Current through April 3, 2024
(1) An ACH must
develop, maintain and implement written policies and procedures for the
definition and handling of its infectious waste. These policies and procedures
must comply with the standards of this rule.
(2) The following waste shall be considered
to be infectious waste:
(a) Waste contaminated
by residents who are isolated due to communicable disease, as provided in the
U.S. Centers for Disease Control "Guidelines for Isolation Precautions in
Hospitals";
(b) Cultures and stocks
of infectious agents including specimen cultures collected from medical and
pathological laboratories, cultures and stocks of infectious agents from
research and industrial laboratories, wastes from the production of
biologicals, discarded live and attenuated vaccines, and culture dishes and
devices used to transfer, inoculate, and mix cultures;
(c) Waste human blood and blood products such
as serum, plasma, and other blood components;
(d) Pathological waste, such as tissues,
organs, body parts, and body fluids that are removed during surgery and
autopsy;
(e) All discarded sharps
(e.g., hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel
blades) used in resident care or which have come into contact with infectious
agents during use in medical, research, or industrial laboratories;
and
(f) Other waste determined to
be infectious by the ACH in its written policy.
(3) Infectious and hazardous waste must be
segregated from other waste at the point of generation (i.e., the point at
which the material becomes a waste) within the ACH.
(4) Waste must be packaged in a manner that
will protect waste handlers and the public from possible injury and disease
that may result from exposure to the waste. Such packaging must provide for
containment of the waste from the point of generation up to the point of proper
treatment or disposal. Packaging must be selected and utilized for the type of
waste the package will contain, how the waste will be treated and disposed, and
how it will be handled and transported, prior to treatment and disposal.
(a) Contaminated sharps must be directly
placed in leak proof, rigid, and puncture-resistant containers which must then
be tightly sealed.
(b) Whether
disposable or reusable, all containers, bags, and boxes used for containment
and disposal of infectious waste must be conspicuously identified. Packages
containing infectious waste which pose additional hazards (e.g., chemical,
radiological) must also be conspicuously identified to clearly indicate those
additional hazards.
(c) Reusable
containers for infectious waste must be thoroughly sanitized each time they are
emptied, unless the surfaces of the containers have been completely protected
from contamination by disposable liners or other devices removed with the
waste.
(d) Opaque packaging must be
used for pathological waste.
(5) After packaging, waste must be handled
and transported by methods ensuring containment and preservation of the
integrity of the packaging, including the use of secondary containment where
necessary. Plastic bags of infectious waste must be transported by
hand.
(6) Waste must be stored in a
manner which preserves the integrity of the packaging, inhibits rapid microbial
growth and putrefaction, and minimizes the potential of exposure or access by
unknowing persons.
(a) Waste must be stored in
a manner and location which affords protection from animals, precipitation,
wind, and direct sunlight, does not present a safety hazard, does not provide a
breeding place or food source for insects or rodents, and does not create a
nuisance.
(b) Pathological waste
must be promptly treated, disposed of, or placed into refrigerated
storage.
(7) In the
event of spills, ruptured packaging, or other incidents where there is a loss
of containment of waste, the ACH must ensure that proper actions are
immediately taken to:
(a) Isolate the area
from the public and all except essential personnel;
(b) To the extent practicable, repackage all
spilled waste and contaminated debris in accordance with the requirements of
paragraph (4) of this rule;
(c)
Sanitize all contaminated equipment and surfaces according to written policies
and procedures which specify how this will be done appropriately; and
(d) Complete an incident report and maintain
a copy on file.
(8)
Except as provided otherwise in this rule a facility must treat or dispose of
infectious waste by one or more of the methods specified in this paragraph.
(a) An ACH may treat infectious waste in an
on-site sterilization or disinfection device, or in an incinerator or a steam
sterilizer, which has been designed, constructed, operated and maintained so
that infectious waste treated in such a device is rendered non-infectious and
is, if applicable, authorized for that purpose pursuant to current rules of the
Department of Environment and Conservation. A valid permit or other written
evidence of having complied with the Tennessee Air Pollution Control
Regulations shall be available for review, if required. Each sterilizing or
disinfection cycle must contain appropriate indicators to assure that
conditions were met for proper sterilization or disinfection of materials
included in the cycle, and appropriate records kept. Proper operation of such
devices must be verified at least monthly, and records of the monthly
verifications shall be available for review. Waste that contains toxic
chemicals that would be volatilized by steam must not be treated in steam
sterilizers. Infectious waste that has been rendered to carbonized or
mineralized ash shall be deemed non-infectious. Unless otherwise hazardous and
subject to the hazardous waste management requirements of the current rules of
the Department of Environment and Conservation, such ash shall be disposable as
a (non-hazardous) solid waste under current rules of the Department of
Environment and Conservation.
(b)
An ACH may discharge liquid or semi-liquid infectious waste to the collection
sewerage system of a wastewater treatment facility which is subject to a permit
pursuant to T.C.A. §§
69-3-101, et seq., provided that
such discharge is in accordance with any applicable terms of that permit and/or
any applicable municipal sewer use requirements.
(c) Any health care facility accepting waste
from another state must promptly notify the Department of Environment and
Conservation, county, and city public health agencies, and must strictly comply
with all applicable local, state and federal regulations.
(9) An ACH may have waste transported
off-site for storage, treatment, or disposal. Such arrangements must be
detailed in a written contract, available for review. If such off-site location
is located within Tennessee, the ACH must ensure that it has all necessary
State and local approvals, and such approvals shall be available for review. If
the off-site location is within another state, the ACH must notify in writing
all public health agencies with jurisdiction that the location is being used
for management of the ACH's waste. Waste shipped off-site must be packaged in
accordance with applicable federal and state requirements. Waste transported to
a sanitary landfill in this state must meet the requirements of current rules
of the Department of Environment and Conservation.
(10) Human anatomical remains which are
transferred to a mortician for cremation or burial shall be exempt from the
requirements of this rule.
(11) All
garbage, trash and other non-infectious waste shall be stored and disposed of
in a manner that must not permit the transmission of disease, create a
nuisance, provide a breeding place for insects and rodents, or constitute a
safety hazard. All containers for waste shall be water tight, constructed of
easily-cleanable material, and shall be kept on elevated platforms.
Authority: T.C.A. §
68-11-209.
