29. BIOMEDICAL WASTES
As set forth in RCW 70.95K the following definition of biomedical wastes shall be the sole definition within the state, and shall preempt biomedical waste definitions established by local health departments or local governments. Biomedical waste means and is limited to, the following types of waste;
- Animal waste - animal carcasses, body parts and bedding of animals that are known to be infected with, or have been inoculated with, human pathogenic microorganisms infectious to humans.
- Biosafety level 4 disease waste - contaminated with blood, excretions, exudates, or secretions from humans or animals who are isolated to protect others from highly communicable infectious disease that are identified as pathogenic organisms assigned to biosafety level 4 by the Center for Disease Control (CDC), national institute of health, biosafety in microbiological and biomedical laboratories, current edition.
- Cultures and stocks - wastes infectious to humans and includes specimen cultures, cultures and stocks of etiologic agents, wastes from production of biological and scums, discarded live and attenuated vaccines, and laboratory waste that has come into contact with cultures and stocks of etiologic agents or blood specimens. Such waste includes, but is not limited to, culture dishes, blood specimen tubes, and devices used to transfer, inoculate and mix cultures.
- Human blood and blood products - discarded waste human blood and blood components, and materials containing free flowing blood and blood products.
- Pathological waste - human source biopsy materials, tissues, and anatomical parts that emanate from surgery, obstetrical procedures and autopsy. Does not include teeth, human corpses, remains and anatomical parts that are intended for internment or cremation.
- Sharp waste - all hypodermic needles, syringes with needles attached, IV tubing with needles attached, scalper blades, and lancets that have been removed from the original sterile package.
29.1 INTRODUCTION
This chapter of the Douglas County Comprehensive Solid Waste Management Plan (DCCSWMP) outlines the regulatory framework overseeing biomedical wastes, discusses the existing conditions and programs within the Regional Planning Area (RPA), establishes objectives to meet the existing and projected needs, identified alternatives, and recommends actions for achieving the established objectives.
29.2 REGULATORY FRAMEWORK
29.2.1 Federal Requirements
Although there is no comprehensive federal medical waste law, several federal laws do regulate some aspect of medical wastes. These include:
- The occupational Safety and Health Act (OSHA) administered by the Department of Labor (DOL) regulates how medical waste is to handled to protect workers from exposures. The Bloodborne Pathogen Standard and the Laboratory Standard in particular focus on medical waste.
- The Resource Conservation and Recovery Act (RCRA) administered by the Environmental Protection Agency (EPA) regulates medical waste in the areas of thermal processing (40 CFR 240), storage and collection (40 CFR 243) and source separation (40 CFR 246). The EPA also regulates medical wastes that maybe discharged to "waters of the United States" (Clean Water Act) and emissions from medical waste activities, especially incineration (Clean Air Act).
- The US Department of Transportation (DOT) regulates the transportation of hazardous materials under 49 CFR Parts 171 - 189 (Hazardous Materials Regulations). Specifically sections 49 CFR Parts 171.14 - 171.16, 172.101, 172.400 - 172.450, 173.134 and 178.600 - 178.609 deal with the transportation of infectious substances. Additionally under 49 CFR Parts 171 - 180 the following regulations have been established:
a. Hazardous Material 181G - Infectious Substances
b. Hazardous Material 200 - Hazardous Materials in Intrastate Transportation
c. Hazardous Material 206 - Vehicle Marking Requirements
d. Hazardous Material 226 - Revisions to Standards for Infectious Substances and Genetically Modified Microorganisms
29.2.2 State Requirements
No comprehensive program of infectious waste regulation currently exists in Washington State. RCW 70.95K defines "biomedical waste" and gives local health departments primary responsibility for regulating infectious waste treatment and disposal. In addition to any local regulations, the following three separate state agencies regulate particular aspects of biomedical waste handling, transportation and disposal:
- The state Department of Labor and Industries (L&I) administers provisions of the Washington Industrial Safety and Health Act (WISHA) preventing occupational exposure to the hepatitis B virus and the human immunodeficiency virus transmitted through medical wastes. L&I also implement's the federal Bloodborne Pathogen Standards.
