Medical waste includes all

infectious waste, hazardous

(including low-level
radioactive wastes), and any
other wastes that are
generated from all types of
health care institutions,
including hospitals, clinics,
doctors (including dental
and veterinary) offices and
medical laboratories.
What is Medical Waste
REGULATED MEDICAL WASTE
Regulated Medical Waste is a subset of all medical
wastes and include seven distinct categories:

1. Cultures and stocks of infectious agents.
2. Human pathological wastes (e.g. tissues, body
parts)
3. Human blood and blood products
4. Sharps (e.g. hypodermic needles and syringes)
5. Certain animal wastes
6. Certain isolation wastes (e.g. wastes from
patients with highly communicable diseases)
7. Unused sharps.
WHAT IS AN INFECTIOUS WASTE?
1. Presence of a pathogen of sufficient
virulence
2. Dose
3. Portal of entry
4. Resistance of host
Thus, for a waste to be infectious, it must
contain a pathogen with sufficient virulence
and quantity so that exposure to the waste by
a person or animal could result in an
infectious disease.
WHAT IS AN INFECTIOUS WASTE?
EPA categorizes infectious wastes into the
following seven categories:
1. Isolation wastes wastes generated by
hospitalized patients who are isolated to protect
others from communicable diseases.
2. Cultures and stocks of infectious agents
and associated biologicals this category
includes:
- Specimens from medical and biological
laboratories
- Cultures and stocks of infectious agents
from clinical, research, and industrial
laboratories
3. Human blood and blood products this
includes waste blood, serum, plasma, and blood
products.
WHAT IS AN INFECTIOUS WASTE?
4. Pathological waste tissues, organs, body
parts, blood, and body fluids.
5. Contaminated sharps contaminated
hypodermic needles, syringes, scalpel blades,
Pasteur pipettes, and broken glass.
6. Contaminated animal carcasses, body
parts, and animal bedding
7. Miscellaneous Contaminated Wastes
these include:
- Wastes from surgery and autopsy
- Miscellaneous laboratory wastes
- Dialysis unit wastes
- Contaminated equipment
INFECTIOUS WASTE MANAGEMENT PLANS
Components of an Infectious Waste Management Plan:
1. Designation of the waste that should be managed as
infectious
2. Segregation of infectious waste from the noninfectious
waste
3. Packaging
4. Storage
5. Treatment
6. Disposal
7. Contingency measures for emergency situations
8. Staff training
DESIGNATION OF AN INFECTIOUS
WASTE
The infectious waste plan for
your facility should specify
which wastes are to be
managed as infectious
wastes. A responsible official
or committee should
determine any other
miscellaneous wastes should
be handled as an infectious
waste.

SEGREGATING MEDICAL WASTES
Segregation of infectious
wastes at the point of origin.
Segregation of infectious waste
with multiple hazards as
necessary for management and
treatment.
Use of distinctive, clearly
marked containers or plastic bags
for infectious wastes.
Use of the universal biological
hazard symbol on infectious
waste containers as appropriate.
SEGREGATING MEDICAL WASTES
Whenever possible, do not
combine medical waste with
hazardous chemicals or radioactive
waste.
Separate sharps waste from
other medical wastes. Sharps
should be stored in puncture-proof
containers.
Separate pathology wastes from
other medical wastes.
Separate chemotherapy wastes
from other medical wastes.
SEGREGATING MEDICAL WASTES
If different types of waste are mixed, treat
mixtures as follows:
Mixtures of medical and radioactive waste --
decontaminate the biohazardous component
and manage as radioactive waste.
Mixtures of medical and hazardous chemical
waste -- if safe to do so, decontaminate the
biohazardous component and manage as
chemical waste.
Mixtures of medical, radioactive, and
hazardous chemical waste -- if safe to do so,
decontaminate the biohazardous component
and manage as radioactive waste.
PACKAGING INFECTIOUS WASTE
Selection of packaging materials for the
type of waste handled:
- Plastic bags for solid or semisolid
infectious waste.
- Bottles, flasks, or tanks for liquids.
Maintains its integrity during storage and
transport,
Closing the top of each bag
Place liquid wastes in capped/ tightly
stopped bottles.
Do not compact infectious wastes before
treatment.
HANDLING SHARPS
The most common times of risk for
spreading bloodborne pathogens occurs:
Recapping needles
Packing in puncture-resistant sharps
containers
Accidental breakage of the tubes used
for collection of blood
HANDLING SHARPS
To protect against needlestick injuries:
Avoid the use of needles where safe
and effective alternatives are available.
Use devices with safety features that
reduce the risk of needlestick injury.
Avoid recapping needles.
Safe handling and disposal of
needles
PACKAGING OF SHARPS
Rigid puncture-resistant containers
Must be red in color, have a biohazard
label, are in the immediate area where
sharps are used.
Must remain upright throughout use
and be replaced routinely.
Containers of contaminated sharps will
be closed immediately.
Secondary containers, prevent leakage
during handling, storage, transport.
STORAGE
Storage temperature and duration are
important considerations.
Locating the storage area near the
treatment site.
Minimizing storage time.
Proper packing and the exclusion of
rodents and vermin.
Limited access to storage areas.
Prominently displaying the universal
biological hazard symbol on storage
area door, waste containers, etc.
TRANSPORT
Avoidance of mechanical loading
devices
Frequent disinfection of carts
Placement of all infectious waste into
rigid or semi-rigid containers
Transport of infectious waste in closed
leakproof trucks or dumpsters.
Use of appropriate hazard symbols
MEDICAL WASTE HAULING

Transporting by the
U.S. Postal Service may
be arranged

A mailed parcel of
used sharps must be
mailed as First Class or
Priority Mail. No package
may be more than 35
pounds, or 50 ml.
MEDICAL WASTE HAULING
1. By a healthcare
professional employed by
the facility.
2. By contract with a
transporter registered with
the state.
3. By mail, parcel post, or
courier service (sharps
only).
ON-SITE TREATMENT

1. Autoclaving (steam sterilization)
2. Incineration
3. Thermal inactivation
4. Gas/Vapor Sterilization
5. Chemical Disinfection
6. Sterilization by irradiation
(radiofrequency and microwave)
AUTOCLAVING
Autoclaving (heating under high pressure)

Steam sterilization, within a pressure
vessel at high temperatures accomplished
primarily by steam penetration.

