Current through August 26, 2024
(1) GENERAL
PROVISIONS. Unless exempt under s. NR 526.16 (2), each director or director's
designee shall prepare a medical waste reduction plan for separating, reducing
and managing the medical waste generated, for evaluating alternatives to
disposable products and for maintaining waste reduction efforts. The director
or director's designee shall do all of the following when preparing the medical
waste reduction plan:
(a) Include all of the
information required in subs. (3) to (10) in the medical waste reduction
plan.
(b) Assess the medical waste
reduction plan and its results annually and update the plan at least every 5
years.
(c) Keep a copy of the most
recent medical waste reduction plan and make it available for the department to
review upon request according to s. NR 526.22 (2). The department may require
the director to submit a copy of the plan and related materials to the
department for its review and approval. The department may approve the plan
with conditions, including but not limited to specifying goals, objectives and
schedules.
(d) Consider the
following priorities in developing the medical waste reduction plan:
1. Waste reduction, including but not limited
to: reducing the amount of packaging and the use of disposable items,
substituting other products and materials, changing or modifying equipment,
changing purchasing policies or procedures, changing housekeeping practices,
providing more effective ways to separate infectious wastes from all other
waste types, and selling or donating unused items and equipment to
others.
2. Reuse by appropriate
reprocessing, including but not limited to: sterilizing, disinfecting,
decontaminating, laundering, recharging, exchanging waste or equipment with
others, and selling or donating reprocessed items or equipment to
others.
3. Recycling of recyclable
materials.
(e) Consider
all of the following factors when evaluating waste management strategies and
alternatives to disposables:
1. Costs,
including benefits, savings and reduced liabilities.
2. Probable adverse effects on patient care
and worker safety posed by the alternatives.
3. Probable effects of transferring waste
disposal to other media, including land, air and water.
4. State recycling laws and rules and local
recycling ordinances.
5. Recycling
options available in the area.
6.
Compliance with other rules and regulations that apply to or within the medical
facility, such as occupational health and safety regulations, state and federal
air management regulations, state and federal wastewater regulations and state
and federal hazardous waste regulations.
7. Availability of products or equipment
needed to implement an alternative.
8. Other considerations specific to the
medical facility.
(2) OPTIONAL PROVISIONS.
(a) The director or director's designee may
also address the waste types listed in s. NR 526.18 (2) in the medical waste
reduction plan, or incorporate the medical waste reduction plan within a
comprehensive waste management plan for the medical facility.
(b) The medical waste reduction plan may
describe, incorporate or refer to waste reduction policies or waste
minimization plans adopted prior to November 1, 1994 or to applicable waste
handling and management policies or plans developed under other rules, such as
s. NR 662.041, or under the requirements of other agencies such as OSHA or the
joint commission on accreditation of healthcare organizations.
(c) If the medical facility manages its
infectious waste with other infectious waste generators, the director or
director's designee may work together with those generators to develop a single
medical waste reduction plan.
(d)
The medical waste reduction plan may describe incentives which are offered to
encourage staff to participate actively in implementing, evaluating and
improving the plan.
(e) When
setting goals in sub. (3), the director or director's designee may recognize
and maintain past accomplishments in reducing medical waste. The plan may list
other goals, including other numerical goals, which encourage continuous
improvement in medical waste reduction. Numerical goals may be modified over
time to reflect changing conditions.
(3) GOALS AND OBJECTIVES. The medical waste
reduction plan shall list the medical facility's internal goals, objectives and
a timetable for reducing the amount of medical waste generated by the medical
facility. Goals shall include, but are not limited to, all of the following:
(a) Meeting a specific numerical goal
expressed in terms of a medical waste generation rate calculated according to
s. NR 526.21 (1). If a medical facility has already significantly reduced its
medical waste generation rate and has implemented policies which meet all of
the goals in pars. (b) to (d), the numerical goal may be to maintain the
current medical waste generation rate.
(b) Preventing the mixing of non-infectious
waste with infectious waste by separating waste at the source according to s.
NR 526.06 and by implementing the waste management procedures developed under
sub. (5).
(c) Reducing the use of
disposable items when it is practical to do so, by implementing the procedures
for evaluating alternatives to disposables developed under sub. (6).
(d) Maintaining an effective program for
reducing medical waste through education, training, monitoring and assessment,
according to subs. (7), (8) and (9).