- The Washington Utilities and Transportation Commission (WUTC) under WAC 480.70 Section 9 specify how biomedical waste are to handled in order to protect the health, safety, and welfare of the public, the environment, and the workers who handle the biomedical waste. Specifically the WUTC has established the following requirements for companies transporting biomedical waste:
a. prepare and maintain a biomedical waste operating plan ensuring that;
* biomedical waste is kept separate from any other solid waste until treatment or disposal;
* only authorized and properly trained persons collect, transport, and dispose of biomedical waste;
* unauthorized persons are prevented from having access to, or contact with, biomedical wastes;
* any motor vehicle used to collect, transport or dispose of biomedical waste is properly decontaminated;
* employees are provided and required to use clean gloves and uniforms, and any other necessary protective clothing when collecting, transporting and disposing of biomedical waste;
* appropriate methods are available to decontaminate any person exposed to biomedical waste during collection, transportation and disposal;
* alternative storage, treatment and disposal sites in case of an accident.
b. develop, publish and maintain an employee training plan;
c. properly package and contain the biomedical waste;
d. transfer of biomedical waste to off-site treatment and disposal facilities;
e. compaction of biomedical waste not allowed;
f. vehicle requirements;
g. shipping paper requirements;
h. inspection
- Under Chapter 173.300 WAC the Department of Ecology (DOE) requires all owners/operators of solid waste incineration facilities to employ an operator certified by the DOE. In addition, the DOE requires medical waste incineration to be conducted so that none of the combustible material is visible after incineration. RCW 70.95K.030 recognized the public health risks posed by the disposal of sharps generated in private homes. Local health departments are required to enforce this section, primarily through an educational approach regarding proper disposal of residential sharps.
29.2.3 Local Requirements
Douglas County
Any jurisdiction, agency, private corporation, individual or other entity wishing to import biomedical waste into Douglas County must conform to the Douglas County Solid Waste Importation Ordinance (DCSWIO). As specified within the ordinance a formal Letter of Request to the Douglas County Board of Commissioners requesting that their application for solid waste importation be reviewed is required. Only after the Douglas County Board of Commissioners has received a Letter of Request will the review and approval process begin. The Douglas County Board of Commissioners will review the information contained within the Letter of Request with county staff and others. If it is determined by the Douglas County Board of Commissioners that sufficient information has been provided, and that all known potential adverse impacts have been identified, assessed and mitigated, the request may be approved.
Within Douglas County no person shall deposit, discard or otherwise dispose of any biomedical waste upon any public place within the county or upon a private residence or other private property not owned by him/her, or in any waters within the county except;
- when such property is designated by the state or any of its agencies or the county for the disposal of biomedical waste, and such person is authorized by the appropriate permitting authority to so use such property;
- with the prior written consent of the landowner approving of such disposal upon their private property.
Additionally, within Douglas County all owners or persons in control of any private residence or other private property shall at all times maintain the premises free of any biomedical waste that pose a risk to public health and safety, the environment or create a nuisance.
29.3 EXISTING CONDITIONS
29.3.1 Biomedical Waste Ordinance
The issue of biomedical waste was first brought to the Douglas County Solid Waste Advisory Committee (SWAC) in the spring of 1994. At that time, the SWAC was asked to investigate the methods used to handle biomedical waste within the RPA. The SWAC referred the issue to the Public Health and Safety Technical Advisory Committee (TAC), which studied the issue for three months and found that current methods of collection and disposal were inconsistent and needed to be reviewed to determine if they comply with state regulations, rules and guidelines. In April 1994 the SWAC recommended to the participating jurisdictions that the Chelan-Douglas Health District (CDHD) prepare a biomedical waste education and public outreach program.
