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The Public Health (Infectious Waste) Regulations, 1991 made the 27th March, 1991 Consolidated with the Public Health (Infectious Waste) (Amendment) Regulations, 2001 made the 19th June, 2001. Consolidated and revised this 30th day of April, 2002. Note (not forming part of the Regulations): This revision replaces the 1997 Revision which should now be discarded. Arrangement of Regulations Public Health Law PUBLIC HEALTH (INFECTIOUS WASTE) REGULATIONS (2002 Revision) Arrangement of Regulations Regulation 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_24\", \"num\": \"24.\", \"text\": \"Arrangement of Regulations Regulation 1 Public Health Law PUBLIC HEALTH (INFECTIOUS WASTE) REGULATIONS (2002 Revision)\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_1\", \"num\": \"1.\", \"text\": \"Citation 1. These regulations may be cited as the Public Health (Infectious Waste) Regulations (2002 Revision).\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_2\", \"num\": \"2.\", \"text\": \"Definitions 2. In these regulations \u2014 \u201ccontinuous temperature recorder\u201d means a device, such as a thermocouple, which continuously monitors and records the temperature at a specific location; \u201cCEHO\u201d means the Chief Environmental Health Officer; \u201cdisposal\u201d means the discharge, deposit, injection, dumping, spilling, leaking or placing of any infectious waste into or on any land or water so that such waste or any constituent thereof may enter the environment, be emitted into the air or discharged into any water including ground water; \u201cdisposal facility\u201d means a facility or part thereof at which infectious waste is intentionally placed into or on any land or water, and at which such waste will be left permanently; \u201cEPA\u201d means the Environmental Protection Agency of the United States of America; \u201cfacility\u201d means all contiguous land, structures and other appurtenances and improvements on the land, used for treating, storing or disposing of infectious Regulation 3 waste, and may consist of several treatment, storage or disposal operational units or a combination of them but does not include storage by a generator; \u201cgenerator\u201d means any person or institution whose act or process produces infectious waste; \u201chealth practitioner\u201d includes professionals in the disciplines of medicine, dentistry, nursing, radiography, medical technology and veterinary medicine; \u201cincinerator\u201d means any enclosed devices which are integral components of combustion process and which use controlled flame; \u201cinstitution\u201d includes any premises used by a health practitioner or any laboratory or premises where infectious waste is generated; \u201cMOH\u201d means the Medical Officer of Health; \u201cresidence time\u201d means the average time for gases to pass through the combustion chamber of an incinerator; \u201csanitary landfill\u201d means a method of disposing of solid waste on land in a manner intended to minimise environmental hazards by compacting the solid waste to the smallest practical volume, and applying cover material thereto; \u201csharps\u201d means any item used in the practice of medicine which has a cutting or piercing edge; \u201csolid waste\u201d means any unwanted residual solid or semi-solid material resulting from industrial, commercial, agricultural or community operations, and includes, but is not limited to, garbage, rubber tires, combustible and noncombustible material, street dirt and debris; and \u201ctreat\u201d or \u201ctreatment\u201d, when used in connection with infectious waste, means any method, technique or process designed to render the waste non-infectious.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_3\", \"num\": \"3.\", \"text\": \"Approval of infectious waste incinerator 3. Before any person constructs, installs or operates an infectious waste incinerator he shall obtain the approval of the MOH.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_4\", \"num\": \"4.\", \"text\": \"Requirements of incinerators 4. Before approval is given under regulation 3, the CEHO shall be satisfied that the incinerator is \u2014 (a) capable of a minimum combustion temperature of one thousand eight hundred degrees Fahrenheit for single chambers; (b) in the case of multiple chamber units, capable of reaching a minimum of one thousand four hundred degrees Fahrenheit for the primary chamber and one thousand eight hundred degrees Fahrenheit for the secondary chambers; (c) equipped with one-second residence time; (d) of a maximum fuel gas temperature of three hundred degrees Fahrenheit; Regulation 5 (e) equipped with a continuous recorder and log maintenance equipment; and (f) equipped with an annual source testing for dioxins.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_5\", \"num\": \"5.\", \"text\": \"Training of operators of incinerators 5. Any person proposing to operate an infectious waste incinerator is required to undergo a course of training conducted by the Environmental Health Department of the Ministry responsible for the Environment.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_6\", \"num\": \"6.