MSW Efficiency Projects

Daniela Ortiz de Montellano & Mario Perez

2015 TCEQ Environmental Trade FairMedical Waste Management

Regulations for the handling, treatment & proper disposal of medical waste, including Ebola waste1Who Regulates Medical Waste in Texas

Medical Waste Definitions

Types of Authorizations

Application Contents/Processing

Ebola Experience 2014

Agenda2Regulatory Agencies

Diagram that shows the different Texas regulatory agencies that manage medical waste. These agencies are the Texas Commission on Environmental Quality, Texas Department of State Health Services, U.S. Department of Transportation and other local and or federal agencies

325 TAC 1.132 (44) - Special waste from health care-related facilitiesAnimal waste exposed to pathogensBulk human blood & body fluids Pathological wasteMicrobiological wasteSharps

Definition - DSHS4 49 C.F.R., Parts 171-180 - DOT Hazardous Materials Regulations Category A Infectious Substance: Capable of causing: permanent disabilitylife-threatening disease fatal diseaseCategory B Infectious Substance

Definition- U.S. DOT530 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 6Exceptions

Definition - TCEQ

Pictures of a house, hotel and farm as examples of entities that are except from the regulations of medical waste.

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Diagram that shows the three different types of authorizations for the management of medical waste. These area notification, registration by rule, and municipal solid waste Type V Registration.8

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 PermitsDiagram that shows the types of notification which is required for self-transporters and on-site treatment9Transporter: 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).

Diagram that shows the types of Registration by Rule that is required for Transporters and On-site Treater

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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 sourcesDiagram that shows the types MSW Type V Registration which aris required for transfer stations, treatment and storage facilites11Medical Waste - Type V RegistrationApplicable Rules in 30 Texas Administrative Code (30 TAC):Chapter 330 Chapter 330 Subchapter Y only for medical wasteChapter 116Chapter 305Chapter 39Chapter 37

12General InformationCore Data Form (Form No. 10400)Part IPart I Form (Form No. 0650)Part IIWaste Acceptance PlanFacility ImpactCoordination Letters

Application CONTENt 13Part III Site Development PlanFacility DesignStorage & Transfer Unit DesignsClosure Plan & Cost Estimates

Part IV Site Operating Plan (SOP)Sub Ch. E (Transfer & Processing Units)Sub Ch. Y (Med Waste Management)Storage Requirements - 330.1209Treatment & Disposition - 330.1219

App. CONTENT - CONT'D14Type V Reg. Application Process

Flow Diagram for a Type V Registration Application Process

15Ebola in the U.S.

Task Force on Infectious Disease Preparedness and ResponseTCEQs roleConclusion - Task Force Report & Recommendations

Ebola Experience 2014Ebola Experience primarily from TCEQs perspective and specifically MSW Permits

16First 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.17The Task Force Created Oct 6 17 members

Immediately provide frontline support for decision makers Identify issues/provide resolutionsPublic transparencyWaste management - TCEQ

task force 17 members led by the Director of the Task Force is Dr. Brett Giroir of Texas A&M Health Science Center along with other high level leaders of from state agencies including our own Executive Director, Mr. Richard Hyde.Duties:Task force mobilized and coordinated with various state and federal agencies; medical experts, and those directly affected by the disease; although the force was created on Oct 6; it was set in motion by then governor perry on october 1st.The task force made available resources needed to enable those folks in charge of public health and safety; to take appropriate actions in response to the ebola emergency.

If you recall during Danielas presentation how she spelled out requirements for package, label, transport, treat and disposal of medical waste. Well under normal circumstances, that all works very well; its orderly and structured but under the situation that Texas faced; issues were identified that required rapid responses; issues such as how to classify infectious waste originating in non health care tionsthe resourcesan open line of communication between the task force all the way down to staff level

18Classification of Ebola contaminated materialList of treatment & disposal facilities Treatment options & how effectivePackaging/Labeling requirements

Sample questions for tceq 19tceqs ResponseClassification 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

20tceqs Response

Map of the State of Texas that shows the location of 16 active medical waste processing facilities.

21tceqs ResponseEfficacy for each type of treatment incineration preferred

Disposal options ash

Packaging & Labeling DOT Cat A Example - Triple Packaging

22tceqs Response

Diagram from the US DOT that shows the packaging materials and steps required for the transportation of Ebola contaminated waste.

23tceqs Response

Clean-up crew in a hazardous material suit carring a 95 gallon overdrum that holds a 55 gallon drum of Ebola contaminated waste.

24December 1, 2014Issue 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 plan84th Legislature Proposed HB 2950 & SB 538

task force recommendations ConclusionThe bill would create a Task Force as an advisory board to the governor and grant the governor authority to appoint members from relevant state agencies, members from institutions of higher education in Texas, and members with expertise in infectious diseases and other issues related to the prevention of the spread of infectious diseases. The governor shall appoint a director of the task force from among the task force members.The Task Force would be assigned duties that include:providing expert, evidence-based assessments, protocols, and recommendations related to state responses to infectious diseases, including Ebola, and a strategic emergency management plan for state and local levels of government; developing a comprehensive plan to ensure that Texas is prepared for potential outbreaks of infectious diseases, such as the Ebola virus, and can provide rapid response that effectively protects the safety and well-being of citizens of this state: the plan shall use significant expertise of medical professionals in Texas and other states;collaborate with local government officials and local health officials;use as practicable, the Texas Emergency Preparedness Plan and structure;identify various responses necessary in the event of an epidemic of infectious disease;establish a command and control structure that will ensure effective preparations and response if the governor takes emergency action under Chapter 418, Government Code, or other law; andcoordinate with appropriate entities to ensure public awareness and education regarding any pandemic threat.evaluating the supplies and resources available to address an infectious disease outbreak; and serving as a reliable and transparent source of information and education for Texas leadership and citizens.

25Mario PerezMario.Perez@tceq.texas.govor (512) 239-6681

Daniela Ortiz de MontellanoDaniela.Ortiz-Demontellano@tceq.texas.govor (512) 239-2210

Contacts:Cartoon with a question mark

26http://www.tceq.texas.gov/permitting/waste_permits/msw_permits/mw_disposal.html - checklists & other info

https://www.tceq.texas.gov/publications/rg/rg-001.html - Texas regulatory guidance document on medical waste

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