1. BUMEDINST 6280.1
MANAGEMENT OF
REGULATED MEDICAL
WASTE
HM1 Enlisted Advancement Program
By HM1(SCW/FMF) Williford Dagher, Jessica

2. Management of Regulated Medical Waste
• Purpose
• To provide standards for management of regulated medical waste
(RMW) (used interchangeably with infectious waste) at Navy shore
medical treatment facilities (MTFs) and dental treatment facilities
(DTFs).
• Pharmaceutical wastes have additional considerations and shall be
managed per reference (a).
• Reference (b) provides guidelines that Navy Shore MTFs and DTFs
will
• incorporate to protect medical personal from occupational exposures
to blood or other potentially
• infectious material.

3. BUMEDINST 6280.1B
• Background
• Concern about potential adverse environmental and public health effects
of RMW noticeably increased after isolated incidents of improper
disposal gained widespread media attention in late I980s to 1990s.
In this presentation regulated medical waste is classified as either
non- RMW or RMW.
∙Non-RMW is solid material intended for disposal, produced as the direct result of
patient diagnosis, treatment, therapy, or medical research. It requires no further
treatment and disposed in general trash. (Ex: soiled dressings, bandages
containing very small amounts of blood or other body fluids, disposable catheters,
swabs, used disposable drapes, gowns, masks, and empty used specimen
containers/urine cups)

4. Management of Regulated Medical Waste
∙RMW is generated during diagnosis, treatment, or immunization of
humans or animals - is capable of causing disease or would pose other
adverse health risks to individuals or the community if improperly
handled
There are 9 groups of RMW-
Based on associated risks and handling, treatment and disposal
requirements provided in enclosure:
1. Cultures, Stocks, and Vaccines, 2. Pathological Waste, 3. Blood and
Blood Products, 4 & 7. Sharps, 5. Animal Waste (when exposed to
infectious agents during research, production of biologicals, or testing
of pharmaceuticals). 6. Isolation Wastes, 8. Other (including fluids
designated by the local infection control authority), 9. Chemotherapy
Trace Wastes.

5. Pharmaceutical Wastes
• Pharmaceutical wastes have separate requirements and
shall be managed per the “Navy Environmental Health
Center Pharmaceutical Waste Management Guidelines.”

6. BUMEDINST 6280.1B
• Collection/ Segregation:
• RMW shall be placed in containers, bags, or sharps containers (as
appropriate for the waste) that are either labeled with universal biohazard
symbol and the word “BIOHAZARD” or red in color.
• Lining containers-
• with plastic bags of sufficient thickness (typically 3 mm) so a single bag
will be enough for most situations, durability, puncture resistance, and
burst strength to prevent rupture or leaks.
• Disposal of Sharps-
• used and unused waste, discarded vaccines/vaccine containers in rigid,
puncture resistant sharps containers. Never clip, cut, bend or recap
needles. Close container to prevent spillage or protrusion of contents.
• Do not overload bags or sharps containers.

7. Management of Regulated Medical Waste
• Packaging and Handling
• Place Sharps containers in a second container (plastic bag or rigid
box) labeled and/or color coded before treatment and disposal. (Do
not transport RMW in chutes or dumbwaiters)
• Anatomical pathology waste: in double-wall corrugated boxes or
equivalent rigid containers that are double-lined with plastic bags for
transport and incineration in an infectious waste incinerator.

8. BUMEDINST 6280.1B
• Storage
• Store RMW (excluding pathological waste) in RMW storage areas not
to exceed 7 days.
• Pathological wastes must be refrigerated or frozen in dedicated cold
storage units.
• RMW storage areas- Shall be easily cleanable, prevent past access,
Main entrance shall have a “RMW” and
a Universal Biohazard Sign and any additional warnings
or instructions necessary for a safe environment.
Pathological Wastes- Must be refrigerated and then
frozen if stored more then 24 hours (not to exceed 30
days).

9. Management of Regulated Medical Waste
• Storage
• Rules & Laws related:
• Regulated Medical Waste must not exceed storage
contracts. Any Local, State or country rules & regulations
that exist should be followed and if more stringent
supersede them.

10. BUMEDINST 6280.1B
• Transportation
• If transporting off site-
• Place in rigid, leak-proof containers prior to transporting
off-site. (labeled or color coded).
• Comply with Federal, State & Local Laws, Regulations or
Status of Forces Agreements (i.e. licensing & vehicle
labeling).

11. Management of Regulated Medical Waste
• Treatment & Disposal
• Treatment of RMW is done through:
• Incineration
or
• Inactivation by heat, chemicals or radiation.
• If absence of Federal Regs- comply with State & Local
regulations.

12. BUMEDINST 6280.1B
• Groups 1-9
• Group 1: Cultures, Stocks & Vaccines include infectious agents,
cultures from lab and culture dishes, d/c’d live & attenuated vaccines.
Microbiologic waste should be separate from general waste for
decontamination. Liquid waste may be sterilized & disposed in
sewage system or kept in original container and placed in sharps
container. Vaccines: Unused vaccine should be given to pharmacy for
return. Nasal mist disposed in non sharps RMW . -Dental procedure
carpules with blood or broken d/c’d in Sharps. Carpules otherwise are
disposed regular.

