Treatment and Disposal Alternatives for Regulated Medical Waste

July 1, 2008 | Healthcare Risk, Quality, & Safety Guidance

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State laws vary widely regarding acceptable disposal options for regulated medical waste (RMW). Many states authorize only a few specific disposal techniques but provide some sort of process, either formally or on a case-by-case basis, for getting approval for other techniques. Thus, one company’s chemical treatment unit might have state approval, but another company’s might not (usually because the company has not yet sought approval). Since testing to meet state approval standards is often costly, vendors often wait for potential customers before applying for state approval.

There is no single definition of medical waste in the United States, although there are many similarities in all states’ definitions. These definitions are variations on the U.S. Environmental Protection Agency’s (EPA) old definition of “regulated” medical waste that was written under the now-expired Medical Waste Tracking Act of 1988. EPA used the word “regulated,” as opposed to “infectious,” to indicate that although these wastes were regulated, they were not necessarily infectious.

The old EPA definition of RMW included the following seven classes of waste generated in the diagnosis, treatment, or immunization of humans or animals, in related research, or in the production or testing of biologicals:

There are no universally accepted efficacy standards for medical waste treatment technologies. * General terms such as “decontaminate,” “sterilize,” “disinfect,” or “render harmless” are sometimes used to describe the level of treatment a technology should achieve. Because of this lack of performance criteria, a group of states joined with several federal agencies in 1994 to produce a consensus-based technical assistance manual to guide state-approval processes. This report, known as the State and Territorial Association on Alternative Treatment Technologies Report (or STAATT I), established microbial efficacy testing criteria, as well as operating protocols, for use in the review and approval of alternative medical waste treatment technologies. ...

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