Managing Regulated Medical Waste in New Mexico Prepared by: Dr. Joe King Camino Real Environmental Research Center Sunland Park, New Mexico
History of Medical Waste Regulations
1988 Legislation in response to medical waste washing up on several East Coast beaches
1988 Medical Waste Tracking Act
Medical Waste Tracking Act Defined medical waste and those waste to be regulated Established a cradle to grave tracking system Required management standards Established record keeping requirements and penalties for mismanagement
Medical Waste Tracking Act Expired June 21, 1999
Medical Waste Tracking Act Allowed the EPA to Gather Information Perform studies related to medical waste Information served as a potential model for state programs
Conclusion Disease causing potential is greatest at the point of generation and naturally tapers off at that point
Conclusion Risk to the public of disease caused by exposure to medical waste is likely to be much lower than the risk for occupationally exposed individuals
Medical Waste
Medical Waste Is Regulated at the State level
Medical Waste in New Mexico Is defined by The New Mexico Solid Waste Management Regulations
20 NMAC 9.1
20 NMAC 9.1 Regulates Generators of Medical Waste Transporters of Medical Waste, and Medical Waste Treatment Facilities
20 NMAC 9.1 Defines Regulated Medical Waste as Infectious Waste
Material rendered non-infectious May be handled as non-infectious waste, provided
provided It is not otherwise regulated
provided The operator of the disposal facility applies daily cover
provided Any person that treats infectious waste shall certify in writing, that the waste has been rendered noninfectious
Infectious Waste Includes but is not limited to a limited class of substances that carry a probable risk of transmitting disease to humans
infectious waste includes Microbiological Laboratory Waste
Microbiological Laboratory Waste disposable culture dishes and devices used to transfer, inoculate and mix cultures
Infectious waste means Pathological waste
Pathological Waste Human or animal tissue, organs and body parts, removed during surgery, autopsy or biopsy Note: Photo depicts non-compliance.
Infectious Waste means disposable equipment, instruments, utensils, and other disposable materials which require special precautions because of contamination by high contagious diseases Smallpox
Infectious waste means Human blood and blood products, including waste blood, blood serum, and plasma
Infectious waste means Used sharps, including used hypodermic needles, syringes, scalpel blades, Pasteur pipettes, and broken glass
Microbiological Laboratory Waste Cultures and stocks of infectious agents from clinical research and industrial laboratories
Infectious waste means Contaminated animal carcasses, body parts, and bedding, especially those intentionally exposed to pathogens in research, in the production of biologicals or the in vivo testing of pharmaceuticals
Regulated Medical Waste Generators Includes but is not limited to: General Acute Care Hospitals Skilled Nursing Facilities or Convalescent Hospitals Intermediate Care Facilities In-Patient care Facilities for the Developmentally Disabled
generators continued. Dialysis Clinics Free Clinics Community Clinics Employee Clinics Health Maintenance Organizations Home Health Agencies Surgical Clinics Urgent Care Clinics
generators continued Acute Psychiatric Hospitals Blood/Plasma Centers Laboratories Medical Buildings Physicians Offices Veterinarians Acupuncturists Funeral Homes
and all infectious waste storage, treatment, and disposal facilities
Medical Waste Facilities generate: Recyclable materials Solid waste Liquid waste Hazardous waste Sharps (regulated medical waste) Radioactive waste Infectious medical waste
Recyclable Materials Paper Plastic Glass Cardboard Metal Etc.
Solid Waste Waste Management Hierarchy Reuse Recycle Waste to Energy Landfill
Liquid Waste If not hazardous or otherwise prohibited waste Must go to a permitted facility Not a Landfill
Liquid Waste Note: It is lawful to dispose of liquid infectious waste into a sewage treatment system after obtaining written approval of the sewage treatment system s operator
Hazardous Waste Must go to a permitted Hazardous Waste Treatment Facility
Used Sharps Must be handled, stored, transported, treated and disposed as infectious waste
Radioactive Waste Must go to a permitted Radioactive Waste Facility
Infectious Waste other than Sharps Must be segregated Disposed of as Regulated Medical Waste
Waste Management Plan Every person who generates, transports, stores, treats, or disposes of infectious waste shall prepare and maintain on file a management plan Camino Real Operating Records
Waste Management Plan Identifies The type of waste the person generates or handles The segregation Packaging Labeling Collection Storage Transportation procedures to be implemented Treatment or disposal method The Transporter Disposal Facility to be used The person responsible for the management of infectious waste
Manifest All infectious waste management facilities may only accept infectious waste that is accompanied by a manifest that contains the information required by Section 712
Manifest Requirements Name, address and phone number of the generator of special waste
Manifest Requirements Name, address and phone number of any and all commercial haulers in the order each will be transporting the waste
Manifest Requirements Type and proper name of waste being shipped
Manifest Requirements Total weight or volume of waste prior to shipment from generator
Manifest Requirements Total weight or volume of waste received at solid waste facility
Manifest Requirements Type and number of containers in shipment
Manifest Requirements Any special handling instructions
Manifest Requirements Date and location the waste was delivered
Manifest Requirements Date of receipt from the generator and total weight or volume of the special waste shall be provided by the transporter
Manifest Requirements If more than one commercial hauler is used, each commercial hauler shall provide the date of receipt and total weight or volume of said waste received from the previous commercial hauler
Manifest Requirements The manifest shall accurately reflect the information and be signed by the generator and each commercial hauler of the special waste, and by the solid waste facility owner or operator, acknowledging delivery, quantify, and receipt of the waste
Manifest Requirements All signatories shall be duly authorized agents of their organizations
Manifest Requirements Upon discovery of any significant discrepancy including, but not limited to, factual misrepresentation on the manifest, irregularities in transportation, discharges, or any unauthorized action in regard to the shipment, delivery, or disposal of the solid waste, the person discovering the discrepancy shall notify the Department, the generator, commercial hauler, and the solid waste facility within 24 hours
Manifest Requirements Upon receipt of special waste shipment at the solid waste facility, the owner or operator shall send a signed copy of the manifest back to the generator
Manifest Requirements A copy of the manifest shall be retained by the commercial hauler and the solid waste facility for their permanent records.
