REPORT TITLE:
Medical Waste Disposal


DESCRIPTION:
Requires the department of health to adopt rules relating to the
treatment, management, and disposal of medical waste on a
statewide basis.  Specifies medical waste treatment methods to
render medical waste into solid waste.  Defines "medical waste"
and related terms.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        1785
HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO MEDICAL WASTE.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The legislature finds that there is an immediate
 
 2 need to address problems related to the treatment, management,
 
 3 and disposal of medical and chemotherapy waste on a statewide
 
 4 basis.
 
 5      Currently, various hospitals around the State are handling
 
 6 medical waste disposal on an individual, piecemeal basis.  For
 
 7 example, in February 1998, Castle Medical Center, stating its
 
 8 concern for maintaining good relations with the Kailua community,
 
 9 voluntarily stopped incinerating medical and chemotherapy waste
 
10 that it had been receiving from nine other hospitals.  While the
 
11 legislature appreciates this responsiveness to community
 
12 concerns, there continues to be a need for the handling,
 
13 treatment, and disposal of medical waste on a statewide, rather
 
14 than community-wide, basis.
 
15      In addition, the legislature notes that the development of
 
16 new treatment technologies is significantly transforming this
 
17 area.  For example, the newly developed "plasma-enhanced-melter"
 
18 uses state-of-the-art technology to melt waste in an oxygen-free
 
19 chamber, so that there is no incineration and, consequently, no
 

 
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 1 carbon dioxide, carbon monoxide, or other troublesome emissions.
 
 2 The legislature finds that this four-ton-a-day, $3,000,000 system
 
 3 could be well suited to the State's medical waste disposal needs,
 
 4 and that such a system could pay for itself in a short period of
 
 5 time and would be a continuing revenue producer for the State.
 
 6      The legislature finds that the incorporation of the plasma-
 
 7 enhanced-melter or comparable technology into the treatment of
 
 8 medical waste in Hawaii would enable the State to enter the new
 
 9 millennium with new ways to treat medical and chemotherapy waste,
 
10 thus rendering it solid waste, rather than the centuries-old
 
11 technology of incineration.  The adoption of this new technology
 
12 would also avoid threats to public health, prevent false starts
 
13 on alternate incinerators that have cost hospitals large amounts
 
14 of money and frustration, and avoid the expense of shipping
 
15 medical waste to the United States mainland for disposal.
 
16      The purpose of this Act is therefore to:
 
17      (1)  Require the department of health to adopt rules for the
 
18           treatment, management, and disposal of medical waste,
 
19           as defined in this Act, on a statewide basis; and
 
20      (2)  Provide for the treatment of medical waste through the
 
21           use of modern alternative technologies that turns
 
22           medical waste into "solid waste", as defined in section
 
23           342G-1, so that it may be disposed of in accordance
 

 
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 1           with existing integrated solid waste management plans
 
 2           under chapter 342G.  The treatment of medical waste by
 
 3           incineration will be terminated as of January 1, 2010.
 
 4      SECTION 2.  Section 321-21, Hawaii Revised Statutes, is
 
 5 amended to read as follows:
 
 6      "[[]§321-21[]  Infectious wastes;] Medical waste; statewide
 
 7 treatment, management, and disposal.  (a)  As used in this
 
 8 section, the term "medical waste" has the same meaning as defined
 
 9 in section 342G-1.
 
10      (b)  The department of health shall adopt rules pursuant to
 
11 section 342G-    and chapter 91 for the treatment, management,
 
12 and disposal, on a statewide basis, of [infectious wastes
 
13 generated by hospitals, clinics, other health care facilities,
 
14 doctors' offices, dentists' offices, research laboratories,
 
15 veterinary clinics, and other generators of infectious wastes.]
 
16 medical waste.  The rules shall [include a definition of
 
17 infectious wastes that clearly and objectively defines infectious
 
18 wastes and specifies] specify acceptable containers and other
 
19 factors related to the identification, segregation, containment,
 
20 and transportation of [infectious wastes.] medical waste on a
 
21 statewide basis.
 
