Section NR 526.19 - Medical waste reduction plan(1) GENERAL PROVISIONS. Unless exempt under s. NR 526.16 (2), each director or director's designee shall prepare a medical waste reduction plan for separating, reducing and managing the medical waste generated, for evaluating alternatives to disposable products and for maintaining waste reduction efforts. The director or director's designee shall do all of the following when preparing the medical waste reduction plan:(a) Include all of the information required in subs. (3) to (10) in the medical waste reduction plan.(b) Assess the medical waste reduction plan and its results annually and update the plan at least every 5 years.(c) Keep a copy of the most recent medical waste reduction plan and make it available for the department to review upon request according to s. NR 526.22 (2). The department may require the director to submit a copy of the plan and related materials to the department for its review and approval. The department may approve the plan with conditions, including but not limited to specifying goals, objectives and schedules.(d) Consider the following priorities in developing the medical waste reduction plan: 1. Waste reduction, including but not limited to: reducing the amount of packaging and the use of disposable items, substituting other products and materials, changing or modifying equipment, changing purchasing policies or procedures, changing housekeeping practices, providing more effective ways to separate infectious wastes from all other waste types, and selling or donating unused items and equipment to others.2. Reuse by appropriate reprocessing, including but not limited to: sterilizing, disinfecting, decontaminating, laundering, recharging, exchanging waste or equipment with others, and selling or donating reprocessed items or equipment to others.3. Recycling of recyclable materials.(e) Consider all of the following factors when evaluating waste management strategies and alternatives to disposables:1. Costs, including benefits, savings and reduced liabilities.2. Probable adverse effects on patient care and worker safety posed by the alternatives.3. Probable effects of transferring waste disposal to other media, including land, air and water.4. State recycling laws and rules and local recycling ordinances.5. Recycling options available in the area.6. Compliance with other rules and regulations that apply to or within the medical facility, such as occupational health and safety regulations, state and federal air management regulations, state and federal wastewater regulations and state and federal hazardous waste regulations.7. Availability of products or equipment needed to implement an alternative.8. Other considerations specific to the medical facility.(2) OPTIONAL PROVISIONS. (a) The director or director's designee may also address the waste types listed in s. NR 526.18 (2) in the medical waste reduction plan, or incorporate the medical waste reduction plan within a comprehensive waste management plan for the medical facility.(b) The medical waste reduction plan may describe, incorporate or refer to waste reduction policies or waste minimization plans adopted prior to November 1, 1994 or to applicable waste handling and management policies or plans developed under other rules, such as s. NR 662.041, or under the requirements of other agencies such as OSHA or the joint commission on accreditation of healthcare organizations.(c) If the medical facility manages its infectious waste with other infectious waste generators, the director or director's designee may work together with those generators to develop a single medical waste reduction plan.(d) The medical waste reduction plan may describe incentives which are offered to encourage staff to participate actively in implementing, evaluating and improving the plan.(e) When setting goals in sub. (3), the director or director's designee may recognize and maintain past accomplishments in reducing medical waste. The plan may list other goals, including other numerical goals, which encourage continuous improvement in medical waste reduction. Numerical goals may be modified over time to reflect changing conditions.(3) GOALS AND OBJECTIVES. The medical waste reduction plan shall list the medical facility's internal goals, objectives and a timetable for reducing the amount of medical waste generated by the medical facility. Goals shall include, but are not limited to, all of the following: (a) Meeting a specific numerical goal expressed in terms of a medical waste generation rate calculated according to s. NR 526.21 (1). If a medical facility has already significantly reduced its medical waste generation rate and has implemented policies which meet all of the goals in pars. (b) to (d), the numerical goal may be to maintain the current medical waste generation rate.(b) Preventing the mixing of non-infectious waste with infectious waste by separating waste at the source according to s. NR 526.06 and by implementing the waste management procedures developed under sub. (5).(c) Reducing the use of disposable items when it is practical to do so, by implementing the procedures for evaluating alternatives to disposables developed under sub. (6).(d) Maintaining an effective program for reducing medical waste through education, training, monitoring and assessment, according to subs. (7), (8) and (9).