Medical Waste Regulation:

Health and Environmental Risks Need to Be Fully Assessed

RCED-90-86: Published: Mar 6, 1990. Publicly Released: Apr 10, 1990.

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Pursuant to a congressional request, GAO assessed: (1) selected states' infectious medical waste regulatory programs; and (2) the status of the Environmental Protection Agency's (EPA) implementation of the Medical Waste Tracking Act.

GAO found that the states': (1) generator regulations varied; (2) legislation or regulations generally defined what types of medical waste should be considered infectious and set appropriate requirements, but the definitions varied; and (3) inspection processes varied, and the states conducted a limited number of inspections and took few enforcement actions. GAO also found that EPA issued regulations for a demonstration program which: (1) listed medical waste types to be regulated and specified tracking procedures; and (2) were criticized for including waste that did not present a substantial health risk and for not including some infectious items. GAO also found that EPA reported on extensive data gathering efforts for a required health hazard assessment, but realized that more research might be needed to assess the risks.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Subsequent to GAO's report and recommendations, Congress amended the Clean Air Act to require EPA to establish regulations for various categories of solid waste incinerators. To implement the act's requirements, EPA identified medical waste incineration as one category to be regulated. Accordingly, in February 1995, EPA proposed standards and guidelines to establish air emission limits for nine pollutants from new and existing medical waste incinerators and to specify requirements for operator training and certification, inspection and siting. To date, EPA has proposed rules, received public comment, and revised its analysis based on these comments.

    Recommendation: The Administrator, EPA, should consider: (1) what minimum temperature and residence time are needed to effectively incinerate infectious waste and whether national standards are needed; (2) for what substances should air emission limits be established for medical waste incinerators and whether the ash should be tested before it is landfilled; (3) whether operators of medical waste incinerators should be certified; (4) whether the incinerators should be inspected at set intervals to determine if performance standards are being complied with; and (5) whether those siting medical waste incinerators should consider prevailing winds and nearby buildings.

    Agency Affected: Environmental Protection Agency

  2. Status: Closed - Not Implemented

    Comments: EPA did plan to address this issue in its report to Congress on the medical waste problem and demonstration program. However, as explained above, it is unlikely that EPA will submit the report to Congress. EPA does not anticipate having a regulatory role in medical waste management.

    Recommendation: The Administrator, EPA, should consider: (1) the impacts on receiving waters and public health from hospitals and other medical facilities discharging infectious waste to combined sanitary and storm sewers; (2) the occupational health risks to hospital and sewer system workers from exposure to those wastes; and (3) whether household disposal of medical waste to sewers presents similar environmental, public health, or occupational risks.

    Agency Affected: Environmental Protection Agency

  3. Status: Closed - Not Implemented

    Comments: EPA did plan to address this issue in its report to Congress on the medical waste problem and demonstration program. However, as explained above, it is unlikely that EPA will submit the report to Congress. EPA does not anticipate having a regulatory role in medical waste management.

    Recommendation: The Administrator, EPA, should consider under what, if any, circumstances untreated infectious waste may be landfilled and whether standard procedures or controls are needed to: (1) protect the health and safety of landfill workers at sites where it is allowed; and (2) prevent pathogens from migrating to groundwater underlying the sites.

    Agency Affected: Environmental Protection Agency

  4. Status: Closed - Not Implemented

    Comments: EPA has gathered comments from federal agencies on infectious waste definition but believes that a consensus may not be necessary and that to expect one may not be realistic. EPA is prepared to advise Congress on possible definitions should new medical waste legislation be considered.

    Recommendation: To help ensure that concerns about mismanaged medical waste and the need for federal regulation are adequately addressed in a timely manner, the Administrator, EPA, should begin to develop a process for bringing together the Centers for Disease Control and other federal agencies, the medical and waste management industries, the states, environmental groups, and other parties, as appropriate, to obtain consensus on a definition of infectious waste and the other medical waste that needs to be regulated or receive other special attention.

    Agency Affected: Environmental Protection Agency

  5. Status: Closed - Not Implemented

    Comments: EPA is required to issue a report to Congress on the nature of the medical waste problem and possible solutions, as well as results of the 2-year demonstration tracking program. EPA has worked on a draft of the report, but has not finished it. The EPA official responsible for the report told GAO that it is unlikely that EPA will devote any resources to completing it. He said that resources are not available and that there is little congressional interest in an EPA role in medical waste management. He said that nearly all states now have their own medical waste regulations.

    Recommendation: To help ensure that concerns about mismanaged medical waste and the need for federal regulation are adequately addressed in a timely manner, the Administrator, EPA, should develop a plan to identify and fill the gaps in the data needed to determine the level of threat to public health and the environment posed by medical waste as soon as practicable.

    Agency Affected: Environmental Protection Agency

  6. Status: Closed - Not Implemented

    Comments: EPA did plan to address this issue in its report to Congress on the medical waste problem and demonstration program. However, as explained above, it is unlikely that EPA will submit the report to Congress. EPA does not anticipate having a regulatory role in medical waste management.

    Recommendation: The Administrator, EPA, should consider: (1) whether autoclaving is effective for all types of infectious wastes or other treatment methods should be used for certain waste types; (2) what minimum temperature, residence time, and pressure should be maintained throughout the autoclaving process and whether those conditions should be established by national standards; (3) what documentation of performance efficiency autoclave operators should be required to maintain; (4) how frequently autoclaves should be inspected; and (5) what assurances should be provided to landfill operators that infectious waste has been effectively autoclaved.

    Agency Affected: Environmental Protection Agency

 

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