In April, 1995 the SWAC asked the Public Health and Safety TAC to revisit the biomedical waste issue to see if the biomedical waste chapter to the adopted Douglas County Solid Waste Management Plan needed to be revised. The TAC recommended that the Douglas County Solid Waste Program Office (DCSWPO) develop a `model' Biomedical Waste Ordinance for the participating jurisdictions; that both WUTC certified solid waste collection companies within the RPA develop and implement infectious waste management plans, or quit collecting, transporting and disposing of biomedical wastes; and that all biomedical waste generators within the RPA dispose of their biomedical waste separately from their municipal solid waste. In August 1995 the SWAC recommended that the DCSWPO meet with the CDHD and discuss the committee's findings and recommendations.
In November, 1995 the SWAC asked the Public Health and Safety TAC to prepare a `draft' biomedical waste ordinance. In May, 1996 the TAC submitted the `draft' biomedical waste ordinance for SWAC approval. The SWAC accepted the `draft' biomedical waste ordinance and referred it for legal and participating jurisdiction review. Public hearings on the `draft' biomedical waste ordinance were held by each of the participating jurisdictions. In November, 1996 the TAC recommended to the SWAC that no action be taken on the `draft' biomedical waste ordinances based upon comments received from the participating jurisdictions. However, the TAC did recommend to the SWAC that the CDHD develop and implement a biomedical waste education and public outreach program. The TAC cited the following reasons to support their recommendation:
- there are currently sufficient federal and state biomedical waste regulations to address the proper handling, collection and disposal of biomedical wastes;
- federal and state biomedical waste regulations (definitions) are confusing and conflicting;
- co-mingled biomedical wastes, regardless of volume, pose inherent problems with handling, collection, transportation and disposal;
- handling, collection, transportation and disposal practices of biomedical waste have been inconsistent within the RPA;
- there is no comprehensive biomedical waste education or public outreach program within the RPA to address the proper handling, collection, transportation or disposal of biomedical wastes;
- currently the two WUTC certified solid waste collection companies within the RPA do not have infectious waste management plans;
- alternative collection, transportation and disposal options currently exist for biomedical wastes generators;
- some biomedical waste generators jointly cooperate in the handling, collection, transportation and disposal of their biomedical waste in order to hold down costs;
- the CDHD is the appropriate agency to ensure proper handling, collection, transportation and disposal of biomedical waste through a biomedical waste education and public outreach program;
- the CDHD has limited staff and resources to offer a biomedical waste education and public outreach program.
After a lengthy discussion the SWAC approved the TAC recommendation and instructed the DCSWPO to meet with the CDHD and discuss the committee's findings and recommendations.
29.3.2 Biomedical Waste Survey
Following the Douglas County, September 18th, 1996, biomedical waste public hearing, the DCSWPO was asked to investigate current biomedical waste disposal practices within the RPA. The DCSWPO contacted each of the thirty identified biomedical waste generators within the RPA and reported its finding to the CDHD and the Douglas County Board of County Commissioners. The Douglas County Board of Commissioners then instructed the DCSWPO to conduct a biomedical waste survey to verify the findings of the site visits. The purpose of the survey was to verify the biomedical waste generator actual status and determine how each identified biomedical waste generator handled, collected, stored, transported and disposed of their biomedical waste. A list of all biomedical waste generators, how each treats their biomedical waste prior to disposal, and specific disposal methods was generated from the collected information. Attached to each survey was a definition page that clarified the terms used within the survey. Additionally, the survey specifically separated `sharps' waste handling, collection, transportation and disposal from the other biomedical waste.
The biomedical waste survey results were to assist the Public Health and Safety TAC in assessing the public risk and generator liability in the handling, collection, storage, transportation and disposal of biomedical waste within the RPA. It was not the purpose of the biomedical waste survey to specifically identify generator practices which may be inconsistent with federal or state regulations as they pertain to infectious, potentially infectious and biomedical wastes. A total of thirty biomedical waste surveys were distributed on September 20th and asked to be returned by September 30th, 1996. Of the thirty surveys distributed, twenty-six were in the Greater East Wenatchee Area and four were in the Town of Waterville. No biomedical waste generators were identified within the Cities of Bridgeport, Rock Island or the Town of Mansfield. Nineteen surveys were returned, of which sixteen were from the Greater East Wenatchee Area and three were from the Town of Waterville. In November, 1996 the DCSWPO prepared the Douglas County Biomedical Waste Report and reported its finding to the CDHD and the SWAC.
