator for more than seven
days before treatment.
To containerize
sharps waste, a facility must do all of the following:
- Place
all sharps waste into a sharps container.
- Tape
closed or tightly lid full sharps containers ready for
disposal to preclude loss of contents.
- Store
sharps containers ready for disposal for not more than
seven days.
- Label
sharps containers with the words “sharps waste” or with
the international biohazard symbol and the word “BIOHAZARD”.
Treatment of Medical Waste
A person generating
or treating medical waste shall ensure that the medical waste
is treated by one of the following methods, thereby rendering
it solid waste prior to disposal:
- Incineration at a permitted medical waste treatment facility
in a controlled-air, multi-chamber incinerator, or other
method of incineration approved by the department which provides
complete combustion of the waste into carbonized or mineralized
ash.
- Treatment with an approved alternative technology that,
due to the extremely high temperatures of treatment in excess
of 1300 degrees Fahrenheit, has received express approval
from the department.
- Steam sterilization at a permitted medical waste treatment
facility or by other sterilization, in accordance with all
approved operating procedures for steam sterilizers or other
sterilization
- Other alternative medical waste treatment methods which
are approved by the department and result in the destruction
of pathogenic micro-organisms.
Disposal of Medical Waste
- A medical waste may be discharged to a public sewage system
without treatment if it is not a biohazardous waste, it is
liquid or semiliquid, and its discharge is consistent with
waste discharge requirements placed on the public sewage
system by the California regional water quality control board
with jurisdiction.
- A medical waste that is a biohazardous
waste may be treated by a chemical disinfection if the
medical waste is liquid
or semi-liquid and the chemical disinfection method is recognized
by the National Institutes of Health, the Centers for Disease
Control and Prevention, or the American Biological Safety
Association, and if the use of chemical disinfection as a
treatment method is identified in the site’s medical waste
management plan. If the waste is not treated by chemical
disinfection, it shall treated by one of the other approved
methods. Following treatment by chemical disinfection, medical
waste may be discharged to the public sewage system if the
discharge is consistent with waste discharge requirements
placed on the public sewage system by the California regional
water control board, and the discharge is in compliance with
the requirements imposed by the owner or operator of the
public sewage system. If the chemical disinfection of the
medical waste causes the waste to become a hazardous waste,
the waste shall be managed in accordance with applicable
requirements
- Recognizable human anatomical parts, with the exception
of teeth not deemed infectious by the attending physician
and surgeon or dentist, shall be disposed of by interment
or in accordance with the regulations, unless otherwise hazardous.
- Sharps waste shall be rendered noninfectious prior to disposal
by Incineration; steam sterilization; or disinfection, using
an alternative treatment method approved by the department.
Sharps waste rendered noninfectious may be disposed of as
solid waste if the waste is not otherwise hazardous.
- Onsite medical waste treatment facilities treating sharps
waste shall ensure that, prior to disposal, the treated sharps
waste is destroyed or that public access to the treated sharps
waste is prevented.
- An operator of a permitted hazardous waste incinerator
may also accept medical waste for incineration.
- Each medical waste treatment facility issued a medical
waste permit shall provide the enforcement agency with an
emergency action plan that the facility shall follow to ensure
the proper disposal of medical waste in the event of equipment
breakdowns, natural disasters, or other occurrences.
- Animals that die from infectious diseases shall be treated
in accordance with the regulations, if, in the opinion of
the attending veterinarian or local health officer, the carcass
presents a danger of infection to humans.
Waste Tracking
Documents
Tracking
documents are provided to the generator by the transporter. Medical
waste generators are required to maintain a completed tracking
document of all medical waste removed for treatment or disposal
for a period of three years.
Contacts
Inquiries
to the Medical Waste Management Program may be sent via e-mail
to: MedWasteInfo@dhs.ca.gov
For more
information on Medical Waste Management Program activities
contact either the Medical Waste Management Program HQ at
(916) 449-5671, or the Southern California Regional Office
at (213) 977-7379 or (213) 977-6877.
OSHA
Regulations
In addition
to the state medical waste environmental regulations there
are some Occupational Safety and Health Administration (OSHA)
rules that apply to medical/infectious waste. California
is one of 24 states operating an approved occupational safety
and health program. This program is operated by the Utah
Occupational Safety and Health. OSHA rules (Occupational
Exposure to Bloodborne Pathogens Standards) impact various
aspects of medical/infectious waste, including management
of sharps, requirements for containers that hold or store
medical/infectious waste, labeling of medical/infectious
waste bags/containers, and employee training. These requirements
can be found in the HERC section entitled OSHA Standards for Regulated Waste
Regulations
The Medical
Waste Management Act governs the management
of medical waste in all jurisdictions of the State.
Other
California
Medical Waste Management Program Overview
The California
Department of Health Services has been working with hospitals
statewide to develop plans that will assist in pollution
prevention (see Hospital
Pollution Prevention Program).
List
of Permitted Medical Waste treatment Facilities in California
Department
of Health Services (DHS) Licensing and Certification program
consulted with the DHS Medical Waste Management Program (MWMP)
and have made a letter explaining the use of reusable sharps containers from these companies offering a reusable sharps container system
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