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Medical Waste Frequent Questions
- What agency(ies) regulate wastes generated at health care facilities?
- What is the Medical Waste Tracking Act (MWTA)?
- What is the status of the MWTA?
- What conclusions did EPA draw from the two-2-year demonstration program?
- How is the incineration of medical waste regulated?
- Are there alternatives to incineration for treating and disposing of medical waste?
- Do other federal agencies regulate potentially infectious medical waste?
- Is EPA involved in any pollution prevention activities within the health care industry?
What agency(ies) regulate wastes generated at health care facilities?
Health care facilities, including, but are not limited to hospitals, physician's offices, dental practices and veterinary hospitals, generate a variety of waste streams. Many of these waste streams are regulated at the state and local level while others may be governed by federal regulations. For example, states develop regulations for office and municipal type waste, whereas the federal government develops regulations for hazardous waste such as mercury or radioactive wastes. State regulations generally cover potentially infectious medical waste, sometimes referred to as regulated medical waste.
What is the Medical Waste Tracking Act (MWTA)?
After medical wastes were found among other wastes washing up on several East Coast beaches, concern over the potential health hazards prompted Congress to enact the Medical Waste Tracking Act (MWTA) in 1988. The Act required EPA to create a two-year Medical Waste Demonstration Program. For the purposes of this two-year program the MWTA:
- Defined medical waste and those wastes to be regulated;
- Established a cradle to grave tracking system utilizing a generator initiated tracking form;
- Required management standards for segregation, packaging, labeling and marking, and storage of the waste; and
- Established record keeping requirements and penalties that could be imposed for mismanagement.
What is the status of the MWTA?
The regulations promulgated under the MWTA expired on June 21, 1999. The Standards for Tracking and Management of Medical Waste were in effect from June 1989 to June 1991 in five states (New York, New Jersey, Connecticut, Rhode Island, Puerto Rico)
During this time, EPA also gathered information and performed several studies related to medical waste management. The MWTA and EPA's associated program served to focus attention on the medical waste issue and provided a model for some states and other federal agencies in developing their own medical waste programs.
The MWTA also required EPA to look at various treatment technologies available at the time for their ability to reduce the disease causing potential of medical waste. The technologies that EPA examined in 1990 included:
- Incinerators and autoclaves (both on site and off site);
- Microwave units; and
- Various chemical and mechanical systems.
What conclusions did EPA draw from the two-year demonstration program?
From the information gathered during this period, EPA concluded that the disease-causing potential of medical waste is greatest at the point of generation and naturally tapers off after that point. Thus, risk to the general public of disease caused by exposure to medical waste is likely to be much lower than risk for the occupationally exposed individual.
How is the incineration of medical waste regulated?
Currently, over 90% of potentially infectious medical waste is incinerated. In August 1997, EPA promulgated regulations governing the emissions from medical waste incinerators. These regulations include:
- Stringent air emissions guidelines for states to use in developing plans to reduce air pollution from medical waste incinerators built on or before June 20, 1996; and
- Final air emission standards for medical waste incinerators (MWIs) built after June 20, 1996.
These guidelines and standards will substantially reduce MWI emissions. EPA estimates that mercury emission will decline by 94%, particulate matter by 90%, hydrogen chloride by 98%, and dioxin by 95%.
Are there alternatives to incineration for treating and disposing of medical waste?
EPA's MWI standards and guidelines will affect the use of alternative technologies for treating medical waste. Because the new standards will be expensive to comply with, EPA estimates that few health care facilities are likely to install new MWIs and many facilities are likely to discontinue use of existing MWIs (we expect that 50% to 80% of the 2400 existing MWIs may be discontinued). Instead, facilities are likely to switch to other methods of waste disposal such as off-site commercial disposal or onsite disinfection technologies.
Alternatives to incineration of medical waste include:
- Thermal treatment, such as microwave technologies;
- Steam sterilization, such as autoclaving;
- Electropyrolysis; and
- Chemical mechanical systems, among others.
EPA has jurisdiction over medical waste treatment technologies which claim to reduce the infectiousness of the waste (i.e. that claim any antimicrobial activity) by use of a chemical. This jurisdiction comes from the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA). Companies wishing to make such claims must register their product under FIFRA through EPA's Office of Pesticide, Antimicrobial Division.
Many states have regulations requiring medical waste treatment technologies to be certified, licensed, or regulated. Individual states have their own requirements. Many states refer to a document called, Technical Assistance Manual: State Regulatory Oversight of Medical Waste Treatment Technologies, developed by the State and Territorial Association on Alternative Treatment Technologies.
Do other federal agencies regulate potentially infectious medical waste?
Yes. Several federal agencies have regulations which cover this waste stream.
Is EPA involved in any pollution prevention activities within the health care industry?
One June 24, 1998, the EPA entered into a voluntary partnership with the Hospitals for a Healthy Environment and its member hospitals to:
- Virtually eliminate mercury waste generated by hospitals by 2005;
- Reduce overall hospital waste volume by 33 percent by 2005 and 50 percent by 2010; and,
- Jointly identify additional substances to target for pollution prevention and waste reduction opportunities.
A number of workgroups have been convened to help achieve these goals, including, but are not limited to:
- Baseline Data Collection;
- Model Mercury Virtual Elimination Plan;
- Model Comprehensive Waste Reduction Plan;
- Education Seminars;
- Awards Program; and
- Clearinghouse of Best Practices and Service Providers.