Low-density material such as plastics,
metal pans, bottles, and flasks.

High-density polyethylene and
polypropylene plastic should NOT because
they do not facilitate steam penetration
AUTOCLAVING
Plastic bags should be placed in a rigid
container - spillage and drain clogging.
Bags should be opened and caps and
stoppers should be loosened
Separate infectious wastes from other
hazardous wastes.
Infectious waste that contains
noninfectious hazards should not be steam-
sterilized.
Waste that contains antineoplastic drugs,
toxic chemicals, or chemicals that would be
volatilized by steam should not be steam-
sterilized.
AUTOCLAVING
Persons involved in steam sterilizing should be
trained in handling techniques to minimize
exposure to hazards from these wastes. These
should include:
Use of protective equipment
Minimization of aerosol formation
Prevention of spillage during autoclave
loading/unloading
Prevention of burns from handling hot
containers
Management of spills
Check autoclave temperature to ensure that
the proper temperature is being maintained for a
long enough period during the cycle.
Steam sterilizers should be routinely inspected.
INCINERATION
Newly Regulated Emissions
from Medical Waste
Incineration:
1. Particulate Matter
2. Carbon Monoxide
3. Dioxin
4. Sulfur Dioxide
5. Hydrogen Chloride
6. Nitrogen Oxides
7. Cadmium
8. Lead
9. Mercury
THERMAL INACTIVATION
Thermal inactivation involves the treatment of
waste with high temperatures to eliminate
infectious agents.
This method is usually used for large volumes.
Liquid waste is collected in a vessel and
heated by heat exchangers or a steam jacket
surround the vessel.
The types of pathogens in the waste
determine the temperature and duration of
treatment.
After treatment, the contents can be
discharged into the sanitary sewer in a manner
that complies with State, Federal, and local
requirements.
This method requires higher temperatures
and longer treatment cycles than steam
treatment.
GAS/VAPOR STERILIZATION
Gas/vapor sterilization uses gaseous or
vaporized chemicals as the sterilizing agents.
Ethylene oxide is the most commonly used
agent, but should be used with caution since
it is a suspected human carcinogen.
Because ethylene oxide may be adsorbed
on the surface of treated materials, the
potential exists for worker exposure when
sterilized materials are handled.

CHEMICAL DISINFECTION
Chemical disinfection is the preferred
treatment for liquid infectious wastes.
Consider the following:
Type of microorganism
Degree of contamination
Amount of proteinaceous material present
Type of disinfectant
Contact time
Other relevant factors such as temperature, pH, mixing
requirements, and the biology of the microorganism
Ultimate disposal of chemically treated
waste should be in accordance with State and
local requirements.
STERILIZATION BY IRRADIATION
Advantages of irradiation:
Electricity requirements are nominal.
Steam is not required.
No heat or chemicals remain the treated
waste.
The principal disadvantages are as follows:
Capital costs are high.
Highly trained personnel are required.
Space requirements are great.
Worker exposure as a result of leaks in
seals or poor work practices.
Disposal of the radiation source may pose
problems.
RADIOFREQUENCY IRRADIATION
Large radiofrequency irradiation medical waste
treatment units include an initial destruction phase.
The waste is automatically fed into a waste
grinding device where it is shredded and sprayed
with steam to increase the moisture content of the
waste to approximately 10 percent. The moist
ground waste is then heated by exposure to
radiofrequency irradiation. This process heats the
waste to >90 C.
The factors which affect radiofrequency
irradiation treatment of medical waste include the
frequency and wavelength of the irradiation, the
duration of the exposure, destruction and moisture
content of the waste material, temperature
achieved throughout the waste load during
treatment, and waste storage duration.
MICROWAVE IRRADIATION
Large microwave irradiation medical waste treatment units
include an initial destruction phase.
The waste is automatically fed into a waste grinding device
where it is shredded and sprayed with steam to increase the
moisture content of the waste to approximately 10 percent.
The moist ground waste is then heated by exposure to six
microwave irradiation units over a 2 hour period. This
process heats the waste to > 90 C.
The factors which affect microwave treatment of medical
waste include the frequency and wavelength of the
irradiation, the duration of the exposure, destruction and
moisture content of the waste material, process
temperature, and the mixing of waste during treatment.
DRAIN DISPOSAL
Some liquid medical wastes, such as
human blood, may be disposed of in sinks if
the waste is first autoclaved or brought to a
final concentration of 1 percent bleach.
The following medical wastes may not be
drain disposed:
Human or animal cultures suspected of
containing infectious agents
Cultures and stocks of infectious agents
Wastes from the production of infectious
bacteria, viruses, spores, discarded live and
attenuated vaccines
Non-infectious medical waste disposal
should only be made to sanitary sewers only.