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11 Waste Management 1. What agency(ies) regulate wastes generated at health care facilities? Health care facilities include, but are not limited to hospitals, physician's offices, dental practices and veterinary hospitals. These facilities generate a variety of waste streams. Many of these waste streams are regulated at the state and local level while others may be governed by federal regulations. For example, regulations for office and municipal type waste are developed by states, whereas regulations for hazardous waste such as mercury or radioactive wastes are developed by the Federal government. Potentially infectious medical waste, sometimes referred to as Regulated Medical Waste is generally covered by state regulations. 2. What is the Medical Waste Tracking Act (MWTA►? Legislation was enacted in the late 1980s after medical wastes were found among other wastes washing up on several East Coast beaches. Concern over the potential health hazards associated with medical wastes on some beaches prompted Congress to enact the Medical Waste Tracking Act (MWTA) in 1988, which required EPA to create a two-year Medical Waste Demonstration Program. For the purposes f this two-year program the MWTA defined medical waste and those wastes to be regulated; established a cradle to grave tracking system utilizing a generator initiated tracking form; required management standards for segregation, packaging, labeling and marking, and storage of the waste. There were also record keeping requirements and penalties that could be imposed for mismanagement. 3. What is the status of the MWTA? The regulations promulgated under the MWTA expired on June 21, 1999. The Standards for Tracking and Management of Medical Waste were in effect from June 1989 to June 1991 in five states (New York, New Jersey, Connecticut, Rhode Island, Puerto Rico). During this time, EPA also gathered information and performed several studies related to medical waste management. The MWTA and EPA's associated program served to focus attention on the medical waste issue and provided a model for some states and other federal agencies in developing their own medical waste programs. The MWTA also required EPA to look at various treatment technologies available at the time for their ability to reduce the disease causing potential of medical waste. The technologies that EPA examined in 1990 included incinerators and autoclaves (both on site and off site), microwave units, and various chemical and mechanical systems. 4. What conclusions did EPA draw from the 2 -year demonstration program? From the information gathered during this period, EPA concluded that the disease -causing potential of medical waste is greatest at the point of generation and naturally tapers off after that point, thus presenting more of an occupational concern rather than a generalized environmental concern. Risk to the general public of disease caused by exposure to medical waste is likely to be much lower than risk for the occupationally exposed individual. 5. How is the incineration of medical waste regulated? Currently, over 90% of potentially infectious medical waste is incinerated. In August 1997, EPA promulgated regulations governing the emissions from Medical Waste Incinerators. These regulations include 1) stringent air emissions guidelines for States to use in developing plans to reduce air pollution from medical waste incinerators built on or before June 20, 1996, and 2) final air emission standards for medical waste incinerators (MWIs)built after June 20, 1996. These guidelines and standards will substantially reduce MWI emissions. EPA estimates that mercury emission will decline by 94%, particulate matter by 90%, hydrogen chloride by 0 Sutter Health Risk Management\2002—Page 3.4