Report Title:

Trauma Scene Waste; Infectious Waste; Management

 

Description:

Regulates the management of trauma scene and infectious waste.

 

HOUSE OF REPRESENTATIVES

H.B. NO.

216

TWENTY-SECOND LEGISLATURE, 2003

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to TRAUMA SCENE and INFECTIOUS WASTE MANAGEMENT.

 

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

SECTION 1. The legislature finds that it is in the interests of the health and safety of both the public and the solid waste industry to regulate the handling and treatment of waste that, but for contamination with large quantities of human blood or body fluids as a result of death, injury, or illness, would be solid waste.

The legislature further finds that, in the interest of safe and uniform management of trauma scene waste, practitioners of trauma scene management should be subject to regulation by the department of health. Accordingly, the purpose of this Act is to regulate the management of trauma scene and infectious waste in Hawaii.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

tRAUMA SCENE and INFECTIOUS WASTE MANAGEMENT

§ -1 Definitions. As used in this chapter, unless the context clearly requires otherwise:

"Biohazardous waste" means any of the following:

(1) Laboratory waste, including all of the following:

(A) Human or animal specimen cultures from medical and pathology laboratories;

(B) Cultures and stocks of infectious agents from research and industrial laboratories; and

(C) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including brucellosis and contagious ecthyma, as identified by the department, and culture dishes and devices used to transfer, inoculate, and mix cultures.

(2) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans;

(3) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans;

(4) Waste, which at the point of transport from the generator's site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans;

(5) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans;

(6) (A) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to chapter 342J;

(B) For the purposes of this paragraph, "chemotherapeutic agent" means an agent that kills or prevents the reproduction of malignant cells; and

(C) For the purposes of this paragraph, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:

(i) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including when tilted or inverted; and

(ii) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping; or

(7) Waste that is hazardous only because it is comprised of pharmaceuticals. Notwithstanding the definition of "infectious waste", infectious waste includes biohazardous waste that meets the conditions of this definition. Biohazardous waste that meets the conditions of this subdivision is not subject to chapter 342J.

"Container" means the rigid container in which the infectious waste is placed prior to transporting for purposes of storage or treatment.

"Department" means the department of health.

"Director" means the director of health.

"Highly communicable diseases" means any disease or condition declared to be communicable or dangerous to the public health in accordance with rules adopted by the director pursuant to section 325-1, and including those diseases caused by organisms classified by the federal Centers for Disease Control as Biosafety Level IV organisms, that, in the opinion of the director, merit special precautions to protect staff, patients, and other persons from infection. "Highly communicable diseases" does not include diseases such as the common cold, influenza, or other diseases not representing a significant danger to nonimmunocompromised persons.

"Household waste" means any material, including garbage, trash, and sanitary wastes in septic tanks and infectious waste, that is derived from households, farms, or ranches. Household waste does not include trauma scene waste.

"Infectious agent" means a type of microorganism, bacteria, mold, parasite, or virus that normally causes, or significantly contributes to the cause of, increased morbidity or mortality of human beings.

"Infectious waste" means waste that meets both of the following requirements:

(1) The waste is composed of waste that is generated or produced as a result of any of the following actions:

(A) Diagnosis, treatment, or immunization of human beings or animals;

(B) Research pertaining to the activities specified in subparagraph (A);

(C) The production or testing of biologicals. For the purposes of this definition, "biologicals" means medicinal preparations made from living organisms and their products, including, but not limited to, serums, vaccines, antigens, and antitoxins;

(D) The accumulation of properly contained home-generated sharps waste that is brought by a patient, a member of the patient's family, or by a person authorized by the department, to a point of consolidation approved by the department; or

(E) Removal of a waste from a trauma scene by a trauma scene waste management practitioner; and

(2) The waste is either of the following:

(A) Biohazardous waste; or

(B) Sharps waste.