22      (c)   [Effective July 1, 1991, all] All generators of
 
23 [infectious wastes] medical waste shall show proof that
 

 
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 1 [infectious wastes are] medical waste is being treated, managed,
 
 2 and disposed of according to section 342G-    and departmental
 
 3 rules upon request of the department."
 
 4      SECTION 3.  Chapter 342G, Hawaii Revised Statutes, is
 
 5 amended as follows:
 
 6      1.  By adding a new section to part III to be appropriately
 
 7 designated and to read:
 
 8      "§342G-    Medical waste treatment.  A person generating or
 
 9 treating medical waste shall ensure that the medical waste is
 
10 treated by one of the following methods, thereby rendering it
 
11 solid waste, as defined in section 342G-1, prior to disposal:
 
12      (1)  Incineration at a permitted medical waste treatment
 
13           facility in a controlled-air, multichamber incinerator,
 
14           or other method of incineration approved by the
 
15           department, which provides complete combustion of the
 
16           waste into carbonized or mineralized ash; provided that
 
17           incineration of medical waste shall not be permitted
 
18           after December 31, 2009;
 
19      (2)  Treatment with an alternative technology approved
 
20           pursuant to paragraph (5), which, due to the extremely
 
21           high temperatures of treatment in excess of 1300
 
22           degrees Fahrenheit, has received express approval from
 
23           the department;
 

 
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 1      (3)  Discharge to a public sewage system if the medical
 
 2           waste is liquid or semiliquid, and not either of the
 
 3           following:
 
 4           (A)  Liquid or semiliquid laboratory waste; or
 
 5           (B)  Microbiological specimens;
 
 6           provided that medical waste discharge shall be
 
 7           consistent with state and county waste discharge
 
 8           requirements placed on the public sewer system;
 
 9      (4)  Steam sterilization at a permitted medical waste
 
10           treatment facility or by other sterilization, in
 
11           accordance with all of the following operating
 
12           procedures for steam sterilizers or other
 
13           sterilization:
 
14           (A)  Standard written operating procedures shall be
 
15                established for biological indicators, or for
 
16                other indicators of adequate sterilization
 
17                approved by the department, for each steam
 
18                sterilizer, including time, temperature, pressure,
 
19                type of waste, type of container, closure on
 
20                container, pattern of loading, water content, and
 
21                maximum load quantity;
 
22           (B)  Recording or indicating thermometers shall be
 
23                checked during each complete cycle to ensure the
 

 
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 1                attainment of 121 degrees centigrade (250 degrees
 
 2                Fahrenheit) for at least one-half hour, depending
 
 3                on the quantity and density of the load, to
 
 4                achieve sterilization of the entire load.
 
 5                Thermometers shall be checked for calibration
 
 6                annually.  Records of the calibration checks shall
 
 7                be maintained as part of the facility's files and
 
 8                records for a period of three years;
 
 9           (C)  Heat-sensitive tape, or another method acceptable
 
10                to the department, shall be used on each biohazard
 
11                bag or sharps container that is processed onsite
 
12                to indicate the attainment of adequate
 
13                sterilization conditions;
 
14           (D)  The biological indicator Bacillus
 
15                stearothermophilus, or other indicator of adequate
 
16                sterilization as approved by the department, shall
 
17                be placed at the center of a load processed under
 
18                standard operating conditions at least monthly to
 
19                confirm the attainment of adequate sterilization
 
20                conditions; and
 
21           (E)  Records of the procedures specified in
 
22                subparagraphs (A), (B), and (D) shall be
 
23                maintained for a period of not less than three
 

 
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 1                years; and
 
 2      (5)  Other alternative medical waste treatment methods which
 
 3           are both of the following:
 
 4           (A)  Approved by the department; and
 
 5           (B)  Result in the destruction of pathogenic micro-
 
 6                organisms.
 
 7      Any alternative medical waste treatment method proposed to
 
 8 the department shall be evaluated by the department and either
 
 9 approved or rejected pursuant to the criteria specified in this
 
10 paragraph."
 
