Mo. Code Regs. Ann. tit. 19, § 30-20.114
PURPOSE: This rule specifies the requirements for environmental and support services provided by a hospital.
(1) Each hospital shall have an organized service which maintains a clean and safe environment.
(A) Housekeeping Services.
is qualified by education, training, and experience in the principles of hospital housekeeping. This individual shall report to a designated administrative officer or his or her designee.
and describe the scope of housekeeping services. These shall be reviewed in cooperation with the infection prevention control program, kept current per hospital policy, and be readily available to staff.
provided.
needs of housekeeping services.
collected in appropriate containers for disposal.
a regular basis of the quality of housekeeping services provided.
(B) Laundry and Linen Services.
that adequate supplies of clean linens are available. There shall be specific written procedures for the processing, distribution, and storage of linen. These shall be reviewed in cooperation with the infection control committee and kept current.
separated from both clean linen storage and soiled linen holding areas. Only commercial laundry equipment shall be used to process hospital linen.
of use in a way that minimizes microbial contamination from surface contact or airborne particles.
transported to the soiled linen holding room in a manner that minimizes microbial dissemination into the environment.
shall be provided to assure the hospital that the processing and handling of linen complies with paragraphs (1)(B)1.–4. of this rule and by following manufacturer recommendations.
on a regular basis of the quality of laundry and linen services provided.
(C) Infectious Waste Management
education, training, and experience in the principles of infectious waste management.
management plan with an annual review identifying infectious waste generated on-site, the scope of the infectious waste program, and policies and procedures to implement the infectious waste program. The plan shall include at least the following:
organizational chart; schematic(s) of waste disposal routes; definition of those wastes handled by the system; department and individual responsibilities; hospital policies and procedures for waste identification, segregation, containment, transport, treatment, and disposal; emergency and contingency procedures; training and educational procedures; and appendices (rules and other applicable institutional policy statements).
facility permit requirements of 10 CSR 80-7.010 and that accepts infectious waste from off-site shall include in its plan requirements for storage, processing, and record keeping of this waste and the cleanup of potential spills in the unloading area.
residence time, and control devices for any infectious waste processing devices shall be included in the plan.
any infectious waste treatment procedures.
at the point of generation and shall be placed in distinctive, clearly marked, leakproof containers or plastic bags appropriate for the characteristics of the infectious waste. Containers for infectious waste shall be identified with the universal biological hazard symbol. All packaging shall maintain its integrity during storage and transport. Infectious waste shall not be placed in a gravity waste disposal chute.
separated from other wastes, in a limited-access enclosure posted with the biological hazard symbol. This enclosure shall afford protection from vermin, be a dry area, and be provided with an impervious floor with a perimeter curb. The floor shall slope to a drain connected to the sanitary sewage system or collection device. If infectious waste is compacted, the mechanical device shall contain the fluids and aerosols and shall not release aerosols or fluids when opened and the container is removed. Provisions for waste stored seventytwo (72) hours or more shall be separately addressed in the infectious waste management plan to include proper storage, handling, and disposal by commercial vendors when utilized.
rendered innocuous, using one (1) of the following methods:
provided that the unit is operated in accordance with the manufacturer’s recommendations and that the autoclave’s effectiveness is verified at least weekly with a biological spore assay containing Bacillus Stearothermophilus. If the autoclave is used for other functions, the infectious waste management plan will develop specific guidelines for its use;
technologies in a manner acceptable to the Department of Health and Senior Services shall be permitted;
may be carefully poured down a drain connected to a sanitary sewer; or
in subparagraphs (1)(C)6.A. or B. of this rule shall be disposed of in accordance with the requirements of 10 CSR 80-7.010.
records of biological spore assay tests if required by treatment methods and the approximate amount of waste disinfected per hour measured by weight per load. The program director shall maintain records demonstrating the proper operation of the disinfection equipment.
of the hospital shall be packaged and transported as provided in sections 260.200–260.207, RSMo.
quantity generators as defined by 10 CSR 80-7.010 or from other Missouri hospitals—in quantities exceeding fifty percent (50%) of the total poundage of infectious waste generated on-site at the hospital—shall notify the Department of Natural Resources and comply with permitting requirements of sections 260.200– 260.207, RSMo. The weight of infectious waste generated on-site shall be calculated by multiplying one and five-tenths (1.5) pounds per day times the number of beds complying with Department of Health and Senior Services standards for hospital licensure. Infectious waste generated off-site may be accepted by a hospital only if packaged according to 10 CSR 80-7.010(2)(A)–(D).
(D) Medication Waste Management.
waste shall be identified in the following categories: general, controlled substances, radiologic, infectious, and hazardous. Medication waste shall include materials contaminated with such medications.
category including storage container type, storage prior to disposal, and final disposition.
disposal except—
staff at the time of administration;
the Missouri Department of Natural Resources, the United States Food and Drug Administration, and the United States Environmental Protection Agency.
to 19 CSR 30-1.078.
the supplier or held and disposed of according to Nuclear Regulatory Commission guidelines.
not limited to, antineoplastic medications shall be handled as follows:
or medication waste shall be trained regarding collection, transportation, containment, segregation, manifest, and disposal; and
other waste in leak proof containers clearly labeled with a statement such as CAUTION: HAZARDOUS CHEMICAL WASTE and held in a secure place until disposed. AUTHORITY: section 192.006, RSMo 2000, and sections 197.080 and 197.154, RSMo Supp. 2013.* This rule previously filed as 19 CSR 30-20.021(5)(A), (C), and (D). Original rule filed June 27, 2007, effective Feb. 29, 2008. Amended: Filed June 6, 2013, effective Jan. 30, 2014. *Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995, 2013; and 197.154, RSMo 2004.