"Infectious waste" includes trauma scene waste. "Infectious waste" that has been treated in accordance with section -3, and that is not otherwise hazardous, shall thereafter be considered solid waste or municipal solid waste as defined in section 342G-1, and not infectious waste. "Infectious waste" does not include any of the following:

(1) Waste generated in food processing or biotechnology that does not contain an infectious agent;

(2) Waste generated in biotechnology that does not contain human blood or blood products or animal blood or blood products suspected of being contaminated with infectious agents known to be communicable to humans;

(3) Urine, feces, saliva, sputum, nasal secretions, sweat, tears, or vomitus, unless it contains fluid blood, as provided in paragraph (4) of the definition of "biohazardous waste";

(4) Waste which is not biohazardous, such as paper towels, paper products, articles containing nonfluid blood, and other infectious solid waste products commonly found in the facilities of infectious waste generators;

(5) Hazardous waste, radioactive waste, or household waste; or

(6) Waste generated from normal and legal veterinarian, agricultural, and animal livestock management practices on a farm or ranch.

"Infectious waste generator" means any person whose act or process produces infectious waste. All of the following are examples of businesses that generate infectious waste:

(1) Medical and dental offices, clinics, hospitals, surgery centers, laboratories, research laboratories, unlicensed health facilities, chronic dialysis clinics, and education and research facilities;

(2) Veterinary offices, veterinary clinics, and veterinary hospitals;

(3) Pet shops; and

(4) Trauma scene waste management practitioners.

"Infectious waste treatment facility" means all adjacent land and structures, and other appurtenances or improvements on the land, used for treating infectious waste or for associated handling and storage of infectious waste. Infectious waste treatment facilities are those facilities treating waste pursuant to section -3(a) or (c). An infectious waste treatment method approved pursuant to section -3(d) may be designated as an infectious waste treatment facility by the department. For the purposes of this definition, "adjacent" means real property within four hundred yards from the property boundary of the existing infectious waste treatment facility.

"Mixed waste" means mixtures of infectious and noninfectious waste. Mixed waste is infectious waste, except for all of the following:

(1) Infectious waste mixed with hazardous waste is hazardous waste and is subject to regulation as specified in the statutes and rules applicable to hazardous waste;

(2) Infectious waste mixed with radioactive waste is radioactive waste and is subject to regulation as specified in the statutes and rules applicable to radioactive waste; and

(3) Infectious waste mixed with hazardous waste and radioactive waste is radioactive mixed waste and is subject to regulation as specified in the statutes and rules applicable to hazardous waste and radioactive waste.

"Offsite" means any location that is not onsite.

"Onsite" means an infectious waste treatment facility, or common storage facility on the same or adjacent property as the generator of the infectious waste being treated. For the purposes of this definition, "adjacent" means real property within four hundred yards from the property boundary of the existing infectious waste treatment facility.

"Pharmaceutical" means a prescription or over-the-counter human or veterinary drug, including a drug as defined in the Federal Food, Drug, and Cosmetic Act, as amended, 21 U.S.C. §321(g)(1). For the purposes of this definition, "pharmaceutical" does not include any pharmaceutical that is regulated pursuant to the federal Resource Conservation and Recovery Act of 1976, as amended 42 U.S.C. §6901 et seq.

"Sharps container" means a rigid puncture-resistant container that, when sealed, is leak resistant and cannot be reopened without great difficulty.

"Sharps waste" means any device having acute rigid corners, edges, or protuberances capable of cutting or piercing, including all of the following:

(1) Hypodermic needles, hypodermic needles with syringes, blades, needles with attached tubing, syringes contaminated with biohazardous waste, acupuncture needles, and root canal files;

(2) Broken glass items, such as Pasteur pipettes and blood vials contaminated with biohazardous waste; and

(3) Any item capable of cutting or piercing that is contaminated with trauma scene waste.

"Storage" means the holding of infectious waste at a designated accumulation area, offsite point of consolidation, other registered facility, or in a vehicle detached from its means of locomotion.

