Medical Waste Guidance and Interpretation The following information references the North Carolina Medical Waste Management rules. For further information contact John Patrone at 336-776-9673 or email@example.com. If you have questions regarding a permitted facility, contact the Solid Waste Section Environmental Specialist responsible for the county in which the facility operates. General Information The North Carolina Department of Environmental Quality, Division of Waste Management - Solid Waste Section regulates the packaging, storage, transportation, treatment, and disposal of medical waste. Effective Date The medical waste management rules became effective October 1, 1990 and were amended April 1, 1993. The latest amendment was adopted on November 1, 2019. Enforcement of the Rules The medical waste management rules are enforced by the Solid Waste Section. Other state laws may also apply as well as federal and local government laws. Preemption of Local Solid Waste Laws - Medical Waste The medical waste management rules preempt local solid waste laws on medical waste where local laws are more lenient. Joint and Several Liability A solid waste generator shall be responsible for the satisfactory storage, collection and disposal of solid waste. The solid waste generator shall ensure that its waste is disposed of at a site or facility which is permitted to receive the waste. Definitions Medical Waste Medical waste means any solid waste which is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals, but does not include any hazardous waste, radioactive waste, household waste, or those substances excluded from the definition of solid waste. Regulated Medical Waste Regulated medical waste means blood and body fluids in individual containers in volumes greater than 20 ml, microbiological waste, and pathological waste that have not been treated. Regulated medical waste must be treated prior to disposal. Regulated medical waste shall not be compacted prior to treatment. Microbiological Waste Microbiological waste means and includes cultures and stocks of infectious agents. The term includes cultures of specimens from medical, pathological, pharmaceutical, research, commercial and industrial laboratories. Pathological Waste Pathological waste means and includes human tissues, organs, body parts, secretions and excretions, blood and body fluids that are removed during surgery and autopsies; and the carcasses and body parts of all animals that were exposed to pathogens in research, were used in the production of biologicals or in the in-vivo testing of pharmaceuticals, or that died of known or suspected infectious disease. Blood and Body Fluids Blood and body fluids means liquid blood, serum, plasma, other blood products, emulsified human tissue, spinal fluids and pleural and peritoneal fluids. Blood and body fluids does not include dialysates, feces, or urine if not removed during surgeries and autopsies. Regulated medical waste specifies blood and body fluids that are in a liquid state and in a container. Blood and body fluids does not include bandages, dressings, gowns, gloves, linens, clothing, furniture and wallboard. Blood and Body Fluids in Individual Containers in Volumes of 20 ml or Less These containers may be disposed of in a municipal solid waste landfill or the liquids in the sanitary sewage system. The containers shall be stored in an area accessible only by the responsible party or their designated representative and shall not be compacted prior to off-site transportation. Do You Know Percentage of the Medical Waste Stream that is Regulated Medical Waste Most medical waste may be handled as general solid waste and does not require treatment. Regulated medical waste makes up a small portion of the total medical waste stream. The percentage of a facility's waste stream comprised of regulated medical waste is dependent on the activities at that facility. Roughly 9 to 15 percent of the waste stream at hospitals is regulated medical waste. Some facilities, such as long-term care facilities, generate medical waste but little or no regulated medical waste. Registration of Medical Waste Generators The North Carolina Department of Environmental Quality, Division of Waste Management - Solid Waste Section does not require generators of medical waste to register. Artificial Body Parts and Implants Removed During Surgical Procedures Items such as artificial limbs and pacemakers are considered medical waste; however, they are not regulated medical waste. Patient Request for the Return of Dressings, Tissues, Organs, Body Parts, etc. The Medical Waste Management rules pertain to medical waste that is designated as a solid waste. If the medical waste is not discarded but given back to the patient, then it is not a solid waste. Healthcare facilities should ensure that the return of dressing's, tissues, organs, body parts, etc. to patients is permissible per other regulatory entities. Medical Waste such as Dressings, Bandages, Gloves, and Tubing These items are not included in the definition of regulated medical waste and may be disposed of in a municipal solid waste landfill. Dialysates, Feces, and Urine Dialysates, feces, and urine, not removed during surgery or autopsies, may be disposed of in the sanitary sewage system. Soiled diapers are not regulated medical waste and may be disposed of as general solid waste. Sharps "Sharps" means needles, syringes and scalpel blades. It also includes syringes with attached needles, capillary tubes, slides and cover slips, lancets, auto injectors, connection needles and sets, exposed ends of dental wires, and objects that can penetrate the skin. Disposal of Sharps The Medical Waste Management rules do not require treatment of sharps before disposal. They must be placed in a container that is rigid, leak-proof when in an upright position, and puncture resistant. The container may then be disposed of in a municipal solid waste landfill. Any OSHA requirements for labeling and packaging must also met. Generators should contact their local government to confirm that there is no local restriction against disposing of sharps in the landfill. Compaction of Sharps Sharps shall not be compacted prior to off-site transportation unless placed in a sealed compactor unit that is hauled