Figure 29-1 Distribution of Biomedical Waste within the RPA in 1999
Source: Bill Tinney II
Table 29-1 Biomedical Waste Generators within the RPA in 2000
|
Classification |
Generator |
Biomedical |
Sharps |
|
Assisted Living (5) |
Cornerstone Care Center |
X |
X |
|
|
Hearthstone Cottage |
X |
X |
|
|
Highline Convalescent Center |
X |
X |
|
|
Mission Vista |
X |
X |
|
|
River Valley Home |
X |
X |
|
Clinics |
Family Medicine |
X |
X |
|
|
Family Practice |
X |
X |
|
|
Waterville Clinic |
X |
X |
|
Dentists (6) |
Dr. Porter |
X |
X |
|
|
Dr. Jacobus |
X |
X |
|
|
Dr. Michael |
X |
X |
|
|
Dr. Williams |
X |
X |
|
|
Family Dentistry |
X |
X |
|
|
Medical Dental |
X |
X |
|
Emergency Response (8) |
Ballard Ambulance |
X |
X |
|
|
Lifeline Ambulance |
X |
X |
|
|
Mansfield Ambulance |
X |
X |
|
|
Waterville Ambulance |
X |
X |
|
|
Douglas County Fire District #1 |
X |
X |
|
|
Douglas County Fire District #2 |
X |
X |
|
|
Douglas County Fire District #4 |
X |
X |
|
|
Douglas County Fire District #5 |
X |
X |
|
Funeral Homes (3) |
Cascade Memorial |
X |
X |
|
|
Tedford Chapel of the Valley |
X |
X |
|
|
Waterville Funeral Home |
|
|
|
Pharmacies (9) |
Bi-Mart |
|
|
|
|
Costco |
|
|
|
|
Eastmont Pharmacy |
|
X |
|
|
Food Pavilion |
|
|
|
|
Fred Meyer |
|
X |
|
|
Gross Drug |
|
|
|
|
Mitchell's |
|
X |
|
|
Safeway |
|
|
|
|
Top Food |
|
|
|
Veterinary (3) |
Eastmont Animal Clinic |
|
X |
|
|
Sunset Veterinary Clinic |
|
X |
|
|
Valley Veterinary Clinic |
|
X |
Source: Bill Tinney II
29.4 OBJECTIVES
29.4.1 Divert Untreated Biomedical Waste from the Municipal Solid Waste Stream
With state regulations requiring the separate handling of biomedical waste from other solid waste until treatment or disposal, it is imperative that generators divert their untreated biomedical waste from the waste stream. Failure to divert untreated biomedical waste from the waste stream can pose a potential financial liability to the generator.
29.4.2 Ensure that Biomedical Wastes are Properly Managed
With generators being responsible for the proper handling, collection and disposal of their biomedical waste from "cradle to grave" it is very important that the generators properly dispose of their biomedical waste. Failure of a generator to properly handle, collect and dispose of their biomedical waste can pose a threat to the public health and safety and the environment.
29.4.3 Ensure that Biomedical Waste Being Disposed of Meet all Federal, State, and Local Regulations
With federal and state regulations specifying how biomedical wastes are to be handled, collected, transported and disposed of it is very important that generators be properly educated. Failure of a generator to comply with these regulations can result in substantial penalties, fines and corrective actions.
29.4.4 Establish a Biomedical Waste Diversion Goal
It is the goal of the DCCSWMP to divert ten percent of all biomedical waste generated within the RPA.
29.5 ALTERNATIVES
29.5.1 Ban all Biomedical Waste from the GWRLF
Another way to increase source-separation is to prohibit the disposal of biomedical waste into landfills. One problem associated with disposal bans is illegal dumping of the banned material. Therefore, an important component of a disposal ban is the development of alternative handling and disposal methods. For example, if biomedical wastes are banned from the solid waste stream, then a biomedical waste collection and disposal facility must be available, convenient and reasonably priced to accommodate the diverted material.