"Trauma scene" means a location soiled by, or contaminated with, human blood, human body fluids, or other residues from the scene of a serious human injury, illness, or death. For the purposes of this definition, a location may include a physical structure that is not fixed geographically, such as mobile homes, trailers, or vehicles.

"Trauma scene waste" means waste that has been removed, is to be removed, or is in the process of being removed, from a trauma scene by a trauma scene waste management practitioner.

"Trauma scene waste management practitioner" means a person who undertakes as a commercial activity the removal of human blood, human body fluids, and other associated residues from the scene of a serious human injury, illness, or death, and who is registered with the department pursuant to section -4.

"Treatment" means any method, technique, or process designed to change the biological character or composition of any infectious waste so as to eliminate its potential for causing disease, as specified in section -3.

§ -3 Infectious waste treatment. (a) A person generating or treating infectious waste shall ensure that the infectious waste is treated by one of the following methods, thereby rendering it solid waste, as defined in section 342G-1, prior to disposal:

(1) Incineration at a permitted infectious waste treatment facility in a controlled-air, multichamber incinerator, or other method of incineration approved by the department, which provides complete combustion of the waste into carbonized or mineralized ash;

(2) Treatment with an alternative technology approved pursuant to paragraph (5), which, due to the extremely high temperatures of treatment in excess of 1300 degrees Fahrenheit, has received express approval from the department;

(3) Discharge to a public sewage system if the infectious waste is liquid or semiliquid, and not either of the following:

(A) Liquid or semiliquid laboratory waste; or

(B) Microbiological specimens;

provided that infectious waste discharge shall be consistent with state and county waste discharge requirements placed on the public sewer system;

(4) Steam sterilization at a permitted infectious waste treatment facility or by other sterilization, in accordance with all of the following operating procedures for steam sterilizers or other sterilization:

(A) Standard written operating procedures shall be established for biological indicators, or for other indicators of adequate sterilization approved by the department, for each steam sterilizer, including time, temperature, pressure, type of waste, type of container, closure on container, pattern of loading, water content, and maximum load quantity;

(B) Recording or indicating thermometers shall be checked during each complete cycle to ensure the attainment of 121 degrees centigrade (250 degrees Fahrenheit) for at least one-half hour, depending on the quantity and density of the load, to achieve sterilization of the entire load. Thermometers shall be checked for calibration annually. Records of the calibration checks shall be maintained as part of the facility's files and records for a period of three years;

(C) Heat-sensitive tape, or another method acceptable to the department, shall be used on each biohazard bag or sharps container that is processed onsite to indicate the attainment of adequate sterilization conditions;

(D) The biological indicator bacillus stearothermophilus, or other indicator of adequate sterilization as approved by the department, shall be placed at the center of a load processed under standard operating conditions at least monthly to confirm the attainment of adequate sterilization conditions; and

(E) Records of the procedures specified in subparagraphs (A), (B), and (D) shall be maintained for a period of not less than three years; and

(5) Other alternative infectious waste treatment methods which are both of the following:

(A) Approved by the department; and

(B) Result in the destruction of pathogenic micro-organisms.

Any alternative infectious waste treatment method proposed to the department shall be evaluated by the department and either approved or rejected pursuant to the criteria specified in this paragraph.

(b) A infectious waste may be discharged to a public sewage system without treatment if it is not a biohazardous waste of a type described in either paragraph (1) or (2) of the definition of "biohazardous waste", it is liquid or semiliquid, and its discharge is consistent with waste discharge requirements placed on the public sewage system by the department or by the county agency having jurisdiction over that system.

(c) (1) A infectious waste that is a biohazardous waste of a type described in paragraph (1) of the definition of "biohazardous waste" may be treated by a chemical disinfection if the infectious waste is liquid or semiliquid and the chemical disinfection method is recognized by the National Institutes of Health, the Centers for Disease Control and Prevention, or the American Biological Safety Association, and if the use of chemical disinfection as a treatment method is identified in the site's infectious waste management plan.