11      2.  By adding three new definitions to section 342G-1 to be
 
12 appropriately inserted and to read:
 
13      ""Biohazardous waste" means any of the following:
 
14      (1)  Laboratory waste, including all of the following:
 
15           (A)  Human or animal specimen cultures from medical and
 
16                pathology laboratories;
 
17           (B)  Cultures and stocks of infectious agents from
 
18                research and industrial laboratories; and
 
19           (C)  Wastes from the production of bacteria, viruses,
 
20                spores, discarded live and attenuated vaccines
 
21                used in human health care or research, discarded
 
22                animal vaccines, including Brucellosis and
 
23                Contagious Ecthyma, as identified by the
 

 
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 1                department, and culture dishes and devices used to
 
 2                transfer, inoculate, and mix cultures;
 
 3      (2)  Human surgery specimens or tissues removed at surgery
 
 4           or autopsy, which are suspected by the attending
 
 5           physician and surgeon or dentist of being contaminated
 
 6           with infectious agents known to be contagious to
 
 7           humans;
 
 8      (3)  Animal parts, tissues, fluids, or carcasses suspected
 
 9           by the attending veterinarian of being contaminated
 
10           with infectious agents known to be contagious to
 
11           humans;
 
12      (4)  Waste, which at the point of transport from the
 
13           generator's site, at the point of disposal, or
 
14           thereafter, contains recognizable fluid blood, fluid
 
15           blood products, containers or equipment containing
 
16           blood that is fluid, or blood from animals known to be
 
17           infected with diseases which are highly communicable to
 
18           humans;
 
19      (5)  Waste containing discarded materials contaminated with
 
20           excretion, exudate, or secretions from humans or
 
21           animals that are required to be isolated by the
 
22           infection control staff, the attending physician and
 
23           surgeon, the attending veterinarian, or the local
 

 
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 1           health officer, to protect others from highly
 
 2           communicable diseases or diseases of animals that are
 
 3           highly communicable to humans;
 
 4      (6)  Waste which is hazardous only because it is comprised
 
 5           of human surgery specimens or tissues which have been
 
 6           fixed in formaldehyde or other fixatives, or only
 
 7           because the waste is contaminated through contact with,
 
 8           or having previously contained, chemotherapeutic
 
 9           agents, including gloves, disposable gowns, towels, and
 
10           intravenous solution bags and attached tubing which are
 
11           empty.
 
12                For purposes of this paragraph, "chemotherapeutic
 
13           agent" means an agent that kills or prevents the
 
14           reproduction of malignant cells.
 
15                For purposes of this paragraph, a container, or
 
16           inner liner removed from a container, which previously
 
17           contained a chemotherapeutic agent, is empty if the
 
18           container or inner liner removed from the container has
 
19           been emptied by the generator as much as possible,
 
20           using methods commonly employed to remove waste or
 
21           material from containers or liners, so that the
 
22           following conditions are met:
 
23           (A)  If the material which the container or inner liner
 

 
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                                     H.B. NO.           
                                                        
                                                        


 1                held is pourable, no material can be poured or
 
 2                drained from the container or inner liner when
 
 3                held in any orientation, including, but not
 
 4                limited to, when tilted or inverted; and
 
 5           (B)  If the material which the container or inner liner
 
 6                held is not pourable, no material or waste remains
 
 7                in the container or inner liner that can feasibly
 
 8                be removed by scraping; and
 
 9      (7)  Waste that is hazardous only because it is comprised of
 
10           pharmaceuticals.
 
11      "Medical waste" means:
 
12      (1)  Waste that meets both of the following requirements:
 
13           (A)  The waste is composed of waste that is generated
 
14                or produced as a result of any of the following
 
15                actions:
 
16                (i)  Diagnosis, treatment, or immunization of
 
17                     human beings or animals;
 
18               (ii)  Research pertaining to the activities
 
19                     specified in subparagraph (A);
 
20              (iii)  The production or testing of biologicals.
 
21                     For purposes of this definition, "biologicals
 
22                     means medicinal preparations made from living
 
23                     organisms and their products, including, but
 

 
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 1                     not limited to, serums, vaccines, antigens,
 
 2                     and antitoxins;
 
 3               (iv)  The accumulation of properly contained home-
 
 4                     generated sharps waste that is brought by a
 
 5                     patient, a member of the patient's family, or
 
 6                     by a person authorized by the department, to
 
 7                     a point of consolidation approved by the
 
 8                     department; or
 
 9                (v)  Removal of waste from a trauma scene; and
 
10           (B)  The waste is either of the following:
 
11                (i)  Biohazardous waste; or
 
12               (ii)  Sharps waste.
 
