Medical Waste Management and Disposal, 1st Edition
Introduction
1. Characterization of Medical Waste
1.1 Introduction
1.2 Medical Waste Generation
1.3 Medical Waste Data Collection Activities
2. 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
waste
3. 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 Waste
4. 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/Disadvantages
5. 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 Handling
6. 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 Compaction
7. 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 Compaction
8. 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 Enforcement
9. 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 Waste
10. Appropriateness of Penalties
11. 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 Option
12. Medical Waste Reuse, Recycling and Reduction
12.1 Recycling and Reuse
12.2 Source Reduction
12.3 Generation Rates
12.4 Agency Action
Part II: EPA Guide for Infectious Waste Management
1. Introduction
1.1 Purpose and Scope
1.2 State Regulations Pertaining to Infectious Waste
2. Infectious Waste Characterization
2.1 Definition of Infectious Waste
2.2 Types of Infectious Waste
2.3 Miscellaneous Contaminated Waste
3. Infectious Waste Management
3.1 Introduction
3.2 Selection of Waste Management Options
3.3 Infectious Waste Management Plan
4. 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 Methods
5. 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 Waste
Part III: Medical Waste Combustion at Municipal Waste Combustion
Facilities
1. Introduction
2. Medical Waste
2.1 Cytotoxic Chemicals
2.2 Hazardous Chemicals
2.3 Pathogens
2.4 Toxic Chemicals
2.5 Radioactive Materials
3. Impact of Medical Waste on Combustor Emissions
4. Important Considerations
4.1 Waste Transportation and Handling
4.2 Operation
4.3 Ash Handling
5. 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 Combustors
6. Current Practices-European and Canadian MWCs
7. MWC Manufacturers'/System Suppliers' Recommendations
7.1 U.S. Firms
7.2 European Firms
8. Preliminary Recommendations and Research Needs
Part IV: Hospital Medical Waste Incinerator Operation and
Maintenance
1. Introduction
2. 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 Systems
3. Air Pollution Control
3.1 Introduction
3.2 Pollutant Formation and Generation
3.3 Control Strategies
4. 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 Systems
5. 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 Instrumentation
7. Operational Problems and Solutions
7.1 Hospital Waste Incinerators
7.2 Wet Scrubbers
7.3 Fabric Filters
8. Recordkeeping
9. Safety Guidelines
9.1 Prevention of Infection During Waste Handling
9.2 Equipment Safety Procedures
9.3 Fire Safety
10. Glossary
Part V: Waste Minimization Options for Selected Waste Streams
1. Waste Minimization Options
Description of Techniques
Better Operating Practices
Chemotherapy and Antineoplastic Wastes
Formaldehyde Wastes
Photographic Chemical Waste
Radionuclides
Solvents
Mercury
Waste Anesthetic Gases
Toxics, Corrosives, and Miscellaneous Chemicals