off for disposal by the transporter. Sharps Generated in Private Households Household waste is not included in the definition of medical waste and is not subject to the Medical Waste Management rules. Households that use sharps are urged to place them in hard-wall containers before disposal in order to protect solid waste staff from needle sticks. Sharps generated from activities associated with farms are subject to the Medical Waste Management rules. Packaging and Storage Storage of Regulated Medical Waste to be Treated Off-Site A medical waste generator that stores regulated medical waste and will have regulated medical waste treated off-site shall comply with 15A NCAC 13B .1202 and 15A NCAC 13B .1203. Storage of Medical Waste not Classified as Regulated Medical Waste A medical waste generator that stores medical waste and will have medical waste disposed of off-site or treated off-site shall comply with 15A NCAC 13B .1202. Packaging Requirements for Regulated Medical Waste Treated Off-Site Regulated medical waste is required to be packaged per 15A NCAC 13B .1203. Packaging Requirements for Regulated Medical Waste Treated On-Site The packaging requirements stated in 15A NCAC 13B .1203 only apply to regulated medical waste treated off-site. There are no packaging requirements for regulated medical waste treated onsite at the generating facility. Required Information Provided to the Division for Transfer or Storage Operations Occurring at a Location other than a Treatment Facility The responsible party for regulated medical waste transfer or storage operations occurring at a location other than a permitted treatment facility shall comply with 15A NCAC 13B .1203(d)(2). Transportation Regulated Medical Waste Records Requirements The medical waste management rules require that regulated medical waste generators and treatment facilities maintain records per 15A NCAC 13B .1203(b) and 15A NCAC 13B .1204(b). Required Information Provided to the Division for Transfer or Storage Operations Occurring at a Location other than a Treatment Facility The responsible party for regulated medical waste transfer or storage operations occurring at a location other than a permitted treatment facility shall comply with 15A NCAC 13B .1203(d)(2). Generators Responsible for the Proper Disposal of Medical Waste Generators are responsible to ensure that medical waste is disposed of properly. Medical waste, not classified as regulated medical waste, may be disposed of at a municipal solid waste landfill. Regulated medical waste is required to be treated at a permitted treatment facility. 15A NCAC 13B .0202(i) states the medical waste treatment and disposal methods. Generators Responsible for Packaging Regulated Medical Waste by Treatment Method Type A generator is responsible for packaging regulated medical waste per the treatment method type to be used. A generator shall comply with 15A NCAC 13B .1203(b)(1). Transport of Regulated Medical Waste Transporters of regulated medical waste shall comply with 15A NCAC 13B .1203. The Medical Waste Management rules do not require that transporters of regulated medical waste register with the Division however, there may be applicable North Carolina Department of Transportation regulations. Treatment and Disposal Treatment Facilities for Regulated Medical Waste Regulated medical waste may be treated at the generating facility per 15A NCAC 13B .1201(2) and 15A NCAC 13B .1202(j). If regulated medical waste is not treated at the generating facility, it must be treated at a permitted treatment facility per 15A NCAC 13B .1204. Permitting of Medical Waste Treatment Facilities The Division does not issue permits for medical waste treated at the generating facility. Permits are required for treatment facilities receiving medical waste generated off-site. Treatment of Large Volumes of Blood and Body Fluids Incineration or sanitary sewage are acceptable treatment methods for blood and body fluids in individual containers in volumes greater than 20 ml. Disposal of Dialysates, Feces, and Urine The term blood and body fluids does not include dialysates, feces, or urine if not removed during surgeries and autopsies. Dialysates, feces and urine that are not designated as blood and body fluids are not regulated medical waste. Disposal of Bloody Gauze, Used Gloves, Tubing, Dressings, etc. Disposal of medical waste such as bloody gauze, used gloves, tubing, and dressings are not regulated medical waste. Medical waste that is not regulated medical waste may be disposed of in a municipal solid waste landfill. The "50 Pound per Month" Record-Keeping Exemption 15A NCAC 13B .1203(b) exempts generators from maintaining records if they generate less than 50 pounds of regulated medical waste per month. Municipal Solid Waste Landfill Rejection of Properly Packaged Sharps or Treated Regulated Medical Waste Municipal solid waste landfills may reject any solid waste for disposal in the landfill, even though State regulations allow for its disposal. Managing Medical Waste After It Has Been Treated Treated regulated medical waste is subject to 15A NCAC 13B .1204(a). Funeral Homes Human Remains Intended for Interment or Disposal The medical waste management rules do not pertain to caskets or the like containing human remains intended for interment or cremation. Interment of a Body with Its Removed Organs, Sharps, Tubing, etc. Due to Religious Practices The medical waste management rules are not intended to interfere with the religious preferences of an individual. Sharps Used During Preparation of a Body Sharps used during the preparation of a body for interment or cremation are medical waste and subject to 15A NCAC 13B .1202(b). Crematorium Use for the Incineration of Regulated Medical Waste Crematoriums do not meet the requirements of a regulated medical waste incinerator and shall not be used for the treatment of medical waste. Funeral Home Waste and Regulated Medical Waste Treatment Facilities With the exception of blood and body fluids, which can be disposed of by sanitary sewer as a form of treatment, most funeral homes do not generate regulated medical waste for disposal. Only regulated medical waste requires treatment prior to disposal. Non-regulated medical waste does not require treatment prior to disposal.