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State of California—Health and Human Services Agency
California Department of Public Health

December 12, 2022

Medical Waste Generators, Medical Waste Transporters, Offsite transfer station and Treatment facilities, Local Enforcement Agencies, and Trauma Scene Waste Practitioners

Mpox Disease Medical Waste Management – Interim Guidelines

Mpox Medical Waste Management

The California Department of Public Health (CDPH), Medical Waste Management Program (MWMP) regulates the generation, handling, storage, and treatment of medical waste by providing oversight under the authority of the Medical Waste Management Act (MWMA). This document provides general guidance for the management of mpox  contaminated medical waste based on federal guidelines and standards.

As of the date of this publication there are no additional regulatory handling, marking, storage, transportation, or treatment requirements for medical waste contaminated with mpox.

Follow the requirements of the Medical Waste Management Act 2017 statutes for managing medical waste in California. Follow the United States Department of Transportation (USDOT) regulations for packaging, labeling and offsite transportation of regulated medical waste (RMW). The details of RMW and Category B infectious substances transportation is in the USDOT Hazardous Materials Regulations (HMR) 49 Code of Federal Regulations 173.197.

General Guidance

CDC - The Centers for Disease Control and Prevention (CDC) has released general guidance on mpox which should be reviewed closely and checked regularly. This includes appropriate infection prevention and control practices for the handling and packaging of items contaminated with mpox.

CDPH - The CDPH webpage, mpox, provides general information on how to limit the spread of mpox.

Cal OSHA (DIR) – The Department of Industrial Relations (DIR) classifies mpox as an aerosol transmissible pathogen pursuant to California Code of Regulations Title 8 Section 5199a; therefore, The California Workplace Guide to Aerosol Transmissible Diseases should be reviewed and followed appropriately.

Who to Contact - Facilities may contact their Local Enforcement Agency (LEA), County Health Director, and CDPH Medical Waste Management Program regarding mpox waste management queries.

Personal Protection Equipment (PPE)

Detailed information on environmental infection control in healthcare settings can be found in CDC's Guidelines for Environmental Infection Control in Health-Care Facilities and Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [section IV.F. Care of the environment].

Disinfecting Agents

Mpox is more susceptible to disinfectants than other types of viruses. Use only appropriate disinfectant products per the US Environmental Protection Agency (EPA).

Trauma Scene Waste Practitioners

Trauma scene waste practitioners who are registered with the MWMP should follow their disinfecting procedures as established. Wear appropriate PPE, follow the OSHA Bloodborne Pathogens standard, and use the technologies and chemicals appropriate to the task for cleanup and disinfection. Additionally, refer to Chapter 9.5 of the MWMA on the statutes for Trauma Scene Waste Management.

Packaging Mpox Contaminated Waste

Waste from mpox infected patients is handled as standard RMW. Refer to the MWMA for the statutes in California. The CDC has provided general, not mpox specific, recommendations in the Guidelines for Environmental Infection Control in Health-Care Facilities (2003). CDC guidance states that the management of RMW should be performed in accordance with routine procedures as it has not been implicated in the transmission of mpox.

Transportation within a Facility and Offsite

Medical waste management (i.e., handling, storage, treatment, and disposal of soiled PPE, patient dressings, etc.) should be performed in accordance with U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR; 49 CFR, Parts 171-180).

Required waste management practices and category designation can differ depending on the mpox virus variant (clade). As of the date of this guidance, the clade recently identified in Europe and in the U.S. is the West African clade and causes less severe disease than the Central African clade. Refer to the USDOT exemption of the West African clade from Category A shipping requirements in Managing Solid Waste Contaminated with a Category A Infectious Substance, pages 39 and 94. All viruses change and evolve over time; however, the pox virus mutates more slowly than coronaviruses and is not a concern currently. Hence waste contaminated with Mpox at this time has been determined to be a Category B Infectious Substance.

Mpox cases are summarized in the CDC US Mpox Outbreak 2022: Situation Summary.

Facility operation and logistics vary among health care facility types requiring each facility to develop a Medical Waste Management Plan (Plan) tailored to address the needs at each facility while maintaining compliance with the MWMA. Each Plan should include the procedures of transporting waste from the room it is generated in to the interim storage room and ultimately to the Designated Accumulation Area. From this area, the waste will then be treated onsite or prepped for transportation offsite for treatment.

All containers for offsite transport should be USDOT approved. Pharmaceutical waste shall also be transported in compliance with the United States Drug Enforcement Administration (DEA) requirements. RMW and Category B infectious substances are listed in the USDOT Hazardous Materials Regulations (HMR) 49 Code of Federal Regulations 173.197.

Treatment of Mpox Infected Waste

RMW is treated or decontaminated to eliminate the microbial load in the waste and to render it safe for solid waste management and disposal. Treatment processes are permitted under each state's medical waste statutes and regulations and treatment methods may include autoclaving, incineration, chemical disinfection, grinding/ shredding/disinfection methods, and energy-based technologies (e.g., microwave or radiowave treatments). Waste treated in California shall follow the requirements outlined in the MWMA Sections 118215 – 118245.

If onsite treatment is not available or the health care facility chooses to not treat the waste onsite, the facility should package the waste appropriately for transport offsite (see Transportation section above) to a permitted medical waste transfer station and/or treatment facility.

Mpox virus infected waste shall be taken to a permitted Transfer Station and Offsite Treatment Facility (TSOST) for treatment. A list of permitted TSOST facilities in California can be found on the Medical Waste Management Program website.

If the medical waste is being sent out of the State of California for treatment, check with the receiving State for their requirements on the treatment of medical waste and specifically medical waste contaminated with mpox virus.

Once the infected waste has been efficaciously treated by a permitted medical waste facility it is no longer considered RMW and can be managed as solid waste. Treatment facilities shall coordinate with the solid waste landfill for final disposal of the waste. Direct efficacy questions for medical waste treatment to your Local Enforcement Agency and/or to the CDPH, Medical Waste Management Program.

MS 7405, IMS K-2 ● P.O. Box 997377
Sacramento, CA 95899-7377
(916) 449-5671

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