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May 22, 2013
New requirements for medical waste incinerators

In a final action taken under Section 129 of the Clean Air Act (CAA), the EPA has issued amendments to regulations to control air emissions from hospital/medical/infectious waste incinerators (HMIWIs). 

Combustion of medical waste results in air emissions containing some of the most harmful pollutants, including dioxin, mercury, and lead.  In contrast to most of the claims the EPA makes about the effects its rules have on businesses, the clear intent of the Agency’s HMIWI regulations is to put an end to the incineration of medical waste.  The strategy has been effective.  When the first federal air rules for medical waste incinerators were issued in the mid-1990s, there were about 2,500 HMIWIs nationwide.  Today, there are probably fewer than 50. 

The action is composed of two parts. 

First, the EPA has amended the federal implementation plan (FIP) for HMIWIs, which applies to the revised emissions guidelines (EG) the Agency published in October 2009.  The revised EGs required improvements in performance for 50 of the then-operating 57 HMIWIs. 

Second, the action amends the New Source Performance Standards (NSPS) for HMIWIs to eliminate an exemption from emissions limits and other standards during periods of start-up, shutdown, and malfunction (SSM).


The CAA requires that states with HMIWIs submit plans that implement and enforce the amended EGs within 1 year of promulgation of the EGs.  For states that have existing HMIWIs but do not have an EPA-approved plan, the Agency must develop and implement a federal plan within 2 years following promulgation of the EGs.  The FIP is an interim measure to ensure that emissions standards are implemented until states assume their role as the preferred implementers of the EGs. 

States without existing HMIWIs must submit a letter of negative declaration certifying that there are no HMIWIs in the state. The EPA reports that it has not received state plans or negative declarations from 25 states and or territories.  Eight states and or territories have indicated they intend to accept delegation of the FIP for HMIWIs.

The EPA estimated that the 2009 EGs would result in total emissions reductions of 393,000 pounds per year of regulated pollutants, of which acid gases (i.e., hydrogen chlorideand sulfur dioxide) comprise about 62 percent; particulate matter, about 0.8 percent; carbon monoxide, about 0.3 percent; NOx, about 37 percent; and metals (e.g., lead, cadmium, and mercury) and dioxins/furans, about 0.2 percent. 

The EPA also estimated that air pollution control devices that would be installed to comply with the 2009 rule would effectively reduce emissions of such pollutants as polycyclic organic matter (POM) and polychlorinated biphenyls (PCB). Further, the 2009 final rule revised waste management plan provisions to encourage segregation of such wastes as chlorinated plastics and PCB-containing wastes, which lead to reductions in emissions.


The current set of amendments includes the following:

  • New dates that specify which are existing HMIWIs and which are new HMIWIs under the 2009 revisions.
  • Tighter emissions limits for all pollutants.  Limits vary based on HMIWI size (i.e., large, medium, small, and small rural).
  • Clarification of the visible ash emissions limit for ash conveyance systems and onetime visible emissions test of ash handling operations.
  • Provisions to ensure that HMIWI owners/operators (O/O) train and educate their clients to conduct their own waste segregation.
  • Annual inspections of emissions control devices.
  • Additional testing, monitoring, recordkeeping, and reporting requirements. 
  • Revised Title V provisions.

The revised FIP requires HMIWI O/Os to either come into compliance with the plan within 1 year after the plan is promulgated or meet increments of progress and come into compliance by October 6, 2014.  However, O/Os that plan to shut down their HMIWIs can apply for a 1-year compliance extension if they demonstrate to EPA’s satisfaction that they need the additional time to install an alternative on-site waste treatment technology. 

Finally, elimination of the SSM exemption responds to a judicial ruling and follows identical amendments the Agency has issued to air regulations governing many source categories. 

EPA’s final FIP and NSPS amendments for HMIWIs were published in the May 13, 2013, FR.

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