29.5.2 Restrict Disposal to Only Permitted and Approved Facilities
By restricting biomedical waste to only permitted and approved facilities, proper disposal will be assured within the RPA. This will ensure that biomedical waste generated within the RPA are managed in a manner that protects the public health and safety and the environment. However, there are currently generators within the RPA who are co-mingling their untreated biomedical waste with the municipal solid waste stream. As required under WAC 480.70.366, biomedical waste is to be kept separate from any solid waste until treatment or disposal. Generators failing to treat their biomedical waste on-site prior to collection, or who co-mingle their untreated biomedical with their solid waste, are in violation of federal and state law.
 |
29.5.3 Require all Biomedical Waste Generators to Include a Collection and Disposal Element in their Biomedical Waste Management Plan
Biomedical waste generators, excluding household sharps waste generators, are required to prepare and implement biomedical waste management plans. These plans must meet specific requirements in order to protect the health, safety and welfare of the public, the environment and the workers who handle biomedical waste within the facilities. Each facility must have a current and up-to-date biomedical waste management plan that meets OSHA requirements in order to operate. Any facility that does not meet the standards established by the L & I may be fined or closed. However, these standards apply to only the activities occurring within the facility and do not apply to what happens to the biomedical waste once it leaves the facility. Therefore, it is very important that all biomedical waste generators within the RPA include a collection and disposal element within their biomedical waste management plans. This will ensure that their generator responsibility is addressed from the point of generation to the final disposal.
29.5.4 Require all Biomedical Waste to be Collected and Transported by WUTC Approved Waste Haulers
As specified within Chapter 480.70 WAC, the co-mingling of untreated biomedical waste within the municipal solid waste stream is prohibited. Therefore, solid waste collection and transporting companies that co-mingle untreated biomedical waste are in violation of state law. Chapter 480.70 WAC does allow solid waste collection and transporting companies to collect and transport untreated biomedical waste if certain requirements are met. Specifically, the following requirement must be met in order for a solid waste collection and transportation company to collect or transport biomedical waste:
- a company collecting, transporting and disposing of biomedical waste must prepare and maintain a biomedical waste operating plan,
- any person involved in collection, transportation and disposal of biomedical waste must be adequately trained,
- biomedical waste, except for sharps waste, must be contained in bags or lined containers that are impervious to moisture and that will not rip, tear, or burst under normal conditions of transportation,
- a company must transport biomedical waste to a facility that meets all federal, state and local environmental regulations for treatment, storage and disposal,
- a company must not compact biomedical waste or any material in a container labeled as containing biomedical waste,
- a company that transports biomedical waste must ensure that all motor vehicles used to transport biomedical waste is equipped with cargo compartments,
- a company collecting or transporting biomedical waste must issue a shipping paper for each shipment transported.
Consolidated Disposal and Zippy Disposal have chosen not to collect or transport biomedical waste.
Waste Management of Greater Wenatchee (WMGW) has chosen not to collect or transport biomedical waste and has a company policy that prohibits the collection or transportation of untreated biomedical waste by its trucks. Additionally, WMGW has stated that any untreated biomedical waste collected from biomedical waste generators have been placed there illegally and are the sole responsibility of the generator and all liability rests with them. Therefore, failure of the biomedical waste generator to properly have their biomedical waste collected and disposed of can lead to potentially costly legal action.
29.5.5 Encourage Pharmacies to Implement a Sharps Take-Back Program
Pharmacies who sell sharps should be encouraged to implement a take-back program. This would allow customers a convenient opportunity to dispose of their sharps properly and at no or at minimum costs. The CDHD could provide the pharmacies with sharps containers which could be provided to the customer at the time of sharps purchase thereby assisting the pharmacies in implementing the take-back program. Additionally, the DCSWPO could provide technical assistance to the pharmacies to implement a sharps take-back program. The DCSWPO could assist the pharmacies by promoting the take-back programs, by offering biomedical waste handling workshops and similar assistance.
