July 21, 2021

Understanding the Five Stages of the Medical Waste Cycle

Medical waste management is a multifaceted process that does not stop after waste leaves your facility. Having a full understanding of what happens at each stage of the waste cycle, including once materials are removed from your building, is helpful to being confident that your approach is compliant and sustainable. Here is a brief breakdown of each stage along the medical waste management continuum.

Stage One: Generating Waste

A healthcare worker may generate a variety of different types of medical waste during the course of care delivery:

  • Regulated medical waste (RMW): This includes any waste that has the potential to cause infection and has regulations around its collection, transportation, treatment, and disposal. Biohazardous waste items that are saturated with blood or other potentially infectious materials fall into this category, such as soiled gauzes, patient drapes, and even some personal protective equipment.
  • Sharps: A subset of RMW, sharps include anything that can puncture the skin, such as needles, scalpels, syringes, and even broken glass.
  • Unused or expired pharmaceuticals: This type of waste can include non-hazardous medications and hazardous drugs like warfarin.
  • Hazardous chemicals: This may include cleaning fluids and other toxic chemicals.
  • Chemotherapeutic waste: Any waste used in the delivery of chemotherapy.
  • Controlled substances: Any drug that is regulated by the Drug Enforcement Administration (DEA), such as opioids.

Various regulatory bodies govern medical waste disposal. For example, the Occupational Safety and Health Administration (OSHA) regulates the handling of any waste that could contain bloodborne pathogens, including sharps and other regulated medical waste. Individual state agencies regulate the disposal of RMW. The Environmental Protection Agency (EPA) regulates the disposal of hazardous waste pharmaceuticals, and the Drug Enforcement Administration (DEA) oversees pharmaceutical handling and disposal if the drug is a controlled substance. The Department of Transportation (DOT) steps in after medical waste leaves the facility and governs the transport of hazardous materials.

Stage Two: Segmenting Waste

To preserve worker safety, limit the spread of pathogens, and ensure proper treatment after waste leaves the facility, healthcare workers should segment waste and dispose of it in marked containers engineered to safely hold that particular waste type. For instance, most RMW—excluding sharps and chemotherapeutic waste—can be disposed of in red bags that fit inside waste containers. For sharps disposal, staff should use FDA-cleared, puncture-proof containers. These can be reusable, which limits the volume of plastic ending up in landfills. There are also specially designed containers for controlled substances, pharmaceuticals, hazardous chemical waste, and trace chemotherapeutic waste.

Stage Three: Preparing Waste Containers for Transport

When a waste receptacle is full, designated staff should prepare it for transport to the waste management facility. Preparation involves securing and sealing the container’s contents to prevent leakage. For non-sharp RMW red bags, the closed bag should be placed in a transport container. Bags should not be visible after the outer container is closed and sealed.

If the waste is being picked up by a waste hauler, you should follow DOT guidelines for proper marking, box weight, manifest or shipping paper details, and other applicable areas. If you are mailing the waste to a waste management facility, be sure to follow postal requirements and use labels that comply with the United States Postal Service (USPS).

Stage Four: Treating Waste

Once waste arrives at the waste management facility, the medical waste management partner will handle the materials in alignment with the waste management facility’s permit, which is usually set by the applicable state regulatory agency.

The most common medical waste treatment method involves using an autoclave to render the waste non-infectious. Staff will weigh the waste and place it in bins to move into the autoclave. Once the bins are in the autoclave, air is evacuated and high-pressure, high-temperature steam is introduced for 20 to 30 minutes, effectively killing any pathogens found in the waste. The “clean” waste is then compacted for transport.

For certain materials, incineration is used. For instance, when sharps are contaminated with pathological or trace chemotherapeutic waste, they should be incinerated, which involves subjecting the waste to high temperatures that promote combustion or burning. This completely destroys the waste, turning it into ash helps prevent chemicals from leaching into waterways.

To keep tabs on waste, your medical waste management partner should provide you with shipping information. Shipping information will allow you to demonstrate compliance should a regulatory authority be interested.

Stage Five: Sending Treated Waste to Its Final Destination

After medical waste has been rendered non-infectious or destroyed, it is sent to a landfill or a waste-to-energy facility (WTE), depending on local regulations. Any waste sent to a WTE site is converted to usable, clean electricity. The WTE process employs specially designed boilers that combust non-hazardous waste in a closed loop system. The technology captures the heat generated by the combustion, using it to create steam, which powers a turbine that produces electricity. The electricity is then sent to local utility companies for use in homes and businesses—or it can be funneled back to the waste management plant to run the equipment.

Seek a Partner that Spans the Waste Management Cycle

A good waste management partner will find ways to drive efficiency and sustainability while helping ensure compliance. At Stericycle, we offer comprehensive medical waste management services, helping you understand the various regulations and setting up programs that meet them while minimizing environmental impact. Whether it’s offering reusable containers for sharps disposal, minimizing the use of landfills after autoclaving, or optimizing resource use throughout the process, we can help you realize more consistent, eco-friendly waste management within and outside of your facility. We also engage in robust tracking and recordkeeping. For more information about how Stericycle can be your total waste management partner, visit our waste solutions hub.

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