(2) If the waste is not treated by chemical disinfection, in accordance with paragraph (1), the waste shall be treated by one of the methods specified in subsection (a).

(3) Following treatment by chemical disinfection, the infectious waste may be discharged to the public sewage system if the discharge is consistent with waste discharge requirements placed on the public sewage system by the department or by the county agency having jurisdiction over that system, and the discharge is in compliance with the requirements imposed by the owner or operator of the public sewage system. If the chemical disinfection of the infectious waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of chapter 342J.

(d) Recognizable human anatomical parts, with the exception of teeth not deemed infectious by the attending physician and surgeon or dentist, shall be disposed of by interment or in accordance with subsection (a), unless otherwise hazardous.

(e) Sharps waste shall be rendered noninfectious prior to disposal by one of the following methods:

(1) Incineration;

(2) Steam sterilization; or

(3) Disinfection using an alternative treatment method approved by the department.

Sharps waste rendered noninfectious pursuant to this subsection may be disposed of as solid waste if the waste is not otherwise hazardous. Onsite infectious waste treatment facilities treating sharps waste pursuant to paragraph (2) or (3) shall ensure that, prior to disposal, the treated sharps waste is destroyed or that public access to the treated sharps waste is prevented.

(f) Each infectious waste treatment facility shall provide the department with an emergency action plan that the facility shall follow to ensure the proper disposal of infectious waste in the event of equipment breakdowns, natural disasters, or other occurrences.

(g) Notwithstanding any law to the contrary, animals that die from infectious diseases shall be treated in accordance with this section if, in the opinion of the attending veterinarian or county health officer, the carcass presents a danger of infection to humans.

§ -4 Trauma scene waste management practitioners; qualifications. (a) A trauma scene waste management practitioner shall register with the department on forms provided by the department.

(b) Subject to subsection (g),The department shall register a trauma scene waste management practitioner and issue a trauma scene waste hauling permit to a trauma scene waste management practitioner who submits a completed application form and the registration fee, upon approval of the application by the department.

(c) A registered trauma scene waste management practitioner shall be exempt from the registration requirements imposed pursuant to section 342J-33 upon transporters of hazardous waste.

(d) Registered trauma scene waste management practitioners shall pay an annual fee of $200 to the department for deposit in the general fund. All moneys necessary for the department to carry out the purposes of this chapter shall be allocated by the legislature through appropriations out of the general fund. The department shall include in its budgetary request for each upcoming fiscal period, the amounts necessary to effectuate the purposes of this chapter.

(e) The department shall maintain an inventory of registered trauma scene waste management practitioners.

(f) The department shall submit a list of registered trauma scene waste management practitioners to all appropriate state and county agencies, and shall make the list available, upon request, to other state and county agencies and to the public.

(g) No person shall be registered as a trauma scene waste management practitioner or be issued a trauma scene waste hauling permit under this section unless the applicant has paid the fees required under this section and has submitted a completed application under subsection (b), together with evidence that is satisfactory to the department that the applicant:

(1) Has attended forty hours of training in hazardous materials and decontamination;

(2) Has earned a certificate of completion in blood borne pathogens training;

(3) Has at least five years of experience in trauma cleaning;

(4) Has attended three trauma, crime, and hazardous environment scenes in Hawaii and has participated in the trauma cleaning process, supervised by a trauma scene waste management practitioner; provided that until there are sufficient practitioners who are registered in Hawaii, supervision may be conducted by a person who has expertise in trauma scene waste management as determined by the department;

(5) Has earned a high school diploma or a general education equivalent;

(6) Possesses a valid Hawaii driver's license;

(7) Has at least two regulated and licensed disposal facility points;

(8) Has a Hawaii general excise tax license and a federal tax identification number; and

(9) Is registered and listed with the department of health.