13. Management of Regulated Medical Waste
• Group 2: Pathological Waste include human tissue,
organs, body parts, teeth or body fluids removed during
surgery, autopsy or other procedures. Dispose in a RMW
container lined with a plastic bag or double bag with RMW
bags

14. BUMEDINST 6280.1B
• Group 3: Blood and Blood Products to include free-
flowing human blood, plasma, serum and other blood
products, absorbent materials soaked or dripping with
blood or items caked with dried blood.
• Disposal: Bulk blood may be disposed in sewer unless
specified otherwise by local, State or host nation laws.
• Breakable containers of blood product- Rigid container
• Blood products, blood bags & tubing (remove needles
avoiding unsafe manipulation)- RMW bags

15. Management of Regulated Medical Waste
• Groups 4 and 7: Sharps such as when used in human or
animal care, medical research treatment or laboratories
•Includes: Needles, syringe (with or without
needle), Pasteur pipettes, scalpel blades, blood
collection tubes & vials, needles attached to
tubing, culture dish (regardless of presence of
infectious agents), included broken or unbroken
glass in contact with infectious agents (i.e. slides
and coverstrips),
• -Do not break, bend or re-cap needles using a two-hand
method
• Group 4: Used
• Group 7: Unused

16. BUMEDINST 6280.1B
• Installation and replacing Sharps containers:
• Wall mounted sharps containers will be at a height that
promotes safe usage by staff.
• Remove and seal sharps containers when ¾ full or above
fill line.

17. Management of Regulated Medical Waste
• Group 5: Animal Waste
Included: Animal carcass, body parts & bedding known to be exposed
to infectious agents during research, biological production or
pharmaceutical testing. (Managed through RMW or incineration)
Excluded: Roadkill Carcass, euthanized animals, animals dying of
natural causes and waste produced by Veternary practices

18. BUMEDINST 6280.1B
• Group 6: Isolation Wastes includes bedding from human or animals
infected with BSL Level 4 agents.
• Included: biological wastes and discarded materials contaminated
with blood, excretion exudates or secretions from humans or animals
isolated from others with highly communicable disease
• Note: Follow facility Infection Control (IC) Directives and/or the IC
Committee on handling isolation waste, particularly with BSL Level 4
agents

19. Management of Regulated Medical Waste
• Group 8: Other
• Includes: Fluids designated as RMW by local infection control.
Cerebrospinal fluid, Semen, Vaginal secretions, Synovial, Amniotic,
peritoneal or pericardial fluids
• Items dripping or saturated with infectious agents should be placed in
RMW bags.
• Consult the facility IC Directives and/or the IC Committee on handling
RMW fluids

20. BUMEDINST 6280.1B
• Group 9: Chemotherapy Trace Wastes
• Includes: needles, empty vials, and syringes, gowns, and tubing
containing chemotherapeutic pharmaceuticals or were exposed to
chemotherapeutic pharmaceuticals during treatment of the patients.
• Note: Do not mix trace chemotherapy waste with non-chemotherapy
RMW or Haz. Waste.
• Disposal: Normally yellow provided by a medical waste disposal
contrator.
• (Consult the facility chemotherapy drugs protocol or contact
• the IC Committee and/or Safety Office for additional guidance)

21. Management of Regulated Medical Waste
• Manifesting and Recordkeeping
• Each MTF/DTF must develop and document a system to
monitor disposal of RMW per local, State, and Federal
regulations.
• Shipping: Federal regulations require facilities maintain
shipping paperwork/manifests for 2 years after the RMW was
accepted by the waste carrier. State regulations may be
stricter.
• Information needed for tracking in the facility:
• Date
• Type of Waste
• Amount (weight, volume, or number of containers)
• & Disposition

22. BUMEDINST 6280.1B
• Training
• All employees with occupational exposure to RMW
receive training prior to beginning work and at least
annually thereafter. Supplemental training is given with
any updates related to RMW.

23. Management of Regulated Medical Waste
• Cleanup of Spills
• Post staff to prevent personal from entering the area.
• Wear appropriate personal protective equipment (PPE) to prevent
exposure to RMW during clean up including required levels of:
• Gloves,
• Coveralls,
• Masks, and
• Goggles
• Remove blood and body fluid spills with an absorbent material and
disinfect the area with an EPA-approved disinfectant or a solution of
household bleach 1:10 dilution with clear water

24. BUMEDINST 6280.1B
• Medical Waste Disposal and Treatment Methods
• Steam sterilization requires temperatures of at least 121° C (250° F)
for at least 90 minutes at15 pounds
• per square inch of gauge pressure to be effective.
• Geobacillus stearothermophilus spore strips must be
• used weekly to test the sterilization process.

25. Management of Regulated Medical Waste

26. BUMEDINST 6280.1: Management of
Regulated Medical Waste
References
• BUMED INSTRUCTION 6280.IB
• Navy Environmental Health Center Pharmaceutical Waste
Management Guidelines
• 29 CFR 1910.1030, Occupational Exposure to
Bloodborne Pathogens

27. BUMEDINST 6280.1: Management of
Regulated Medical Waste
• The End
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