Whether you’re opening a new clinic or reviewing your compliance plan, knowing the state’s minimum requirements for medical waste is essential to avoiding violations and keeping your staff safe.
This guide outlines the core compliance obligations for North Carolina medical practices when it comes to handling medical waste. We also provide a practical checklist for getting (and staying) compliant, with references to the laws and regulations so you can cross-reference for yourself.
1. The Regulatory Framework
Medical waste management in North Carolina is governed by both state environmental rules and federal occupational safety standards:
- State Rule: 15A NCAC 13B .1200 – Management of Regulated Medical Waste
Defines how medical waste must be stored, labeled, transported, and treated in North Carolina. - Federal Rule: OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030)
OSHA Bloodborne Pathogens Standard
Requires staff training, exposure control plans, and safe handling of sharps and contaminated materials.
2. What Qualifies as Medical Waste
Under NCDEQ regulations, Regulated Medical Waste (RMW) includes any material generated in the diagnosis, treatment, or immunization of humans or animals that may be infectious or hazardous. These categories include:
- Sharps: Needles, scalpels, syringes, and other items capable of puncturing skin.
- Blood-soaked or saturated materials: Items dripping with blood or bodily fluids.
- Microbiological waste: Cultures, stocks, or laboratory specimens.
- Pathological waste: Human tissues or body parts.
- Pharmaceutical waste: Expired or partially used medications that cannot be discarded as regular trash.
- Trace chemotherapy waste: Gloves, IV bags, tubing, or gowns contaminated with small amounts of chemotherapy drugs.
Pharmaceutical and chemo waste are also regulated under the EPA’s Pharmaceuticals Rule and require specialized handling and labeling. Biosafe provides compliant collection and disposal for all of these waste streams.
3. Handling and Storage Requirements
Medical waste must be:
- Collected in leakproof, puncture-resistant, and properly labeled containers displaying the biohazard symbol.
- Segregated by type (sharps, biohazard, pharmaceutical, chemo).
- Stored in a secure, limited-access area to prevent tampering or exposure.
- Removed from the facility at intervals that prevent putrescence or odor — typically on a regular schedule based on waste volume and activity.
Maintaining written procedures for waste handling and storage is a best practice and can help demonstrate compliance during inspections.
4. OSHA Training and Exposure Control Plans
Under OSHA’s Bloodborne Pathogens Standard, all employees with potential exposure to blood or bodily fluids must complete training at hire and annually thereafter.
Training must include:
- Safe sharps handling and container use
- PPE and hygiene practices
- Exposure control plan review
- Post-exposure evaluation procedures
Employers must maintain records of all training. A compliant Exposure Control Plan (ECP) must also be kept on-site and updated each year. OSHA provides a free ECP template on their website and can be found with a quick Google search.
Your medical waste vendor can be a valuable partner in compliance. Biosafe provides both in-person and online OSHA training programs to help practices meet their annual training requirements efficiently.
5. Choosing a Medical Waste Transporter
While North Carolina does not require waste transporters to register with NCDEQ, medical waste must still be transported according to U.S. Department of Transportation (DOT) regulations.
When selecting a transporter or disposal vendor, ensure that they:
- Are fully insured and can provide proof of liability coverage.
- Follow DOT packaging, labeling, and manifesting regulations.
- Offer documented proof of disposal for each pickup.
- Provide OSHA-compliant staff training support.
- Offer transparent, predictable pricing without hidden fees or long-term auto-renewing contracts.
For a more detailed breakdown of how to evaluate medical waste vendors, see our related blog: How to Choose a Medical Waste Vendor: What North Carolina Clinics Should Know
Medical Waste Compliance Starter Checklist
| Task | Regulation/Reference |
| Identify all regulated, pharmaceutical, and chemo waste streams in your facility | 15A NCAC 13B .1201 / 40 CFR 266 Subpart P |
| Segregate waste into labeled sharps, biohazard, pharmaceutical, and chemo containers | 15A NCAC 13B .1204 |
| Store waste securely to prevent unauthorized access or leaks | NCDEQ Guidance |
| Arrange regular waste pickups with a DOT-compliant, insured transporter | 49 CFR 171–180 |
| Keep manifests and disposal documentation for at least 3 years | NCDEQ, DOT and EPA Guidance |
| Train all affected staff on OSHA Bloodborne Pathogens Standard annually | 29 CFR 1910.1030 |
| Maintain and review your Exposure Control Plan annually | OSHA Requirement |
| Inspect containers weekly and replace when ¾ full | OSHA/NCDEQ best practice |
| Verify transporter’s insurance and compliance documentation | Best Practice |
| Conduct an annual compliance audit and vendor review | Internal Audit |
