(1) Each home for
the aged must develop, maintain and implement written policies and procedures
for the definition and handling of its infectious waste. These policies and
procedures must comply with the standards of this section.
The following waste shall be considered
to be infectious waste:
contaminated by residents who are isolated due to communicable disease, as
provided in the U.S. Centers for Disease Control "Guidelines for Isolation
Precautions in Hospitals";
Cultures and stocks of infectious agents including specimen cultures collected
from medical and pathological laboratories, cultures and stocks of infectious
agents from research and industrial laboratories, wastes from the production of
biologicals, discarded live and attenuated vaccines, and culture dishes and
devices used to transfer, inoculate, and mix cultures;
(c) Waste human blood and blood products such
as serum, plasma, and other blood components;
(d) Pathological waste, such as tissues,
organs, body parts, and body fluids that are removed during surgery and
(e) All discarded sharps
(including but not limited to, hypodermic needles, syringes, pasteur pipettes,
broken glass, scalpel blades) used in resident care or which have come into
contact with infectious agents during use in medical, research, or industrial
(f) Other waste
determined to be infectious by the facility in its written policy.
(3) Infectious and hazardous waste
must be segregated from other waste at the point of generation (i.e., the point
at which the material becomes a waste) within the facility.
Waste must be packaged in a manner that
will protect waste handlers and the public from possible injury and disease
that may result from exposure to the waste. Such packaging must provide for
containment of the waste from the point of generation up to the point of proper
treatment or disposal. Packaging must be selected and utilized for the type of
waste the packages will contain, how the waste will be treated and disposed,
and how it will be handled and transported, prior to treatment and disposal.
(a) Contaminated sharps must be directly
placed in leakproof, rigid, and puncture-resistant containers which must be
disposable or reusable, all containers, bags, and boxes used for containment
and disposal of infectious waste must be conspicuously identified. Packages
containing infectious waste which pose additional hazards (including but not
limited to, chemical, radiologicals) must also be conspicuously identified to
clearly indicate those additional hazards.
(c) Reusable containers for infectious waste
must be thoroughly sanitized each time they are emptied, unless the surfaces of
the containers have been completely protected from contamination by disposable
liners or other devices removed with the waste.
(d) Opaque packaging must be used for
After packaging, waste must be handled and transported by methods ensuring
containment and preservation of the integrity of the packaging, including the
use of secondary containment where necessary. Plastic bags of infectious waste
must be transported by hand.
Waste must be stored in a manner which preserves the integrity of the
packaging, inhibits rapid microbial growth and putrefaction, and minimizes the
potential of exposure or access by unknowing persons.
(a) Waste must be stored in a manner and
location which affords protection from animals, precipitation, wind, and direct
sunlight, does not present a safety hazard, does not provide a breeding place
or food source for insects or rodents, and does not create a
(b) Pathological waste
must be promptly treated, disposed of, or placed into refrigerated
event of spills, ruptured packaging, or other incidents where there is a loss
of containment of waste, the facility must ensure that proper actions are
immediately taken to:
(a) Isolate the area
from the public and non-essential personnel;
(b) To the extent practicable, repackage all
spilled waste and contaminated debris in accordance with the requirements of
paragraph 6 of this section;
Sanitize all contaminated equipment and surfaces according to written policies
and procedures which specify how this will be done appropriately;
(d) Complete an incident
report and maintain a copy on file.
Except as provided otherwise in this
rule, a facility must treat or dispose of infectious waste by one or more of
the methods specified in this paragraph.
A facility may treat infectious waste in an on-site sterilization or
disinfection device, or in an incinerator or a steam sterilizer, which has been
designed, constructed, operated and maintained so that infectious waste treated
in such a device is rendered non-infectious and is, if applicable, authorized
for that purpose pursuant to current rules of the Department of Environment and
Conservation. A valid permit or other written evidence of having complied with
the Tennessee Air Pollution Control Regulations shall be available for review,
if required. Each sterilizing or disinfecting cycle must contain appropriate
indicators to assure that conditions were met for proper sterilization or
disinfection or materials included in the cycle, and appropriate records kept.
Proper operation of such devices must be verified at least monthly, and records
of the monthly verifications shall be available for review. Waste that contains
toxic chemicals that would be violatilized by steam must not be treated in
steam sterilizers. Infectious waste that has been rendered to carbonized or
mineralized ash shall be deemed non-infectious. Unless otherwise hazardous and
subject to the hazardous waste management requirements of the current rules of
the Department of Environment and Conservation, such ash shall be disposable as
a (non-hazardous) solid waste under current rules of the Department of
Environment and Conservation.
facility may discharge liquid or semi-liquid infectious waste to the collection
sewerage system of a wastewater treatment facility which is subject to a permit
pursuant to T.C.A. §§
69-3-101, et seq., provided that
such discharge is in accordance with any applicable terms of that permit and/or
any applicable municipal sewer use requirements.
(c) Any health care facility accepting waste
from another state must promptly notify the Department of Environment and
Conservation, county, and city public health agencies, and must strictly comply
with all applicable local, state and federal regulations.
(9) The facility may have waste transported
off-site for storage, treatment, or disposal. Such arrangements must be
detailed in a written contract, available for review. If such off-site location
is located within Tennessee, the facility must ensure that it has all necessary
State and local approvals, and such approvals shall be available for review. If
the off-site location is within another state, the facility must notify in
writing all public health agencies with jurisdiction that the location is being
used for management of the facility's waste. Waste shipped off-site must be
packaged in accordance with applicable federal and state requirements. Waste
transported to a sanitary landfill in this state must meet the requirements of
current rules of the Department of Environment and Conservation.
(10) Human anatomical remains which are
transferred to a mortician for cremation or burial shall be exempt from the
requirements of this rule.
garbage, trash and other non-infectious waste shall be stored and disposed of
in a manner that must not permit the transmission of disease, create a
nuisance, provide a breeding place for insects and rodents, or constitute a
safety hazard. All containers for waste shall be water tight, constructed of
easily-cleanable material, and shall be kept on elevated platforms.