\", \"text\": \"Storage, packaging, transportation and disposal of infectious waste 6. (1) Facilities for the storage (excluding storage by a generator), packaging, transport and treatment of infectious waste shall be capable of dealing with at least two hundred and twenty lbs. of such waste per month, must be classified as commercial facilities and approved by the MOH prior to commencement of operations, and annually thereafter. (2) Generators of infectious waste shall, within thirty days prior to the effective date thereof, submit to the CEHO a plan for the management of the storage, packaging and transportation of infectious waste. (3) The transporter of infectious waste shall keep records for at least three years of \u2014 (a) the amount of infectious waste transported from each generator per month; (b) the name and location of any storage facilities used; (c) the period during which the infectious waste was stored; and (d) the dates when the infectious waste was picked up from each generator or storage facility. (4) The operator of every disposal facility is required to submit to the CEHO quarterly reports of the volume of infectious waste managed by the facility. (5) Infectious waste may be disposed of in a sanitary landfill after it has been treated. Incineration and steam sterilisation are the primary treatment methods, but sharps must be rendered unrecognisable by the process of incineration or grinding before being disposed of. Recognisable human tissue, organs and body parts must be made unrecognisable by incineration, grinding or interment.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_7\", \"num\": \"7.\", \"text\": \"Transportation of infectious waste 7. Any person who transports infectious waste shall \u2014 (a) not accept infectious waste which is not properly packaged and labelled; (b) transport infectious waste only in leak-resistant, fully covered vehicle compartments; Regulation 8 (c) secure the load in such a manner as to prevent spilling; (d) transport untreated infectious waste in shipments consisting only of untreated infectious waste; (e) not grind or compact any infectious waste; (f) deliver the waste only to a treatment facility approved by the MOH; (g) deliver infectious waste from the generator to the treatment facility within twenty-four hours; (h) disinfect, using surface disinfection procedures approved by the CEHO, any surface of any vehicle which comes into contact with infectious waste, after unloading and before subsequent use. All fluids resulting from the disinfection procedure shall be treated and disposed of by a method approved by the CEHO; (i) wear clean coveralls or uniforms while loading and unloading infectious waste; and (j) immediately inform the CEHO of any accidental spilling which may occur during loading, transportation or unloading of infectious waste.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_8\", \"num\": \"8.\", \"text\": \"Autoclaving 8. Autoclaves \u2014 (a) shall operate at a minimum temperature of one hundred and twenty one degrees Centigrade or two hundred and fifty degrees Fahrenheit at a minimum of fifteen pounds per square inch of gauge pressure; (b) shall operate at the specified temperature and pressure for half an hour or longer, depending on the quantity and compaction of the load in order to achieve sterilisation of the entire load; (c) shall be operated with a maximum registering thermometer, except for fast exhaust loads: and (d) may be approved by the MOH in other combinations of operational temperature, pressure and time if the equipment has been proven to achieve a reliable and complete kill of all infectious agents in waste at design capacity.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_9\", \"num\": \"9.\", \"text\": \"Chemical treatment for cultures 9. (1) Approved treatment solutions are \u2014 (a) chlorine compounds solutions, specifically hypochlorite and chlorinated isocyanurates, at a strength of fifteen per cent and pH range of six to eight; (b) iodoform solutions, with 150 ppm of available iodine, and a pH range of neutral to acidic; and Regulation 10 (c) any other solution approved by the CEHO. (2) All cultures shall be submerged for a minimum of ten minutes in the chemical. (3) Excess chemical solution shall be decanted from cultures before disposal.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_10\", \"num\": \"10.\", \"text\": \"Treatment methods 10. The operational requirements for the treatment of infectious waste are incineration, steam sterilisation and any other method approved by the MOH.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_11\", \"num\": \"11.\", \"text\": \"Incineration 11. (1) In the procedure of incineration, the loading and unloading operations shall be performed in such a manner as not to result in compaction or puncture of containers of infectious waste. (2) All incinerators shall follow specific quality control procedures, and shall not be charged beyond the design capacity. (3) The following documents shall be kept at any incineration treatment facility \u2014 (a) applicable public health regulations relating to infectious waste and air pollution control; (b) the infectious waste permit of the facility; (c) manufacturer\u2019s specifications and maintenance procedures; (d) infectious waste containment and clean up procedures; (e) contingency plans and emergency co-ordinator\u2019s procedures; (f) quality control procedures; and (g) standard operating procedures, and the CEHO shall ensure that operators are trained in those areas before they become responsible for the operations. (4) Water used for cooling ash shall be recycled into the cooling tank and any excess or overflow must be diverted into a storage system. (5) Treatment facilities shall use an enclosed system to transfer particulates captured by the air pollution control system into leakproof and enclosed containers. (6) Sludge of particulates shall be stored in leakproof containers and must contain no free liquid before disposal. (7) Access to the treatment facility shall be restricted to authorised personnel. For the purposes of this subregulation, the facility shall include any buildings, storage areas, decontamination areas or other areas where infectious waste may be found. Regulation 12 (8) Every treatment facility using incineration shall adopt and keep posted, in the immediate area of the incinerator, standard written operating procedures which shall include \u2014 (a) operating time; (b) operating temperature; (c) operating air flow; and (d) maximum load quantity.