Regulations that medical waste managers must account for include workplace/occupational safety regulations, emissions that exit to the environments (during storage or treatment), and final disposal of solid refuse. In the United States, federal regulations apply to hazardous and radioactive wastes; any regulations on infectious waste are set by state or local governments.

In the US, environmental laws that sometimes (but usually do not) have an impact on treatment or disposal of medical waste include:

  • Resource Recovery and Conservation Act (RCRA)
  • Toxic Substances Control Act (TSCA)
  • Federal Insecticide, Fungicide and Rodenticide Act (FIFRA)
  • Clean Air Act (CAA)
  • Clean Water Act (CWA)

The hospital industry has an organization - "The Joint Commission" - that accredits individual facilities and offers guidance on operations. As part of their accreditation, commission auditors look into waste and hazardous material management practices. The commission offers advice on waste management for hospital administrators.

Workplace Safety

OSHA (Occupational Safety and Health Administration) has rules to protect healthcare workers who work with hazardous and dangerous materials. OSHA has a lot to say about about "regulated waste" (blood products). Even the Drug Enforcement Agency sometimes gets involved when pharmaceutical waste is involved.


Regulators take a multi-media approach to emissions. Early on in environmental regulation - the 1960s and 70s - land, water, and air were considered separately. But they are interwoven today. One reason medical waste poses such a headache is that a portion - maybe 15 percent - is regulated by more than one agency in the US. In the United States, federal government and state government agencies regulate aspects of medical waste management, as do some local governments. RCRA hazardous waste is regulated by the Environmental Protection Agency. Radioactive waste is regulated by the Nuclear Regulatory Commission. The federal Department of Transportation has regulations on transport of infectious and pathological waste. The Drug Enforcement Agency even gets involved sometimes. Treatment of biological waste is subject to state laws; the federal government does not get involved for the most part, although the EPA regulates air emissions from medical waste incinerators.

The EPA released standards and guidelines in 1997 for emissions from medical waste incinerators. Partly as a result of the regulations, there are fewer incineration units operating in the US than there were decades ago, and the remaining ones are larger and cleaner.

The Medical Waste Treatment Act (MWTA)

In 1989 Congress enacted this law partly as an experiment to test regulation of the medical industry’s waste production, storage, treatment and disposal. (The MWTA was actually an amendment to the Solid Waste Disposal Act.) While MWTA was in effect the EPA regulated waste in New York, Connecticut, New Jersey, Rhode Island, and Puerto Rico. The law took effect in June 1989 and the findings were reported to Congress by September 1991. At that time Congress declined to extend the act and make EPA authority over medical waste permanent.

EPA authorities stated that they hoped the regulations under MWTA would be adopted by states in formulating their own regulations.

In 2013 a bill introduced to the House of Representatives (H.R.2891 - Medical Waste Management Act of 2013) would have required generators of medical waste, including tattoo parlors, to register with the EPA and to provide information to the EPA about shipments of waste off-site. The bill did not get through committee. This bill was similar to H.R. 2552 (111th): Medical Waste Management Act of 2009 which was sponsored by the same congressman and which also did not get through the House.

State Agencies

Alabama Department of Environmental Management
Alaska Department of Environmental Conversation
Arizona Department of Environmental Quality
Arkansas Department of Environmental Quality
California Environmental Protection Agency
Colorado Department of Public Health and Environment
Connecticut Department of Energy and Environmental Protection
Delaware Division of Waste and Hazardous Substances
District of Columbia Dept of Energy and Environment
Florida Department of Health
Georgia Department of Consumer Affairs
Hawaii Department of Health
Idaho Department of Environmental Quality
Illinois Environmental Protection Agency
Indiana Department of Environmental Management
Iowa Department of Natural Resources
Kansas Department of the Environment
Kentucky Energy and Environment Cabinet
Louisiana Department of Environmental Quality
Maine Department of Environmental Protection
Maryland Department of the Environment
Massachusetts Department of Environmental Protection
Michigan Department of Environment, Great Lakes, and Energy
Minnesota Pollution Control Agency
Mississippi Department of Environmental Quality
Missouri Department of Natural Resources
Montana Department of Environmental Quality
Nebraska Department of Environment and Energy
Nevada Department of Environmental Protection
New Hampshire Department of Environmental Services
New Jersey Department of Environmental Protection
New Mexico Environment Department
New York Department of Environmental Conservation
North Carolina Department of Environmental Quality
North Dakota Division of Waste Management
Ohio Environmental Protection Agency
Oklahoma Department of Environmental Quality
Oregon Department of Environmental Quality
Pennsylvania Department of Environmental Protection
Rhode Island Department of Environmental Management
South Carolina Department of Health and Environmental Control
South Dakota Department of Agriculture & Natural Resources
Tennessee Department of Environmental and Conservation
Texas Commission on Environmental Quality
Utah Division of Waste Management and Environmental Control
Vermont Department of Environmental Conservation
Virginia Department of Environmental Quality
Washington Department of Ecology
West Virginia Department of Environmental Protection
Wisconsin Department of Natural Resources
Wyoming Department of Environmental Quality


Guam Environmental Protection Agency
American Samoa Environmental Protection Agency
Northern Mariana Islands Division of Environmental Quality
Puerto Rico Solid Waste Authority

The majority of regulations for the treatment and disposal of potentially infectious medical waste are enforced by state and local agencies. For example, in Massachusetts the regulations on medical waste are under the jurisdiction of the commonwealth’s Department of Public Health for the state, and Boards of Health on the local level. The Department of Public Health administers the State Sanitary Code, part of which regulates the storage, treatment and disposal of medical waste. In California, the Environmental Management Branch of the California Department of Public Health regulates the storage, treatment and disposal of medical waste. Information on state regulations can generally be found on the state government web sites under the department of public health.

Cross-Border Regulations

A major international treaty on trade involving medical waste is the Basel Convention, formally called the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal. While the convention speaks of “hazardous” waste, this is hazardous in its more general sense, not as defined by RCRA in US law. One section is "H 6.2 – Infectious substances – substances or wastes containing viable microorganisms or their toxins which are known or suspected to cause disease in animals or humans." It also refers to pharmaceuticals waste and medical waste from hospitals. It tries to apply the “prior informed consent” principle and to prohibit exploitation, it outlaws shipments without consent to and from people who did not explicitly agree to be involved.