§ -5 Trauma scene waste management; standards and rules. (a) The department shall be the sole enforcement agency with regard to the management of trauma scene waste.

(b) The department, working with the trauma scene waste management industry and the health care industry, shall establish the following standards:

(1) Documentation of personal protection required to be provided for, and used by, workers in accordance with bloodborne pathogen standards adopted by the occupational safety and health division of the department of labor and industrial relations; and

(2) Technologies and chemicals appropriate to the task of cleanup and disinfecting.

(c) The department may adopt rules in accordance with chapter 91 as may be necessary for the implementation of this chapter, including rules pursuant to which trauma scene waste management practitioners shall document:

(1) Identification of trauma scene waste within the scope of this chapter; and

(2) Compliance with disposal requirements, including tracking the transportation of trauma scene waste.

(d) The department shall adopt procedures to provide information to trauma scene waste management practitioners for removing trauma scene waste from trauma scenes.

(e) A trauma scene waste management practitioner who transports trauma scene waste shall be deemed the generator of the trauma scene waste for purposes of this chapter.

§ -6 Removal and transportation of trauma scene waste. (a) Trauma scene waste shall be removed from the trauma scene immediately upon completion of the removal phase of a trauma scene waste removal operation.

(b) Trauma scene waste shall be transported to a permitted treatment facility, or may be stored in a dedicated freezer at the business location of the trauma scene waste management practitioner, for a period of not more than fourteen days, or as otherwise approved by the department.

§ -7 Scope of chapter. (a) This chapter does not limit or abridge the jurisdiction of the occupational safety and health division or the department of industrial relations.

(b) This chapter does not prohibit a business from employing or contracting with a person to provide cleanup or consultative services with respect to trauma scene waste if those services are incidental to the principal course and scope of services provided by the person."

SECTION 3. Section 321-21, Hawaii Revised Statutes, is amended to read as follows:

"[[]§321-21[]] Infectious [wastes;] waste; treatment, management, and disposal. (a) As used in this section, the term "infectious waste" has the same meaning as defined in section -1.

(b) The department of health shall adopt rules pursuant to section -2 and chapter 91 for the treatment, management, and disposal of infectious [wastes generated by hospitals, clinics, other health care facilities, doctors' offices, dentists' offices, research laboratories, veterinary clinics, and other generators of infectious wastes.] waste. The rules shall [include a definition of infectious wastes that clearly and objectively defines infectious wastes and specifies] specify acceptable containers and other factors related to the identification, segregation, containment, and transportation of infectious [wastes.] waste.

(c) [Effective July 1, 1991, all] All generators of infectious [wastes] waste shall show proof that infectious [wastes are] waste is being treated, managed, and disposed of according to section -2 and departmental rules upon request of the department."

SECTION 4. Chapter 342G, Hawaii Revised Statutes, is amended as follows:

1. By amending the definition of "special waste" in section 342G-1 to read:

""Special waste" means any solid waste which, because of its source or physical, chemical, or biological characteristics, requires special consideration for its proper processing or disposal, or both. This term includes[, but is not limited to,] asbestos, used oil, petroleum-contaminated soil, lead acid batteries, municipal waste combustion ash, sewage sludge that is not hazardous waste, agricultural and farm-generated wastes that are normally placed in landfills, [medical wastes,] tires, white goods, and derelict vehicles."

2. By amending subsection (e) of section 342G-26 to read:

"(e) The special waste component shall describe the existing waste handling and disposal practices for special wastes, including, but not limited to, asbestos, used oil, petroleum-contaminated soil, lead acid batteries, municipal waste combustion ash, sewage sludge that is not hazardous waste, agricultural and farm-generated wastes, [medical wastes,] tires, white goods, and derelict vehicles. The component shall identify current and proposed programs to ensure the proper handling, reuse, and long-term disposal of special wastes."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 2003.

INTRODUCED BY:

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