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_12\", \"num\": \"12.\", \"text\": \"Steam sterilisation or autoclaving 12. (1) The following documents shall be kept at any steam sterilisation or auto cleaning treatment facility \u2014 (a) applicable public health regulations regarding infectious waste; (b) manufacturer\u2019s specifications and maintenance procedures; (c) infectious waste containment and clean up procedures; (d) contingency plans, located in a place accessible to operators of the autoclaves; (e) quality control procedures; (f) standard operating procedures; and (g) posting of emergency telephone numbers including the fire department, the local health department and the police department, and the MOH shall ensure that the operators are trained in each discipline prior to being put in charge of autoclave operations. (2) Every treatment facility which uses autoclaves shall adopt, and post in the immediate locality of the autoclave, standard written operating procedures for each autoclave. Such operating procedures shall include \u2014 (a) the duration of sterilisation; (b) temperatures; (c) pressure; (d) type of waste; (e) type of container; (f) closure of container; (g) maximum load quantity; and (h) water content. (3) Every package of waste in a load shall have heat sensitive tape or its equivalent to indicate the attainment of adequate sterilisation conditions. If the indicator fails to indicate that the required temperature was reached during the sterilisation process the waste will not be considered as satisfactorily treated. Regulation 13 (4) After autoclaving, all sharps shall be dealt with in such a manner as to eliminate the potential of those wastes causing lacerations or puncture wounds during handling, transportation or disposal. (5) Only authorised persons shall be allowed access to the treatment facility. (6) Loading, unloading, processing and storage areas of infectious waste and ash, and decontamination areas shall be paved and have drainage into a disposal system. Facilities shall have appropriate slopes and drainage to avoid settlement of water. (7) In this regulation- \u201ctreatment facility\u201d includes any building, storage area, staging area, decontamination area and other areas where infectious waste may be found.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_13\", \"num\": \"13.\", \"text\": \"Quality control guidelines 13. (1) The guidelines set out in this regulation shall be adhered to by treatment facilities. (2) Incinerators shall \u2014 (a) continuously monitor and record primary and secondary chamber temperatures, using strip charts; (b) sample stack gas after adding spores of Bacillus Subtilis Var. Niger (Globigii) to a load of infectious waste before it is incinerated. Sampling shall be by the use of standard emission testing methods. The number of spores added to the waste and the sampling time, shall be adjusted to ensure a theoretical challenge of at least one million spores in the collected sample. Monitoring shall be repeated whenever substantial repairs are made to the incinerator or when otherwise required by the CEHO or his authorised representative; (c) obtain representative samples of ash, using the Simple Random Sample Method described in the EPA test methods for evaluating solid waste. The samples shall be tested monthly for the EPA toxicity characteristics utilising an independent analytical laboratory which uses the methodology provided in the EPA test methods for evaluating solid waste; and (d) maintain a maintenance log. (3) Every autoclave shall \u2014 (a) calibrate all maximum registering thermometers at least every three months or when required by the CEHO or his authorised representative; (b) make a daily evaluation, under full load, of conditions for the effectiveness of sterilisation with spores of Bacillus Stearothermophilus placed in a position in the autoclave determined to have the lowest Regulation 14 temperature during full load cycle according to the manufacturer\u2019s specifications; (c) keep a log at the unit which shall contain \u2014 (i) the date; (ii) the times the cycle started and ended; (iii) the name of the operator; (iv) the type and amount of waste treated; (v) the temperature of maximum registering thermometer; and (vi) post-sterilisation reading of the temperature-sensitive tape. (4) All quality control measures shall be kept in a quality control log for a minimum period of three years.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_14\", \"num\": \"14.\", \"text\": \"Annual report 14. An annual report of the activities of an infectious waste facility shall be submitted to the MOH not later than 1st February in each year. Such a report shall contain monthly totals in the different categories of waste, and such other information as the MOH may think necessary.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_15\", \"num\": \"15.