Environmental Waste Management and Support Services

PURPOSE: This rule specifies the requirements for environmental and support services provided by a hospital. (1) Each hospital shall have an organized service which maintains a clean and safe environment. (A) Housekeeping Services. 1. The housekeeping services shall have a director who is qualified by education, training, and experience in the principles of hospital housekeeping. This individual shall report to a designated administrative officer or his or her designee. 2. Approved written policies and procedures shall define and describe the scope of housekeeping services. These shall be reviewed in cooperation with the infection prevention control program, kept current per hospital policy, and be readily available to staff. 3. Adequate space for housekeeping services shall be provided. 4. There shall be sufficient trained personnel to meet the needs of housekeeping services. 5. All solid waste generated within the hospital shall be collected in appropriate containers for disposal. 6. There shall be a process for the review and evaluation on a regular basis of the quality of housekeeping services provided. (B) Laundry and Linen Services. 1. The hospital shall have organized services which ensure that adequate supplies of clean linens are available. There shall be specific written procedures for the processing, distribution, and storage of linen. These shall be reviewed in cooperation with the infection control committee and kept current. 2. Soiled linen processing functions shall be physically separated from both clean linen storage and soiled linen holding areas. Only commercial laundry equipment shall be used to process hospital linen. 3. Clean linen shall be stored and distributed to the point of use in a way that minimizes microbial contamination from surface contact or airborne particles. 4. Soiled linen shall be collected at the point of use and transported to the soiled linen holding room in a manner that minimizes microbial dissemination into the environment. 5. If a commercial laundry service is used, verification shall be provided to assure the hospital that the processing and handling of linen complies with paragraphs (1)(B)1.–4. of this rule and by following manufacturer recommendations. SENIOR SERVICES 6. There shall be a process for the review and evaluation on a regular basis of the quality of laundry and linen services provided. (C) Infectious Waste Management 1. The director of this program shall be qualified by education, training, and experience in the principles of infectious waste management. 2. Every hospital shall write an infectious waste management plan with an annual review identifying infectious waste generated on-site, the scope of the infectious waste program, and policies and procedures to implement the infectious waste program. The plan shall include at least the following: A. Contact information for responsible individuals; organizational chart; schematic(s) of waste disposal routes; definition of those wastes handled by the system; department and individual responsibilities; hospital policies and procedures for waste identification, segregation, containment, transport, treatment, and disposal; emergency and contingency procedures; training and educational procedures; and appendices (rules and other applicable institutional policy statements). B. Any hospital exempt from infectious waste processing facility permit requirements of 10 CSR 80-7.010 and that accepts infectious waste from off-site shall include in its plan requirements for storage, processing, and record keeping of this waste and the cleanup of potential spills in the unloading area. C. Manufacturers’ specifications for temperature, residence time, and control devices for any infectious waste processing devices shall be included in the plan. 3. A trained operator shall operate the equipment during any infectious waste treatment procedures. 4. Infectious waste shall be segregated from other wastes at the point of generation and shall be placed in distinctive, clearly marked, leakproof containers or plastic bags appropriate for the characteristics of the infectious waste. Containers for infectious waste shall be identified with the universal biological hazard symbol. All packaging shall maintain its integrity during storage and transport. Infectious waste shall not be placed in a gravity waste disposal chute. 5. Pending disposal, infectious waste shall be stored, separated from other wastes, in a limited-access enclosure posted with the biological hazard symbol. This enclosure shall afford protection from vermin, be a dry area, and be provided with an impervious floor with a perimeter curb. The floor shall slope to a drain connected to the sanitary sewage system or collection device. If infectious waste is compacted, the mechanical device shall contain the fluids and aerosols and shall not release aerosols or fluids when opened and the container is removed. Provisions for waste stored seventytwo (72) hours or more shall be separately addressed in the infectious waste management plan to include proper storage, handling, and disposal by commercial vendors when utilized. 6. Hospital infectious waste treated on site shall be rendered innocuous, using one (1) of the following methods: A. Sterilization of the waste in an autoclave is permitted, provided that the unit is operated in accordance with the manufacturer’s recommendations and that the autoclave’s effectiveness is verified at least weekly with a biological spore assay containing Bacillus Stearothermophilus. If the autoclave is used for other functions, the infectious waste management plan will develop specific guidelines for its use; B. Decontamination of the infectious waste by other technologies in a manner acceptable to the Department of Health and Senior Services shall be permitted; C. Bulk blood, suctioned fluids, excretions, and secretions may be carefully poured down a drain connected to a sanitary sewer; or D. Infectious waste rendered innocuous by the methods in subparagraphs (1)(C)6.A. or B. of this rule shall be disposed of in accordance with the requirements of 10 CSR 80-7.010. 7. An infectious waste treatment program shall include records of biological spore assay tests if required by treatment methods and the approximate amount of waste disinfected per hour measured by weight per load. The program director shall maintain records demonstrating the proper operation of the disinfection equipment. 8. All infectious waste when transported off the premises of the hospital shall be packaged and transported as provided in sections 260.200–260.207, RSMo. 9. Any hospital which accepts infectious waste from small quantity generators as defined by 10 CSR 80-7.010 or from other Missouri hospitals—in quantities exceeding fifty percent (50%) of the total poundage of infectious waste generated on-site at the hospital—shall notify the Department of Natural Resources and comply with permitting requirements of sections 260.200– 260.207, RSMo. The weight of infectious waste generated on-site shall be calculated by multiplying one and five-tenths (1.5) pounds per day times the number of beds complying with Department of Health and Senior Services standards for hospital licensure. Infectious waste generated off-site may be accepted by a hospital only if packaged according to 10 CSR 80-7.010(2)(A)–(D). (D) Medication Waste Management. 1. Disposal of unwanted medications and medication waste shall be identified in the following categories: general, controlled substances, radiologic, infectious, and hazardous. Medication waste shall include materials contaminated with such medications. A. Specific waste streams shall be identified for each category including storage container type, storage prior to disposal, and final disposition. B. Medications shall be returned to the pharmacy for disposal except— (I) Single doses that may be disposed of by medication staff at the time of administration; (II) Doses that are an infectious hazard; and (III) Radiopharmaceuticals. C. Medications shall be disposed of according to the Missouri Department of Natural Resources, the United States Food and Drug Administration, and the United States Environmental Protection Agency. D. Disposal of controlled substances shall be according to 19 CSR 30-1.078. E. Unused radiopharmaceuticals shall be returned to the supplier or held and disposed of according to Nuclear Regulatory Commission guidelines. F. Disposal of hazardous medications including, but not limited to, antineoplastic medications shall be handled as follows: (I) Personnel who handle hazardous medications and/ or medication waste shall be trained regarding collection, transportation, containment, segregation, manifest, and disposal; and (II) Waste shall be contained and segregated from other waste in leak proof containers clearly labeled with a statement such as CAUTION: HAZARDOUS CHEMICAL WASTE and held in a secure place until disposed. AUTHORITY: section 192.006, RSMo 2000, and sections 197.080 and 197.154, RSMo Supp. 2013.* This rule previously filed as 19 CSR 30-20.021(5)(A), (C), and (D). Original rule filed June 27, 2007, effective Feb. 29, 2008. Amended: Filed June 6, 2013, effective Jan. 30, 2014. *Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995, 2013; and 197.154, RSMo 2004.