Medical Waste Management and Disposal

Introduction1. Characterization of Medical Waste 1.1 Introduction 1.2 Medical Waste Generation 1.3 Medical Waste Data Collection Activities2. Health Hazard Assessment 2.1 Background 2.2 Coordination with the Agency for Toxic Substances and Disease Registry (ATSDR) 2.3 Definitions 2.4 Scope of Health Hazard Assessment 2.5 General Approach to Evaluating Health Hazards Posed by Exposure to Medical Waste 2.6 Evaluation of Health Hazards Posed by Incinerating Medical Waste 2.7 Evaluation of Health Hazards Posed by Landfilling Medical Waste 2.8 Evaluation of Health Hazards Posed by Disposal in Sewage Systems 2.9 Data gaps and Research Needs 2.10 Potential Health Hazards Associated with Handling Medical waste3. Estimated Costs of the Demonstration Program and Improper Management of Medical Wastes 3.1 Cost Methodology 3.2 Characterizing the Regulated Community 3.3 Medical Waste Generation Rates 3.4 Regulatory Costs 3.5 Results 3.6 Sensitivity Analysis 3.7 Cost of Improperly Managed Medical Waste4. Demonstration Program Objectives and Evaluation 4.1 Objectives of the MWTA 4.2 Measuring Effectiveness 4.3 Conclusions on the Success of the Demonstration Program 4.4 Treatment/Disposal Practices 4.5 Available Tracking Methods 4.6 Advantages/Disadvantages5. Medical Waste Handling Methods 5.1 Introduction 5.2 Current Practices 5.3 Standards Implemented by the Rule 5.4 Evolving Handling and Management Techniques 5.5 Methods to Evaluate Medical Waste Handling6. Medical Waste Treatment Methods 6.1 Incineration 6.2 Steam Sterilization 6.3 Gas Sterilization 6.4 Chemical Disinfection with Grinding 6.5 Thermal Inactivation 6.6 Irradiation 6.7 Microwave Treatment 6.8 Grinding and Shredding 6.9 Compaction7. Medical Waste Treatment Effectiveness 7.1 Incineration 7.2 Steam Sterilization 7.3 Gas Sterilization 7.4 Chemical Disinfection 7.5 Thermal Inactivation 7.6 Microwave Treatment 7.7 Grinding and Shredding 7.8 Compaction8. Existing State and Local Requirements 8.1 Definition of a Medical Waste 8.2 Handling 8.3 Treatment 8.4 Disposal 8.5 Recordkeeping and Reporting 8.6 Tracking 8.7 Permitting/Licensing 8.8 Enforcement9. Regulatory Options for a National Program 9.1 Nationwide Tracking 9.2 Development of Control Options 9.3 Federal/State Relations 9.4 Export of Medical Waste10. Appropriateness of Penalties11. Home Health Care and Small Quantity Generator Waste 11.1 Background 11.2 Identification and Characterization of Home Health Care Waste 11.3 Estimated Quantities of Home Health Care Waste 11.4 Effects of Excluding Home Health Care Waste from Regulation Under Subtitle J 11.5 EPA Home Health Care Waste Education Program 11.6 Recommendations for Packaging, Storage, and Disposal of Home Health Care Waste 11.7 Alternative Management Option12. Medical Waste Reuse, Recycling and Reduction 12.1 Recycling and Reuse 12.2 Source Reduction 12.3 Generation Rates 12.4 Agency ActionPart II: EPA Guide for Infectious Waste Management1. Introduction 1.1 Purpose and Scope 1.2 State Regulations Pertaining to Infectious Waste2. Infectious Waste Characterization 2.1 Definition of Infectious Waste 2.2 Types of Infectious Waste 2.3 Miscellaneous Contaminated Waste3. Infectious Waste Management 3.1 Introduction 3.2 Selection of Waste Management Options 3.3 Infectious Waste Management Plan4. Treatment of Infectious Waste 4.1 Introduction 4.2 Steam Sterilization 4.3 Incineration 4.4 Thermal Inactivation 4.5 Gas/Vapor Sterilization 4.6 Chemical Disinfection 4.7 Sterilization by Irradiation 4.8 Other Treatment Methods5. Suggested Treatment Methods for Each Infectious Waste Category 5.1 Introduction 5.2 Isolation Wastes 5.3 Cultures and Stocks of Infectious Agents and Associated Biologicals 5.4 Human Blood and Blood Products 5.5 Pathological Wastes 5.6 Contaminated Sharps 5.7 Contaminated Animal Carcasses, Body Parts, and Bedding 5.8 Miscellaneous Contaminated WastePart III: Medical Waste Combustion at Municipal Waste Combustion Facilities1. Introduction2. Medical Waste 2.1 Cytotoxic Chemicals 2.2 Hazardous Chemicals 2.3 Pathogens 2.4 Toxic Chemicals 2.5 Radioactive Materials3. Impact of Medical Waste on Combustor Emissions4. Important Considerations 4.1 Waste Transportation and Handling 4.2 Operation 4.3 Ash Handling5. Current Practices-U.S. MWCs 5.1 Mass Burn Waterwall MWCs 5.2 Mass Burn Refractory MWCs 5.3 Modular Starved Air Systems 5.4 Modular Excess Air Systems 5.5 Fluidized Bed Combustors6. Current Practices-European and Canadian MWCs7. MWC Manufacturers'/System Suppliers' Recommendations 7.1 U.S. Firms 7.2 European Firms8. Preliminary Recommendations and Research NeedsPart IV: Hospital Medical Waste Incinerator Operation and Maintenance1. Introduction2. Hospital Incineration Systems 2.1 Introduction 2.2 Fundamental Concepts Related to Hospital Waste Incineration 2.3 Hospital Waste Characteristics 2.4 Types of Hospital Waste Incinerator Systems3. Air Pollution Control 3.1 Introduction 3.2 Pollutant Formation and Generation 3.3 Control Strategies4. Operation 4.1 General Objectives 4.2 Incinerator Key Operating Parameters 4.3 Waste Feed Handling 4.4 Incinerator Operation, Control and Monitoring 4.5 Add-On Air Pollution Control Systems5. Maintenance 5.1 Hospital Waste Incinerators 5.2 Wet Scrubbers 5.3 Maintenance of Fabric Filters 6. Control and Monitoring Instrumentation 6.1 Operating Parameters that Should be Monitored 6.2 Typical Instrumentation7. Operational Problems and Solutions 7.1 Hospital Waste Incinerators 7.2 Wet Scrubbers 7.3 Fabric Filters8. Recordkeeping9. Safety Guidelines 9.1 Prevention of Infection During Waste Handling 9.2 Equipment Safety Procedures 9.3 Fire Safety10. GlossaryPart V: Waste Minimization Options for Selected Waste Streams1. Waste Minimization Options Description of Techniques Better Operating Practices Chemotherapy and Antineoplastic Wastes Formaldehyde Wastes Photographic Chemical Waste Radionuclides Solvents Mercury Waste Anesthetic GasesToxics, Corrosives, and Miscellaneous Chemicals