13      (2)  Does not include any of the following:
 
14           (A)  Waste generated in food processing or
 
15                biotechnology that does not contain an infectious
 
16                agent;
 
17           (B)  Waste generated in biotechnology that does not
 
18                contain human blood or blood products or animal
 
19                blood or blood products suspected of being
 
20                contaminated with infectious agents known to be
 
21                communicable to humans;
 
22           (C)  Urine, feces, saliva, sputum, nasal secretions,
 
23                sweat, tears, or vomitus, unless it contains fluid
 

 
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 1                blood;
 
 2           (D)  Waste which is not biohazardous, such as paper
 
 3                towels, paper products, articles containing
 
 4                nonfluid blood, and other medical solid waste
 
 5                products commonly found in the facilities of
 
 6                medical waste generators;
 
 7           (E)  Hazardous waste, radioactive waste, or household
 
 8                waste; or
 
 9           (F)  Waste generated from normal and legal
 
10                veterinarian, agricultural, and animal livestock
 
11                management practices on a farm or ranch.
 
12      "Sharps waste" means any device having acute rigid corners,
 
13 edges, or protuberances capable of cutting or piercing,
 
14 including, but not limited to, all of the following:
 
15      (1)  Hypodermic needles, hypodermic needles with syringes,
 
16           blades, needles with attached tubing, syringes
 
17           contaminated with biohazardous waste, acupuncture
 
18           needles, and root canal files;
 
19      (2)  Broken glass items, such as Pasteur pipettes and blood
 
20           vials contaminated with biohazardous waste; and
 
21      (3)  Any item capable of cutting or piercing that is
 
22           contaminated with trauma scene waste."
 
23      3.  By amending the definition of "special waste" in section
 

 
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 1 342G-1, Hawaii Revised Statutes, to read:
 
 2      ""Special waste" means any solid waste which, because of its
 
 3 source or physical, chemical, or biological characteristics,
 
 4 requires special consideration for its proper processing or
 
 5 disposal, or both.  This term includes[, but is not limited to,]
 
 6 asbestos, used oil, petroleum-contaminated soil, lead acid
 
 7 batteries, municipal waste combustion ash, sewage sludge that is
 
 8 not hazardous waste, agricultural and farm-generated wastes that
 
 9 are normally placed in landfills, [medical wastes,] tires, white
 
10 goods, and derelict vehicles."
 
11      4.  By amending subsection (e) of section 342G-26, Hawaii
 
12 Revised Statutes, to read:
 
13      "(e)  The special waste component shall describe the
 
14 existing waste handling and disposal practices for special
 
15 wastes, including, but not limited to, asbestos, used oil,
 
16 petroleum-contaminated soil, lead acid batteries, municipal waste
 
17 combustion ash, sewage sludge that is not hazardous waste,
 
18 agricultural and farm-generated wastes, [medical wastes,] tires,
 
19 white goods, and derelict vehicles.  The component shall identify
 
20 current and proposed programs to ensure the proper handling,
 
21 reuse, and long-term disposal of special wastes."
 
22      SECTION 4.  All existing holders of permits under section
 
23 342B-25 or 342H-4, Hawaii Revised Statutes, or under any other
 

 
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 1 law, for medical waste treatment or disposal in this State on the
 
 2 effective date of this Act shall:
 
 3      (1)  File an environmental impact statement pursuant to
 
 4           chapter 343, Hawaii Revised Statutes, concerning the
 
 5           facility's compliance with section 342G-   , Hawaii
 
 6           Revised Statutes, as provided in section 3(1) of this
 
 7           Act; and 
 
 8      (2)  Conduct a public hearing concerning the facility before
 
 9           December 31, 2001.
 
10      SECTION 5.  Statutory material to be repealed is bracketed.
 
11 New statutory material is underscored.
 
12      SECTION 6.  This Act shall take effect upon its approval.
 
13 
 
14                              INTRODUCED BY:______________________