(4) BASELINE AND PAST PRACTICES. The medical
waste reduction plan shall briefly describe the practices related to medical
waste management that were in effect during the most recent waste audit and any
past efforts to reduce medical waste. Descriptions of baseline practices shall
include but not be limited to all of the following: the waste management
practices identified during the most recent waste audit under s. NR 526.18 (5);
how alternatives to disposables were being evaluated; how medical waste
management costs were being estimated; where any records of total medical waste
generation, on-site treatment and off-site transportation were kept, and which
positions were responsible for implementing each of these activities.
Descriptions of past practices shall include what the medical facility has done
to reduce medical waste from November 1, 1994 until the most recent audit and
may include waste reduction efforts prior to November 1, 1994.
(5) WASTE MANAGEMENT. The director or
director's designee shall consider the priorities in sub. (1) (d) and the
factors in sub. (1) (e) when evaluating alternative waste management practices
and developing waste management policies or procedures. The medical waste
reduction plan shall briefly describe how the director or director's designee
intends to prevent the mixing of non-infectious waste with infectious waste.
The plan shall include or refer to written policies or procedures for
collecting, storing, transporting and treating medical waste from the point of
generation to the point of disposal, including any medical waste discharged to
a publicly-owned wastewater treatment system.
(6) ALTERNATIVES TO DISPOSABLE ITEMS. The
medical waste reduction plan shall include or refer to written policies or
procedures for evaluating alternatives to disposables when purchasing medical
materials, supplies and equipment. The policies or procedures shall specify how
alternative products, replacement costs, treatment costs, disposal costs, the
priorities in sub. (1) (d) and the factors in sub. (1) (e) will be evaluated
prior to purchasing.
(7) PUBLIC
EDUCATION. The medical waste reduction plan shall include or refer to specific
written policies and procedures for informing volunteers, patients and their
guests about waste disposal in order to prevent non-infectious waste from being
put in containers meant only for infectious waste. Education is required only
in areas where volunteers, patients and their guests have access to infectious
waste containers. Education may include but is not limited to any one or more
of the following: labels placed on or signs near infectious waste containers
indicating who may place waste in those containers or what may be placed in
them, pamphlets, notices, verbal education or other means.
(8) STAFF TRAINING. The medical waste
reduction plan shall provide for the training of all employees and medical
personnel who work within the medical facility, as follows:
(a)
Initial training.
Initial training shall include, at a minimum, the waste management practices,
policies and procedures for medical waste and for any other waste types
generated in the source areas in the areas in which they work.
1. Existing employees and medical personnel
who work within the medical facility shall receive training regarding the waste
management policies and practices within 6 months after the medical waste
reduction policy goes into effect. If the director or director's designee has
implemented a medical waste reduction plan prior to November 1, 1994, initial
training done to implement the plan will meet the intent of this
subdivision.
2. New employees and
medical personnel who work within the medical facility shall be trained as part
of their initial orientation.
(b)
Annual updates. All
employees and medical personnel who work within the medical facility shall
receive training annually on waste handling and management policies, procedures
and practices for the waste types generated in the source areas in which they
work.
(9) MONITORING AND
ASSESSMENT. The medical waste reduction plan shall describe how the director or
director's designee will monitor and assess waste reduction efforts. The plan
shall include or refer to policies or procedures, where appropriate, for doing
all of the following:
(a) Keeping records of
total medical waste generation, on-site treatment and off-site shipment of
medical waste for at least 5 years in order to meet the requirement in par.
(g).
(b) Inspecting the medical
facility periodically and enforcing the medical waste reduction plan.
(c) Monitoring the medical facility annually
for changes which would make it necessary for the facility to repeat the waste
audit according to s. NR 526.18.
(d) Reviewing the process of plan
implementation annually.
(e)
Assessing progress toward goals and objectives annually.
(f) Reviewing the contents of the medical
waste reduction policy every 5 years and the medical waste reduction plan
annually.
(g) Updating the policy
and plan as necessary or at least every 5 years.
(h) Preparing and submitting progress reports
according to s. NR 526.21.
(10) POSITIONS. The medical waste reduction
plan shall identify the employee positions that will be responsible for each of
the following activities in the plan: preparing the plan, evaluating and
implementing alternative waste management practices, evaluating and
implementing alternatives to disposables, education and training, and the
activities associated with monitoring and assessment under sub. (9).