\", \"text\": \"Spill containment and clean up kit 15. (1) Every infectious waste treatment facility shall keep a spill containment and clean up kit within the vicinity of any area where infectious waste is managed and the location of the kit shall be such as to facilitate rapid and efficient clean up of spills anywhere within the area. (2) The minimum requirements for a clean up kit are \u2014 (a) material designed to absorb liquids, such material being of an absorptive rating of ten gallons of liquid; (b) one gallon of an approved chemical disinfectant in a sprayer capable of dispensing its charge in a mist and in a stream at a safe distance. The disinfectant shall be of hospital grade and effective against mycobacteria; (c) two new sets of liquid impermeable and disposable \u2014 (i) overalls; (ii) gloves; (iii) boots; (iv) caps; (v) protective eye wear; and (vi) protective breathing devices; and (d) a first aid kit, fire extinguisher, boundary tape, lights and other appropriate safety equipment. Regulation 16 (3) Overalls, boots, and caps shall be oversized or fitted to infectious waste workers. Boots may be of thick rubber and gloves may be of heavy neoprene or the equivalent. Breathing protection devices shall be graded superior in filtering particulates and mists. Tape for sealing wrists and ankles shall also be in the kit.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_16\", \"num\": \"16.\", \"text\": \"Disinfectants 16. The disinfectants used in cleaning up a spill shall be used at the specified concentrations for a minimum of ten minutes for continuous rinsing or submersion. The following disinfectants are approved for use at their expressed concentrations \u2014 (a) hypochlorite solution with 500 ppm available chlorine with a pH range of six to eight; (b) iodoform solution with 150 ppm available iodine with a pH of neutral to acidic; (c) gluteraldehyde two per cent solution with pH seven to eight; and (d) other disinfectant approved by the CEHO.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_17\", \"num\": \"17.\", \"text\": \"Minimum clean up procedures 17. Every infectious waste facility shall implement the following minimum procedures subsequent to a spill of infectious waste or to its discovery \u2014 (a) ensure that the clean up crew wear protective clothing during the entire clean up operation; (b) limit access to the area of spill to authorised personnel only; (c) spray broken containers of infectious waste with disinfectant; (d) place broken containers and spillage in over-pack bags in the clean up kit to minimise exposure; (e) disinfect the area and take such other clean up steps as may be appropriate to the circumstances; (f) clean and disinfect non-disposable items; (g) clean and disinfect clean up outfits before storing them; (h) remove protective equipment and place disposable items in a clean up bag; (i) take any necessary steps to replenish containment and clean up kit with items which have been used; (j) make an immediate report of the spill or accident to the CEHO; (k) if necessary, call the CEHO for emergency help; and (l) within twenty-four hours of its occurrence, report every infectious waste spill or accident to the CEHO, using the spill or accident form prescribed Regulation 18 by the CEHO. The report should include any spill of infectious waste outside the limited access area.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_18\", \"num\": \"18.\", \"text\": \"Standards for the packaging of infectious waste 18. (1) Packaging of infectious waste shall conform to the requirements specified in this regulation. (2) Bags shall be red in colour or conspicuously labelled with the international biohazard symbol. The bags shall be made of material of sufficient single thickness to resist tearing or bursting under normal conditions of handling. The international biohazard symbol on the bags shall be a minimum of five inches in diameter. (3) Bags shall be impervious to moisture, and, when containing waste, shall be securely tied or sealed so as to prevent breakage or expulsion of waste during storage, handling or transport. (4) Containers for infectious waste shall be labelled with the international biohazard symbol with the words \u201cINFECTIOUS WASTE\u201d printed on them and visible from any direction when the containers are upright. (5) Containers shall \u2014 (a) be kept clean on the outside; (b) be leakproof; (c) have tight fitting covers; (d) be of sufficient strength to withstand the wear and tear of handling during transport without compromising their integrity; and (e) be capable of being re-used after chemical disinfection, and, in the case of sharps, containers shall be rigid, puncture resistant, leakproof and tightly closed to prevent loss of contents.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_19\", \"num\": \"19.\", \"text\": \"Use of chutes forbidden 19. The use of chutes is strictly forbidden in the transfer of infectious waste.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_20\", \"num\": \"20.