Manifest Requirements The generator shall retain both the original copy and the returned copy signed by the solid waste facility owner or operator for the generator s s permanent record
Manifest Requirements Copies of the manifest shall be made available to the Secretary upon request and shall be retained by the facility owner or operator throughout the post-closure period and any extended time period deemed necessary by the secretary
What is Infectious Waste in New Mexico? Gloves stained/smeared with blood
What is Infectious Waste in New Mexico? Gauze that is saturated, dripping, caking or flaking with blood or other potentially infectious substance
What is Infectious Waste in New Mexico? Dressing from patients that that are saturated, dripping, caking or flaking with blood or other potentially infectious agents
What is Infectious Waste in New Mexico? IV Bags used to give blood
What is Infectious Waste in New Mexico? IV bags for blood products
What is Infectious Waste in New Mexico? IV tubing with blood or evidence of blood contamination
What is Infectious Waste in New Mexico? Syringes with a used or attached needle or Syringes that are visibly contaminated with blood or OPIM
What is Infectious Waste in New Mexico? Ventilator tubing visibly contaminated with blood or OPIM
What is Infectious Waste in New Mexico? Suction tubing visibly contaminated with blood or OPIM
What is Infectious Waste in New Mexico? Suction Canisters visibly contaminated with blood or OPIM
Uncontaminated Canisters Are not regulated as infectious waste
Storage and Containment Requirements
Storage and Containment Requirements Shall be in a manner which affords protection from animal intrusion, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public
Storage and Containment Requirements Infectious waste shall be segregated by separate containment from other waste at the point of origin Note: Photo depicts an overfilled rigid container and is noncompliant.
Storage and Containment Requirements Except for sharps, shall be contained in plastic bags inside rigid containers
Storage and Containment Requirements The bags shall be securely tied to prevent leakage or expulsion of solid or liquid waste during storage, handling or transport
Storage and Containment Requirements Sharps, shall be contained for storage, transportation, treatment, and disposal in leak-proof, rigid, puncture resistant containers which are manufactured for the purpose of sharps containment and are taped closed or tightly lidded to preclude loss of contents
Storage and Containment Requirements All bags used for containment purposes shall be red or orange and clearly identified as specified in 29 CFR 1910.145(f)(4) Note: This slide demonstrates the purpose behind high visibility bags.
Storage and Containment Requirements Rigid containers shall be labeled biomedical waste, or otherwise conspicuously labeled as holding infectious waste, or placed in disposal bags used for other infectious waste
Storage and Containment Requirements If other waste is placed in the same container as regulated infectious waste, then the generator shall package, label and mark the container and its entire contents as infectious waste
Storage and Containment Requirements Rigid infectious waste containers may be reused for infectious or non- infectious waste if they are thoroughly washed and decontaminated each time they are emptied and
Storage and Containment Requirements the surfaces or the containers have been completely protected from contamination by disposable, unpunctured or undamaged liners, bags, or other devices that are removed with the infectious waste, and the surface of the containers have not been damaged or punctured
Generators of medical waste Shall place an absorbent material inside the liner of the rigid container equal to one (1) cup of absorbent material per each six (6) cubic feet of box area if the rigid container is to hold any containers which had held free liquid
Absorbent material if the rigid container is to hold containers which do hold free liquids, then enough absorbent material shall be placed inside the liner of the rigid container sufficient to absorb 15% of the total volume of free liquid inside the rigid container 15%
Storage and containment areas Shall protect infectious waste from the elements Be ventilated to the outdoors Be only accessible to authorized persons Be marked with prominent warning signs on or adjacent to the exterior doors or gates
Storage and Containment Requirements Warning signs shall be easily read during daylight from a distance of 25 feet
Storage and Containment Compactors, grinders or similar devices shall not be used to reduce the volume of infectious waste before the waste has been rendered non- infectious unless prior approval has been obtained from the Department Requirements
Time - Storage Requirements Special waste shall not be stored for longer than 45 days, unless other wise approved by the Department.
Key to Successful Waste Management Identify Regulated Waste Segregate, Segregate, Segregate
Regulated Waste Hazardous/Toxic Waste PCB s Asbestos Liquid Waste Infectious Waste Radioactive Waste
Acceptable treatment of infectious waste
Incineration
Sterilization by heating in a steam sterilizer
Acceptable treatment of infectious waste Other methods approved by the Secretary
What happens when waste is mismanaged?
What happens when waste is mismanaged?
What happens when waste is mismanaged?
What happen when waste is mismanaged?
What happens when waste is mismanaged?
What happens when waste is mismanaged?
What happens when waste is mismanaged?
What happens when waste is mismanaged?
New Mexico Environment Department 1190 St. Francis Dr Suite N4050 Santa Fe, NM 87505 tel. (800) 219-6157 www.nmenv.state.nm.us