(4) BASELINE AND PAST PRACTICES. The medical waste reduction plan shall briefly describe the practices related to medical waste management that were in effect during the most recent waste audit and any past efforts to reduce medical waste. Descriptions of baseline practices shall include but not be limited to all of the following: the waste management practices identified during the most recent waste audit under s. NR 526.18 (5); how alternatives to disposables were being evaluated; how medical waste management costs were being estimated; where any records of total medical waste generation, on-site treatment and off-site transportation were kept, and which positions were responsible for implementing each of these activities. Descriptions of past practices shall include what the medical facility has done to reduce medical waste from November 1, 1994 until the most recent audit and may include waste reduction efforts prior to November 1, 1994.(5) WASTE MANAGEMENT. The director or director's designee shall consider the priorities in sub. (1) (d) and the factors in sub. (1) (e) when evaluating alternative waste management practices and developing waste management policies or procedures. The medical waste reduction plan shall briefly describe how the director or director's designee intends to prevent the mixing of non-infectious waste with infectious waste. The plan shall include or refer to written policies or procedures for collecting, storing, transporting and treating medical waste from the point of generation to the point of disposal, including any medical waste discharged to a publicly-owned wastewater treatment system.(6) ALTERNATIVES TO DISPOSABLE ITEMS. The medical waste reduction plan shall include or refer to written policies or procedures for evaluating alternatives to disposables when purchasing medical materials, supplies and equipment. The policies or procedures shall specify how alternative products, replacement costs, treatment costs, disposal costs, the priorities in sub. (1) (d) and the factors in sub. (1) (e) will be evaluated prior to purchasing.(7) PUBLIC EDUCATION. The medical waste reduction plan shall include or refer to specific written policies and procedures for informing volunteers, patients and their guests about waste disposal in order to prevent non-infectious waste from being put in containers meant only for infectious waste. Education is required only in areas where volunteers, patients and their guests have access to infectious waste containers. Education may include but is not limited to any one or more of the following: labels placed on or signs near infectious waste containers indicating who may place waste in those containers or what may be placed in them, pamphlets, notices, verbal education or other means.(8) STAFF TRAINING. The medical waste reduction plan shall provide for the training of all employees and medical personnel who work within the medical facility, as follows: (a)Initial training. Initial training shall include, at a minimum, the waste management practices, policies and procedures for medical waste and for any other waste types generated in the source areas in the areas in which they work. 1. Existing employees and medical personnel who work within the medical facility shall receive training regarding the waste management policies and practices within 6 months after the medical waste reduction policy goes into effect. If the director or director's designee has implemented a medical waste reduction plan prior to November 1, 1994, initial training done to implement the plan will meet the intent of this subdivision.2. New employees and medical personnel who work within the medical facility shall be trained as part of their initial orientation.(b)Annual updates. All employees and medical personnel who work within the medical facility shall receive training annually on waste handling and management policies, procedures and practices for the waste types generated in the source areas in which they work.(9) MONITORING AND ASSESSMENT. The medical waste reduction plan shall describe how the director or director's designee will monitor and assess waste reduction efforts. The plan shall include or refer to policies or procedures, where appropriate, for doing all of the following:(a) Keeping records of total medical waste generation, on-site treatment and off-site shipment of medical waste for at least 5 years in order to meet the requirement in par. (g).(b) Inspecting the medical facility periodically and enforcing the medical waste reduction plan.(c) Monitoring the medical facility annually for changes which would make it necessary for the facility to repeat the waste audit according to s. NR 526.18.(d) Reviewing the process of plan implementation annually.(e) Assessing progress toward goals and objectives annually.(f) Reviewing the contents of the medical waste reduction policy every 5 years and the medical waste reduction plan annually.(g) Updating the policy and plan as necessary or at least every 5 years.(h) Preparing and submitting progress reports according to s. NR 526.21.(10) POSITIONS. The medical waste reduction plan shall identify the employee positions that will be responsible for each of the following activities in the plan: preparing the plan, evaluating and implementing alternative waste management practices, evaluating and implementing alternatives to disposables, education and training, and the activities associated with monitoring and assessment under sub. (9).Wis. Admin. Code Department of Natural Resources NR 526.19
Cr. Register, October, 1994, No. 466, eff. 11-1-94; correction in (2) (b) made under s. 13.93(2m) (b) 7, Stats., Register April 2013 No. 688.Amended by, correction in (2) (b) made under s. 13.92 (4) (b) 7, Stats., Register July 2022 No. 799, eff. 8/1/2022.