\", \"text\": \"Storage of infectious waste 20. (1) Generators, transporters and treatment facilities storing infectious waste shall \u2014 (a) store infectious waste in a safe manner and place; (b) maintain the waste in a non-putrescent state, using refrigeration or freezing, if necessary; (c) lock the outside of storage areas which contain infectious waste to prevent unauthorised access; Regulation 21 (d) designate and label storage areas by posting a sign marked \u201cWARNING - INFECTIOUS WASTE\u201d in a conspicuous place and also displaying the international biohazard symbol at all points of access; and (e) cause infectious waste to be stored in such a manner that animals have no access to it, and it does not provide a breeding place or source of food for insects or rodents. (2) Generators shall not store infectious waste on their premises longer than seven days at a time, except that sharps containers, currently in use, are exempt from this provision if their generators satisfy subregulation (1). (3) Treatment facilities shall not store infectious waste longer than fourteen days at a time. Such facilities shall formulate a contingency plan, a copy of which shall be given to the MOH. A contingency plan shall \u2014 (a) meet all the requirements of subregulation (1) in relation to the removal of infectious waste to an alternative treatment facility; (b) be maintained at the treatment facility; and (c) designate an emergency co-ordinator and an alternate emergency coordinator. The contingency plan shall be implemented if treatment facility exceeds or is reasonably expected to exceed the storage capacity of the treatment facility.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_21\", \"num\": \"21.\", \"text\": \"Registration of generators of infectious waste 21. (1) Every health practitioner in active practice and practising alone, every medical institution and every other generator shall register with the MOH as a generator of infectious waste. In the case of a new generator, he or it shall register within thirty days of opening operations. (2) An application for registration shall relate to each premises owned or operated by the generator and the validity of a generator\u2019s certificate shall be for a period of one year. (3) Any person who, by reason of his state of health, uses disposable sharps for home testing or for self-administration of injectables (such as insulin) shall not be required to register as a generator; but in any such case the health practitioner or pharmacy from whom or from which the sharps were acquired shall ensure the safe disposal of such sharps according to these regulations.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_22\", \"num\": \"22.\", \"text\": \"Fees 22. (1) The fee for registration under regulation 21(1) is one hundred dollars payable upon first registration and thereafter on the anniversary of such registration. (2) Every generator shall pay a fee of two dollars per pound for the collection, transportation and disposal of infectious waste. Regulation 23 (3) The fee for an approval of the MOH under regulation 6(1) is two hundred and fifty dollars per annum.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_23\", \"num\": \"23.\", \"text\": \"Registration of vehicles 23. (1) Every transporter of infectious waste shall register with the MOH the vehicle used to transport infectious waste. (2) A registered transporter shall obtain an amended infectious waste permit from the MOH whenever motor vehicles listed under the current registration certificate are either removed from service, or replaced, or more vehicles are added for use by the transporter to transport infectious waste. Application for an amended permit shall be made on a form prescribed by the MOH, not more than thirty days before the proposed utilisation for transport of infectious waste. If the number of motor vehicles in the fleet decreases, the MOH shall not refund to the transporter any portion of a registration or renewal fee applicable to a motor vehicle transferred or otherwise removed from use for transporting such waste. If the number of motor vehicles in the transporter\u2019s fleet increases, the application for the amended infectious waste permit shall be accompanied by a fee prorated on an annual basis according to the time remaining in the registration cycle. (3) It is an offence to use an unregistered motor vehicle to transport infectious waste. 24. Offences and penalties 24. Any person who is in breach of these regulations is guilty of an offence and liable on summary conviction to the penalty laid down in section 70(2). Publication in consolidated and revised form authorised by the Governor in Council this 30th. day of April, 2002. 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June, 2002.\n\nPage 2\nRevised as at 30th day of April, 2002\nc\n\nPUBLISHING DETAILS\nRevised under the authority of the Law Revision Law (1999 Revision).\nThe Public Health (Infectious Waste) Regulations, 1991 made the 27th March, 1991\nConsolidated with the Public Health (Infectious Waste) (Amendment) Regulations, 2001\nmade the 19th June, 2001.\nConsolidated and revised this 30th day of April, 2002.\nNote (not forming part of the Regulations): This revision replaces the 1997 Revision\nwhich should now be discarded.\n\nPublic Health (Infectious Waste) Regulations\nArrangement of Regulations\n\nc\nRevised as at 30th day of April, 2002\nPage 3\n\nCAYMAN ISLANDS\n\nPublic Health Law\nPUBLIC HEALTH (INFECTIOUS WASTE)\nREGULATIONS\n(2002 Revision)\nArrangement of Regulations\nRegulation\nPage\n1.\nCitation ......................................................................................................................................5\n2.\nDefinitions ..................................................................................................................................5\n3.\nApproval of infectious waste incinerator .....................................................................................6\n4.\nRequirements of incinerators .....................................................................................................6\n5.