Current through Reg. 50, No. 187; September 24, 2024
(1) Biomedical waste shall be treated by
steam, incineration, or an alternative process approved by the department as
described in subsection
64E-16.007(4),
F.A.C., prior to disposal. Treatment shall occur within 30 days of collection
from the generator.
(2) Steam
treatment units shall subject loads of biomedical waste to sufficient
temperature, pressure, and time to demonstrate a minimum Log 4 kill of
Bacillus stearothermophilus spores placed at the center of the
waste load, and shall be operated in accordance with the following:
(a) Before placing a steam treatment unit
into service, operating parameters such as temperature, pressure, and treatment
time shall be determined according to the following:
1. Test loads of biomedical waste which
consist of the maximum weight and density of biomedical waste to be treated
shall be prepared. Separate loads of red bags, sharps containers, boxes, and
compacted waste shall be prepared if they are to be treated
separately.
2. Prior to treatment,
Bacillus stearothermophilus spores shall be placed at the
bottom and top of each treatment container, at the front of each treatment
container at a depth of approximately one-half of the distance between the top
and bottom of the load, in the approximate center of each treatment container,
and in the rear of each treatment container at a depth of approximately
one-half of the distance between the top and bottom of the load.
3. If the operating parameters used during
the treatment of the test loads demonstrate a minimum Log 4 kill of
Bacillus stearothermophilus spores at all locations, the steam
treatment unit shall operate under those parameters when placed into service.
If the operating parameters fail to provide a minimum Log 4 kill of
Bacillus stearothermophilus spores at all locations, treatment
time, temperature, or pressure shall be increased and the tests must be
repeated until a minimum Log 4 kill of Bacillus
stearothermophilus spores is demonstrated at all locations. The steam
treatment unit shall be operated under those parameters when placed into
service. Tests shall be repeated and new parameters established if the type of
biomedical waste to be treated is changed.
(b) When operating parameters have been
established and documented using the criteria in paragraph
64E-16.007(2)(a),
F.A.C., the steam treatment unit may be placed into service.
(c) The steam treatment unit shall be
serviced for preventive maintenance in accordance with the manufacturer's
specifications. Records of maintenance shall be onsite and available for
review.
(d) Unless a steam
treatment unit is equipped to continuously monitor and record temperature and
pressure during the entire length of each treatment cycle, each package of
biomedical waste to be treated will have a temperature tape or equivalent test
material such as a chemical indicator placed on a non-heat conducting probe at
the center of each treatment container in the load that will indicate if the
treatment temperature and pressure have been reached. Waste shall not be
considered treated if the tape or equivalent indicator fails to show that a
temperature of at least 250 degrees F (121 degrees C) was reached during the
process.
(e) Each steam treatment
unit shall be evaluated for effectiveness with spores of Bacillus
stearothermophilus at least once each 7 days for permitted treatment
facilities, or once each 40 hours of operation for generators who treat their
own biomedical waste. The spores shall be placed at the center of the waste
load. Evaluation results shall be maintained onsite and available for
review.
(f) A written log shall be
maintained for each steam treatment unit. The following shall be recorded for
each usage:
1. The date, time, and operator
name,
2. The type and approximate
amount of waste treated,
3. The
post-treatment confirmation results by either:
a. recording the temperature, pressure, and
length of time the waste was treated, or
b. the temperature and pressure monitoring
indicator,
(g)
A current written operating procedure shall specify, at a minimum, the
following:
1. Parameters, determined from
testing, that provide consistent treatment, such as exposure time, temperature,
and pressure.
2. Identification of
standard treatment containers and placement of the load in the steam treatment
unit.
(3)
Incineration of biomedical waste shall be achieved in a biological waste
incinerator permitted by the Department of Environmental Protection.
(4) An alternative treatment process, such as
chemical, gas, dry heat, or microwave shredding, shall be considered by the
department upon receipt of a written request. The written request shall be
directed to the State Health Officer and shall include:
(a) The specific treatment process and type
of facility for which acceptance is sought;
(b) The reason for the request;
(c) Microbiological evidence, using the
organisms listed in Table 1, that the proposed process provides sterilization
or a satisfactory level of disinfection. Using the protocol described in
subsection 64E-16.007(4),
F.A.C., alternative treatment systems must show either:
1. For disinfection, a minimum Log 6 kill for
the vegetative organisms listed in Table 1 and a minimum Log 4 kill against
Bacillus stearothermophilus spores utilizing steam or a
minimum Log 4 kill against Bacillus Subtilis spores utilizing
dry heat, chemicals, or microwave shredding, or
2. For sterilization, a minimum Log 6 kill
against Bacillus stearothermophilus spores utilizing steam or
a minimum Log 6 kill against Bacillus Subtilis spores
utilizing dry heat, chemicals, or microwave shredding.
