1. Daniela Ortiz de Montellano & Mario Perez 2015 TCEQ Environmental Trade Fair MEDICAL WASTE MANAGEMENT REGULATIONS FOR THE HANDLING, TREATMENT & PROPER DISPOSAL OF MEDICAL WASTE, INCLUDING EBOLA WASTE

2. Who Regulates Medical Waste in Texas “Medical Waste” Definitions Types of Authorizations Application Contents/Processing Ebola Experience 2014 AGENDA

3. REGULATORY AGENCIES

4. 25 TAC §1.132 (44) - Special waste from health care-related facilities –Animal waste exposed to pathogens –Bulk human blood & body fluids –Pathological waste –Microbiological waste –Sharps DEFINITION - DSHS

5. 49 C.F.R., Parts 171-180 - DOT Hazardous Materials Regulations Category A Infectious Substance: Capable of causing: –permanent disability –life-threatening disease –fatal disease Category B Infectious Substance DEFINITION- U.S. DOT

6. –30 TAC §330.3(85) - Treated and untreated special waste from health care-related facilities as used by: DSHS, and; “Regulated Medical Waste” defined in 49 CFR §173.134(a)(5) - a waste or reusable material known or suspected of containing a Category B infectious substance that is derived from medical treatment or biomedical research. DEFINITION - TCEQ

7. Exceptions DEFINITION - TCEQ

9. Self Transporters: Generate > 50 pounds per month of untreated medical waste Transport their own waste to an authorized medical waste processing facility. Form TCEQ-20287 (07/2006) On-site Treatment: Generator required to notify the TCEQ for the operation of an approved treatment process unit used only for treatment of on-site generated medical waste. Acknowledgement Letter from MSW Permits

10. Transporter : for persons that plan to transport untreated medical waste and that are not the generator of the waste. Form TCEQ-00426 (07/2006). Mobile On-site Treatment : for persons that plan to treat untreated medical waste on- site and that are not the generator of the waste. Form TCEQ-00427 (07/2006).

11. Type V Registrations: 30 TAC §330.9(n) - for a facility that stores, transfers or process (i.e. stores, treats and transfers) untreated medical waste that is received from off-site sources

12. MEDICAL WASTE - TYPE V REGISTRATION Applicable Rules in 30 Texas Administrative Code (30 TAC):  Chapter 330  Chapter 330 – Subchapter Y only for medical waste  Chapter 116  Chapter 305  Chapter 39  Chapter 37

13.  General Information  Core Data Form (Form No. 10400)  Part I  Part I Form (Form No. 0650)  Part II  Waste Acceptance Plan  Facility Impact  Coordination Letters APPLICATION CONTENT

14.  Part III – Site Development Plan  Facility Design  Storage & Transfer Unit Designs  Closure Plan & Cost Estimates  Part IV – Site Operating Plan (SOP)  Sub Ch. E (Transfer & Processing Units)  Sub Ch. Y (Med Waste Management)  Storage Requirements - 330.1209  Treatment & Disposition - 330.1219 APP. CONTENT - CONT'D

15. TYPE V REG. APPLICATION PROCESS

16. Ebola in the U.S. Task Force on Infectious Disease Preparedness and Response TCEQ’s role Conclusion - Task Force Report & Recommendations EBOLA EXPERIENCE 2014

17. First Case on Sept. 30, 2014 at a Texas hospital Task Force on Infectious Disease Preparedness and Response Creation & Duties The second and third cases within 2 weeks Total of 337 people were monitored throughout the crisis EBOLA IN THE U.S.

18. The Task Force Created Oct 6 – 17 members Immediately provide frontline support for decision makers Identify issues/provide resolutions Public transparency Waste management - TCEQ TASK FORCE

19. Classification of Ebola contaminated material List of treatment & disposal facilities Treatment options & how effective Packaging/Labeling requirements SAMPLE QUESTIONS FOR TCEQ

20. TCEQ’S RESPONSE Classification of Ebola: hospital generated – Cat A; private residences: special waste and managed as Cat A Identify Med Waste Facilities: types of equipment and capacities for each treatment unit at each facility

21. TCEQ’S RESPONSE

22. Efficacy for each type of treatment – incineration preferred Disposal options – ash Packaging & Labeling – DOT Cat A Example - Triple Packaging

23. TCEQ’S RESPONSE

25. December 1, 2014 Issue 14 – Decontamination & Waste Removal Direct the appropriate state agencies to: –work with hospitals/medical professionals: how can waste be properly and safely treated on-site; –evaluate all portable treatment options; –evaluate and identify all decontamination and waste handling procedures; and –assure availability of regional supplies to handle Category A waste Develop a public health emergency action plan 84 th Legislature – Proposed HB 2950 & SB 538 TASK FORCE RECOMMENDATIONS CONCLUSION

26. Mario Perez Mario.Perez@tceq.texas.gov or (512) 239-6681 Daniela Ortiz de Montellano Daniela.Ortiz-Demontellano@tceq.texas.gov or (512) 239-2210 CONTACTS :

27. http://www.tceq.texas.gov/permitting/waste_permits/msw_ permits/mw_disposal.html - checklists & other infohttp://www.tceq.texas.gov/permitting/waste_permits/msw_ permits/mw_disposal.html https://www.tceq.texas.gov/publications/rg/rg-001.html - Texas regulatory guidance document on medical wastehttps://www.tceq.texas.gov/publications/rg/rg-001.html REFERENCES