NR 526.18NR 526.18 Waste audit. Before completing or updating the medical waste reduction plan required in s. NR 526.19, each director or director’s designee shall audit the medical facility’s current solid waste management practices. Each director or director’s designee shall repeat the audit at least every 5 years for the whole medical facility or more frequently for any part of the facility where there has been a significant change in solid waste characteristics or amounts of solid waste due to major remodeling, expansion of service or other factors. Each director or director’s designee shall keep a copy of the results of the initial audit and all subsequent audits at the medical facility. The department may review these records upon request. The waste audit shall address all of the following: NR 526.18(1)(1) Source areas. The waste audit shall identify all areas within the medical facility where solid waste, not just medical waste, is generated. NR 526.18(2)(2) Waste types. The waste audit shall identify the types of waste that are generated within each source area. It is not necessary to determine how much of each waste type is generated in each source area. The waste types are: medical waste, including infectious waste items listed in s. NR 526.05 and items which are either being mixed with infectious waste or handled as infectious waste; hazardous waste, including but not limited to hazardous chemotherapy waste; radioactive waste; trace chemotherapy waste; recyclable materials; wastes which may have to be managed separately because they are any combination of infectious, hazardous or radioactive waste; and other solid waste. NR 526.18 NoteNote: Infectious waste which is also hazardous may also be regulated by the department under hazardous waste rules. See chs. NR 660 to 670 and s. NR 526.11 (2) (f). Infectious waste which is also radioactive is regulated by the department of health services under ch. DHS 157 and the federal government under Title 10 CFR until no longer regulated as radioactive material, as provided in s. NR 526.02 (6). NR 526.18(3)(3) Quantity of medical waste. The waste audit shall identify how many pounds of medical waste the medical facility, as a whole, generated during the previous 12 months. NR 526.18(4)(4) Medical waste generation rate. The waste audit shall identify the rate at which the medical facility generated medical waste during the 12 months covered by the audit. The waste generation rate shall be calculated according to the appropriate formula in s. NR 526.21 (1). NR 526.18(5)(5) Waste management practices. The waste audit shall identify how medical waste is collected, stored, transported and treated from the point of generation to the point of final disposal, including any medical waste discharged to a publicly-owned wastewater treatment system. The audit shall identify how non-infectious waste is prevented from being mixed with infectious waste. The audit shall include any waste types that are currently mixed with or may be mixed with infectious waste. The audit may also identify waste management practices for waste types that are not mixed with medical waste. NR 526.18 HistoryHistory: Cr. Register, October, 1994, No. 466, eff. 11-1-94; CR 05-020: am. (2) Register January 2006 No. 601, eff. 2-1-06. NR 526.19NR 526.19 Medical waste reduction plan. NR 526.19(1)(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: NR 526.19(1)(a)(a) Include all of the information required in subs. (3) to (10) in the medical waste reduction plan. NR 526.19(1)(b)(b) Assess the medical waste reduction plan and its results annually and update the plan at least every 5 years. NR 526.19(1)(c)(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. NR 526.19(1)(d)(d) Consider the following priorities in developing the medical waste reduction plan: NR 526.19(1)(d)1.1. 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. NR 526.19(1)(d)2.2. 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. NR 526.19(1)(e)(e) Consider all of the following factors when evaluating waste management strategies and alternatives to disposables: NR 526.19(1)(e)2.2. Probable adverse effects on patient care and worker safety posed by the alternatives. NR 526.19(1)(e)3.3. Probable effects of transferring waste disposal to other media, including land, air and water. NR 526.19(1)(e)6.6. 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. NR 526.19(1)(e)7.7. Availability of products or equipment needed to implement an alternative. NR 526.19(2)(a)(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. NR 526.19(2)(b)(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. NR 526.19(2)(c)(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. NR 526.19(2)(d)(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. NR 526.19(2)(e)(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. NR 526.19(3)(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: NR 526.19(3)(a)(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. NR 526.19(3)(b)(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). NR 526.19(3)(c)(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). NR 526.19(3)(d)(d) Maintaining an effective program for reducing medical waste through education, training, monitoring and assessment, according to subs. (7), (8) and (9). NR 526.19(4)(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. NR 526.19(5)(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. NR 526.19(6)(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. NR 526.19(7)(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. NR 526.19(8)(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: NR 526.19(8)(a)(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. NR 526.19(8)(a)1.1. 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. NR 526.19(8)(a)2.2. New employees and medical personnel who work within the medical facility shall be trained as part of their initial orientation. NR 526.19(8)(b)(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. NR 526.19(9)(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: NR 526.19(9)(a)(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). NR 526.19(9)(b)(b) Inspecting the medical facility periodically and enforcing the medical waste reduction plan. NR 526.19(9)(c)(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. NR 526.19(9)(e)(e) Assessing progress toward goals and objectives annually. NR 526.19(9)(f)(f) Reviewing the contents of the medical waste reduction policy every 5 years and the medical waste reduction plan annually. NR 526.19(9)(g)(g) Updating the policy and plan as necessary or at least every 5 years. NR 526.19(10)(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). NR 526.19 HistoryHistory: 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; correction in (2) (b) made under s. 13.92 (4) (b) 7., Stats., Register July 2022 No. 799. NR 526.20NR 526.20 Implementation and assessment. Unless exempt under s. NR 526.16, a director shall implement the medical waste reduction plan and assess the plan and the results of its implementation annually. If the department determines that a reasonable effort has not been made to follow the process outlined in this subchapter or to reduce waste, the department may require the director to submit the plan for review and require changes to the plan, which may include but are not limited to changes in goals, objectives, objective waste generation rate, schedules and waste management practices. NR 526.20(1)(1) Implementation. A director shall implement the medical waste reduction plan by the following dates: NR 526.20(1)(a)(a) For a medical facility which generates 500 pounds or more of medical waste per month, within 12 months of November 1, 1994. NR 526.20(1)(b)(b) For a medical facility which generates 200 pounds or more but less than 500 pounds of medical waste per month, within 24 months of November 1, 1994. NR 526.20(1)(c)(c) For a medical facility which generates 50 pounds or more but less than 200 pounds of medical waste per month, within 36 months of November 1, 1994. NR 526.20(2)(2) Assessment. Each director or director’s designee shall assess annually both the medical waste reduction plan and the results of implementation of the plan, unless the medical facility is exempt under s. NR 526.16 (2). After completing each annual assessment, the director shall submit a progress report to the department according to s. NR 526.21. NR 526.20 HistoryHistory: Cr. Register, October, 1994, No. 466, eff. 11-1-94. NR 526.21NR 526.21 Progress reports. Unless exempt under s. NR 526.16 (2), each director shall submit progress reports to certify that the director has adopted a medical waste reduction policy, prepared and implemented a medical waste reduction plan and is maintaining efforts to reduce medical waste. The director shall submit progress reports to the department using the infectious waste annual report form required in s. NR 526.15 and supplied by the department, regardless of whether or not infectious waste manifests have been used during the preceding calendar year. NR 526.21 NoteNote: Infectious waste annual report forms (DNR form 4400-177) may be obtained from the department of natural resources, bureau of waste management, 101 S. Webster Street, P.O. Box 7921, Madison, WI 53707-7921. Phone number (608) 266-2111.
NR 526.21(1)(1) First progress report. The first progress report shall be submitted to the department within 4 months of the date specified in s. NR 526.20 (1) for implementation of the plan. The first progress report shall include all of the following: NR 526.21(1)(a)(a) Selected information required on the infectious waste annual report form provided by the department. NR 526.21(1)(c)(c) Rate of medical waste generated. For waste audits and the first progress report, the year used shall be the audited year. For annual progress reports, the year used shall be the calendar year on which the progress report is based. The medical waste generation rate shall be expressed as follows: NR 526.21(1)(c)1.1. For hospitals and nursing homes, in pounds per patient-day, according to the following formula, unless the department approves an alternative formula in writing: NR 526.21(1)(c)2.2. For clinics, except free-standing dialysis clinics, in pounds per day per treatment area, according to the following formula, unless the department approves an alternative formula in writing: NR 526.21(1)(c)3.3. For free-standing dialysis clinics, in pounds per dialysis treatment, according to the following formula, unless the department approves an alternative formula in writing: NR 526.21(1)(d)(d) Dates and titles of the medical waste reduction policy and the medical waste reduction plan and of any revisions to the policy or plan. NR 526.21(1)(e)(e) An executive summary of the medical waste reduction plan, including goals and objectives. NR 526.21(1)(f)(f) A brief description of progress toward meeting goals and implementing objectives, including but not limited to: the impact of waste reduction efforts on waste generation weight and rates; impacts of other factors on waste generation weight and rates, such as changes in types of treatment performed or acuity level of patients; benefits and problems with implementation; and how the problems have been addressed. NR 526.21(1)(g)(g) Certification by the director that the information on the form is true and accurate. NR 526.21(2)(2) Annual progress reports. After the first progress report, the director shall submit annual progress reports for each calendar year by March 1 of the following year. Annual progress reports shall: NR 526.21(2)(b)(b) Indicate whether or not the policy and plan have been revised in the previous year, specify the dates of any revisions and briefly describe the revisions. NR 526.21 HistoryHistory: Cr. Register, October, 1994, No. 466, eff. 11-1-94; am. (1) (intro.), (h), Register, June, 1996, No. 486, eff. 7-1-96; CR 05-020: am. (1) (c) 2., cr. (1) (c) 3. Register January 2006 No. 601, eff. 2-1-06. NR 526.22NR 526.22 Availability. Unless exempt under s. NR 526.16 (2), each director shall make its medical waste reduction policy and medical waste reduction plan available as follows: NR 526.22(1)(1) Each director shall submit copies of the most recent medical waste reduction policy and plan, any amendments to the policy or plan, and all progress reports to the operator of each medical waste incinerator used to burn medical waste generated by the medical facility. NR 526.22(2)(2) Each director shall make available copies of the most recent medical waste reduction policy and plan, any amendments to the policy or plan, the results of all waste audits, and all progress reports to the department for review upon request. The department may require the director to provide a copy of this material to the department without charge to the department. Upon receipt of the plan, the department will send an invoice for the medical waste reduction plan review fee required in s. NR 520.04, Table 2. NR 526.22(3)(3) Each director shall make available copies of the most recent medical waste reduction policy and plan, any amendments to the policy or plan, and the progress reports, to other persons for review upon request, during normal administrative business hours. Each director shall provide copies of the policy, plan, annual assessments or amendments to any person who requests these documents either in writing or in person. The director may charge the person a reasonable fee to cover the cost of copying and mailing the documents.
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