Table 1
1. Bacteria
a.
Bacillus spores -
mandatory, species determined by treatment process
Any two
b.
Enterococcus faecalis
c.
Pseudomonas
aeruginosa
d.
Staphylococcus aureus
e.
Nocardia
species
2. Mycobacteria
species - any one
a.
Mycobacterium
bovis
b.
Mycobacterium fortuitum
3. Fungus - any one
a.
Candida
albicans
b.
Aspergillus fumigatus
4. Protozoa - Giardia
intestinalis or similar
5.
Virus - Poliovirus or similar.
(d) Each step of the efficacy testing must be
thoroughly described in the application for approval. A detailed description of
the treatment process, preparation of organisms, preparation of test loads,
recovery of organisms, and raw data must be provided.
(e) To begin the efficacy testing, two
challenge loads must be sterilized. These loads must be composed of materials
commonly found in biomedical waste (tissues, sharps, plastics, glass, woven
materials, blood and blood products, etc.), and must be of adequate quantity to
equal the maximum capacity of the treatment system. The test load must be fully
described (weight, moisture content, composition, etc.).
(f) The purity of all organisms and spores
must be certified by a clinical or commercial laboratory. Each organism must be
processed separately and placed in the test load in the most difficult location
to treat. Before each test run, the total number of viable test organisms must
be determined and documented. Treatment of the test load must take place within
thirty minutes of inoculating the load with the test organism.
(g) The test load containing the test
organism must be processed without the agent (e.g., chemical, microwaves, etc.)
used to kill the test organisms. If this agent is a liquid, it must be replaced
with an equal amount of sterile saline solution or tapwater. After the test
load has completed one cycle in the treatment device, a minimum of three grab
samples must be taken from the test load and the number of test organisms
present determined. If the number of organisms recovered after the test run is
less than Log 6, the number of organisms originally introduced into the device
must be increased, and the run must be performed again, until at least Log 6
organisms are recovered. If the number of organisms recovered from the test run
is Log 6 or greater, there is an adequate number of organisms being introduced
into the device, and the inoculum size should be equal to this
number.
(h) Using the inoculum size
determined in the above procedure, the second sterilized test load must be
inoculated separately. During these test runs, the chemical or physical agent
used to treat the waste must be used.
(i) After each test run is completed, the log
kill for that particular organism or spore must be calculated. The number of
organisms that were not recovered from the initial (non-treating) test run must
be subtracted from the number of organisms that were introduced into the second
(treatment) run. The number of organisms that survive the treatment process
must be subtracted from the first calculation. The resulting figure is the log
kill provided by the treatment process.
(j) Approved alternative treatment processes,
except single-use, shall meet the requirements of paragraph
64E-16.007(2)(e),
F.A.C.
(5) Biomedical
waste may be disposed into a sanitary sewer system, an onsite sewage treatment
and disposal system, or other system approved to receive such waste by The
Department of Environmental Protection or the department, if it is in a liquid
or semi-solid form and aerosol formation is minimal.
(6) Body tissues that have been
histologically fixed are considered treated biomedical waste. Tissues prepared
by frozen sectioning only are not considered treated.
(7) Acute care hospitals, licensed under
Chapter 395, F.S., which utilize a certified onsite treatment process involving
grinding and treatment, may dispose of such treated biomedical waste in the
normal municipal solid waste stream upon notifying the local government
responsible for solid waste collection and disposal under the following
conditions:
(a) For the purposes of this
chapter, certified shall mean that the treatment process is steam treatment, or
has been approved as an alternative biomedical waste treatment process under
subsection 64E-16.007(4),
F.A.C.
(b) For the purposes of this
chapter, grinding shall also mean shredding or hammermilling.
(c) If grinding takes place prior to
treatment, procedures that minimize the chance of exposure to waste handlers
must be developed and implemented should the grinder fail or become
jammed.
(d) Individuals operating
the treatment unit must be trained in all aspects of its operation, including
contingency procedures.
(e) Acute
care hospitals must inform the department in writing of the installation of the
unit at least 30 days prior to placing the unit into service.
(f) Inspection of the unit, including
treatment and maintenance records, will occur during the annual inspection for
the hospital's biomedical waste permit.
Rulemaking Authority 381.006, 381.0098 FS. Law Implemented
381.006, 381.0098, 395.002(13), 395.1011
FS.
New 6-19-89, Amended 12-14-92, 1-23-94, 8-20-95, 6-3-97,
Formerly 10D-104.007.