29.5.6 Encourage Cooperative Ventures for Proper Handling and Disposal of Biomedical Waste
The DCSWPO should encourage cooperative ventures to properly handle and dispose of biomedical waste. Most of the biomedical waste facilities within the RPA are small private operations and, because of the requirements and costs of proper handling and disposing of biomedical wastes, the collection of a biomedical waste can be prohibitive. Therefore, the DCSWPO should assist these small biomedical waste facilities in setting up cooperative ventures among themselves in order to share the collection costs. Any cooperative venture should be done in coordination and cooperation with the medical community and the CDHD.
29.5.7 Conduct a Biomedical Waste Generator Study
The CDHD should conduct a biomedical waste generator study. This study should specifically identify all biomedical waste generators within the RPA. Each generator would be required to provide information on what type of biomedical waste they generate, how much they generate, how it is handled, contained, treated and disposed of. Without knowing these basic facts, it is impossible to determine the public health risk, worker safety, liability exposure and similar issues concerning the proper management of biomedical waste within the RPA.
29.5.8 Develop a Biomedical Waste Management Plan
The CDHD should take the lead to ensure that biomedical wastes are properly handled and disposed of within the RPA. The current management system may not be adequate to protect public health. The CDHD should consider developing a Biomedical Waste Management Plan (BWMP). The decision to produce a BWMP could be based on the SWAC task force recommendation, or the result of new federal or state regulations. This BWMP should include a definition of infectious wastes, outline proper handling methods, disposal requirements, acceptable sterilization and incineration methods, and requirements for each generator to have a BWMP. The Washington State Infectious Waste Project (Ecology 1989) can provide guidance for the development of a BWMP. Also, other county plans that have been developed and successfully implemented (i.e., King County) may be consulted in developing a BWMP for the RPA. The BWMP could include a requirement for all infectious waste generators to submit a permit application providing information such as the type and quantity of waste disposed annually, the current method of treatment or disposal, and a contingency plan if the current method becomes unavailable.
This alternative could also require that each facility or organization obtain an infectious waste permit to the CDHD. This would provide a mechanism for the CDHD to finance its infectious waste monitoring and enforcement activities. The administration of this fee, and determining its amount, would be the responsibility of the CDHD. Implementation of this alternative would provide useful information about existing biomedical waste practices. It would also provide a tool for evaluating the need for additional biomedical waste management facilities in the RPA.
29.5.9 Develop a Biomedical Waste Education Program
The CDHD should develop a biomedical waste education program. This program would specifically provide the public and generators with information on how to properly handle, treat, contain and dispose of their biomedical waste. The hazards of improper handling and disposal of these materials should be emphasized. The program could provide information on what is biomedical waste, how it is regulated, how it may be treated on-site, how it is to be disposed of and other similar information. The CDHD should develop brochures and information sheets to educate the public, generators and pharmacies about how biomedical wastes are to be managed properly. Brochures and other informational packets should be placed at pharmacies and hospitals where patients purchase their medications. Pamphlets could also be distributed to visiting nurse services and other home health care agencies. Appropriate labels for at-home disposal containers could also be distributed at these locations. Existing sharps take-back programs should be promoted.
29.5.10 Monitor and Track Biomedical Waste
The DCSWPO needs to monitor and track all biomedical waste to determine who is generating the biomedical waste, the volume and type of biomedical waste being generated, where they originated from, how they are being treated, where they are being disposed of and how they are being disposed of. Without knowing these basic facts, it is impossible to properly manage the solid waste stream within the RPA. Therefore, the DCSWPO should establish a data tracking program which monitors and tracks all biomedical waste being generated within the RPA annually.
29.6 RECOMMENDATIONS
29.6.1 Require all Biomedical Waste to be Collected and Transported by WUTC Approved Waste Haulers
29.6.2 Encourage Pharmacies to Implement Sharps Take-Back Programs
29.6.3 Conduct a Biomedical Waste Generator Study
29.6.4 Implement a Biomedical Waste Education Program
29.6.5 Monitor and Track Biomedical Waste