HomeMy WebLinkAboutac-medical-waste-management-planPage 1 of 6 Medical Waste Management Plan
Revised March 31, 2021
Ronald Browder, Director of Environmental Health
Phone: (510) 567-6790 Fax: (510) 337-9234
MEDICAL WASTE MANAGEMENT PLAN
(as required in Sections 117935 & 117960 Medical Waste Management Act)
FACILITY INFORMATION:
Facility Name: ______________________________________________________________
Address: __________________________________________________________________
City: ______________________ State: _________________ Zip Code: _______________
Type of Business: __________________________________________________________
Phone Number: __________________ Email Address: ____________________________
Name of Authorized Representative: ___________________________________________
Phone Number: __________________ Email Address: ____________________________
Name of Person Responsible for Implementation of the Medical Waste Management Plan (MWMP): _______________________________________________________________
Phone Number: __________________ Email Address: ____________________________
SECTION 1: TYPES OF MEDICAL WASTE GENERATED AT THIS FACILITY
□Biohazardous waste, including:
o Regulated/biohazardous/medical waste – material from the medical treatment
of a human or animal suspected of being infected with a contagious pathogen;
material from biomedical research; waste suspected of contamination with a
highly communicable disease.
o Laboratory waste – specimen or microbiological cultures; stocks of infectious
agents; live and attenuated vaccines and culture mediums.
o Blood or blood products – fluid human blood and blood products; containers or
equipment containing human blood that is fluid.
o Infectious waste – material contaminated with excretion, exudates or secretions
from humans or animals isolated due to a highly communicable disease.
□Sharps – hypodermic needles, hypodermic needles with syringes, blades, needles with
attached tubing, acupuncture needles, root canal files, broken glass items used in health
care such as Pasteur pipettes, pipette tips, and blood vials contaminated with biohazardous
waste.
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□Pharmaceutical waste – a prescription or over-the-counter human or veterinary drug
medication.
□Pathology waste – human body parts; human or animal surgery specimen or tissues that
may be contaminated with infectious agents.
□Trace chemotherapeutic waste – waste that is contaminated through contact with
chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels,
and intravenous solution bags and attached tubing that are empty.
□Other (specify) -
___________________________________________________________________
SECTION 2: TYPE OF FACILITY
1.This facility is classified as a:
□Small Quantity Generator (less than 200 pounds per month) with NO OnsiteTreatment of Medical Waste
□Small Quantity Generator (less than 200 pounds per month) WITH Onsite
Treatment
□Large Quantity Generator (greater than 200 pounds in any month of the year) –less than 100 licensed Beds with NO Onsite Treatment
□Large Quantity Generator (greater than 200 pounds in any month of the year) –100-200 licensed beds with NO Onsite Treatment
□Large Quantity Generator (greater than 200 pounds in any month of the year) –
Over 200 licensed beds with NO Onsite Treatment
□Large Quantity Generator (greater than 200 pounds in any month of the year) –Less than 100 licensed beds WITH Onsite Treatment
□Large Quantity Generator (greater than 200 pounds in any month of the year) –100-200 licensed beds WITH Onsite Treatment
□Large Quantity Generator (greater than 200 pounds in any month of the year) –
Over 200 licensed beds WITH Onsite Treatment
2.The estimated quantity of medical waste generated (including sharps waste andpharmaceutical waste) by this facility on a monthly basis is ____________ pounds.
Page 3 of 6
Medical Waste Management Plan
Revised March 31, 2021
3.Describe the method of handling: segregation, containment or packaging, labeling,
collection, and storage of each type of biohazardous/medical waste generated by yourfacility (continued on the following page).
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
4.Medical Waste Storage
Is this facility a Common Storage Facility that accumulates onsite, for collection by aregistered biohazardous waste hauler, medical waste from onsite Small QuantityGenerators (SQG) who would otherwise operate independently?
□Yes□No
If “Yes,” please complete the following information for each SQG that uses this Common
Storage Facility (attach additional pages if needed):
5.Describe all disinfection procedures used in your facility for treatment or cleaning ofreusable medical waste receptacles and medical waste spills.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
*
*
*
*Please attach additional pages if needed
Page 4 of 6 Medical Waste Management Plan Revised March 31, 2021
6.Describe the designated accumulation area(s) used for the storage of medical waste.
(Note: A designated accumulation area is an area used for the storage of medicalwaste containers prior to transportation or treatment shall be secured so as to denyaccess to unauthorized persons. See Section 118310 for more detailed requirements.)
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
7.Onsite Medical Waste Treatment (Check all that apply):
□This facility treats medical waste onsite.□Yes□No
If yes, what treatment method(s) are utilized? □Steam sterilization
□Microwave technology□Other approved alternative treatment (Specify)
□This facility uses a registered biohazardous/medical waste hauler to haulregulated waste to an offsite treatment facility.
Hauler Name: ________________________________________________________
Address: ____________________________________________________________
City/State/Zip: _______________________________________________________
Phone: ______________________________
Offsite Treatment Facility: ______________________________________________
□Describe the training program for employees that use treatment equipment at thisfacility._______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
□Describe the closure plan for the termination of treatment at this facility.______________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________
*
Page 5 of 6 Medical Waste Management Plan Revised March 31, 2021
(continued from the previous page)
□Decontamination procedures as specified in Section 118295, sub (a) or (b);
□Statement certifying that the information is complete and correct;□A copy of the Medical Waste Closure Plan is attached;□Contact Alameda County LEA Inspector to arrange a final walkthrough.
SECTION 3: EMERGENCY ACTION PLAN
Note: Large Quantity Generators are required to have an Emergency Action Plan. While not required for Small Quantity Generators (SQG), it is recommended that SQGs complete this section as a good management practice.
In the case of an emergency, such as equipment breakdown on the part of the registered hauler or natural disaster, medical waste will be (check one):
□Stored for up to seven (7) days on the premises. Sufficient storage space is available in:______________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________
□The following alternate registered biohazardous/medical waste hauler will be utilized:
Name: ________________________________________________________________
Address: ______________________________________________________________
City/State/Zip: __________________________________________________________
□This facility utilizes a registered “mail-back” system for our biohazardous/medical waste.
Name: ________________________________________________________________
Address: ______________________________________________________________
City/State/Zip: __________________________________________________________
□Describe in detail how this facility manages medical waste spills (e.g. gloves, mask,gown, disinfectant):
__________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________
□Describe in detail how this facility handles, treats, and disposes of liquid/semi-liquidlaboratory waste:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Page 6 of 6 Medical Waste Management Plan Revised March 31, 2021
□Describe employee training provided by employer.Bloodborne Pathogen Training Provided?
□Yes□No□Other (please describe below)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
SECTION 4: CATEGORIZING PHARMACEUTICALS
□Describe the steps taken to categorize and properly dispose of the pharmaceuticalwastes generated at this facility, specifically, how this facility will separatepharmaceuticals classified by the federal Drug Enforcement Agency (DEA) as“controlled substances” from the standard regulated medical waste stream (if
applicable):____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
□The following registered biohazardous/medical waste hauler will be utilized to haulpharmaceutical wastes.
Name: ________________________________________________________________
Address: ______________________________________________________________
City/State/Zip: __________________________________________________________
I hereby certify that to the best of my knowledge and belief, the statements made
herein are true and correct.
Signature: ___________________________________________________________________
Print Name: _____________________________________ _____ Date: ____/____/____
OFFICIAL USE ONLY
Date received: ____________ ☐ Approved ☐ Approved with changes: _________________________
Additional requirements: ______________________________________________________________
Inspector signature: ______________________________________ Date: ______________________