\nTraining of operators of incinerators ...........................................................................................7\n6.\nStorage, packaging, transportation and disposal of infectious waste ..........................................7\n7.\nTransportation of infectious waste..............................................................................................7\n8.\nAutoclaving ................................................................................................................................8\n9.\nChemical treatment for cultures .................................................................................................8\n10.\nTreatment methods ....................................................................................................................9\n11.\nIncineration ................................................................................................................................9\n12.\nSteam sterilisation or autoclaving............................................................................................. 10\n13.\nQuality control guidelines ......................................................................................................... 11\n14.\nAnnual report ........................................................................................................................... 12\n15.\nSpill containment and clean up kit ............................................................................................ 12\n16.\nDisinfectants ............................................................................................................................ 13\n17.\nMinimum clean up procedures ................................................................................................. 13\n18.\nStandards for the packaging of infectious waste ...................................................................... 14\n19.\nUse of chutes forbidden ........................................................................................................... 14\n20.\nStorage of infectious waste ...................................................................................................... 14\n21.\nRegistration of generators of infectious waste .......................................................................... 15\n22.\nFees ........................................................................................................................................ 15\n23.\nRegistration of vehicles ............................................................................................................ 16\n24.\nOffences and penalties ............................................................................................................ 16\n\nArrangement of Regulations\nPublic Health (Infectious Waste) Regulations\n\nPage 4\nRevised as at 30th day of April, 2002\nc\n\nPublic Health (Infectious Waste) Regulations\nRegulation 1\n\nc\nRevised as at 30th day of April, 2002\nPage 5\n\nCAYMAN ISLANDS\n\nPublic Health Law\nPUBLIC HEALTH (INFECTIOUS WASTE)\nREGULATIONS\n(2002 Revision)\n\n1.\nCitation\n1.\nThese regulations may be cited as the Public Health (Infectious Waste) Regulations\n(2002 Revision).\n2.\nDefinitions\n2.\nIn these regulations \u2014\n\u201ccontinuous temperature recorder\u201d means a device, such as a thermocouple,\nwhich continuously monitors and records the temperature at a specific\nlocation;\n\u201cCEHO\u201d means the Chief Environmental Health Officer;\n\u201cdisposal\u201d means the discharge, deposit, injection, dumping, spilling, leaking\nor placing of any infectious waste into or on any land or water so that such\nwaste or any constituent thereof may enter the environment, be emitted into\nthe air or discharged into any water including ground water;\n\u201cdisposal facility\u201d means a facility or part thereof at which infectious waste is\nintentionally placed into or on any land or water, and at which such waste will\nbe left permanently;\n\u201cEPA\u201d means the Environmental Protection Agency of the United States of\nAmerica;\n\u201cfacility\u201d means all contiguous land, structures and other appurtenances and\nimprovements on the land, used for treating, storing or disposing of infectious\n\nRegulation 3\nPublic Health (Infectious Waste) Regulations\n\nPage 6\nRevised as at 30th day of April, 2002\nc\n\nwaste, and may consist of several treatment, storage or disposal operational\nunits or a combination of them but does not include storage by a generator;\n\u201cgenerator\u201d means any person or institution whose act or process produces\ninfectious waste;\n\u201chealth practitioner\u201d includes professionals in the disciplines of medicine,\ndentistry, nursing, radiography, medical technology and veterinary medicine;\n\u201cincinerator\u201d means any enclosed devices which are integral components of\ncombustion process and which use controlled flame;\n\u201cinstitution\u201d includes any premises used by a health practitioner or any\nlaboratory or premises where infectious waste is generated;\n\u201cMOH\u201d means the Medical Officer of Health;\n\u201cresidence time\u201d means the average time for gases to pass through the\ncombustion chamber of an incinerator;\n\u201csanitary landfill\u201d means a method of disposing of solid waste on land in a\nmanner intended to minimise environmental hazards by compacting the solid\nwaste to the smallest practical volume, and applying cover material thereto;\n\u201csharps\u201d means any item used in the practice of medicine which has a cutting\nor piercing edge;\n\u201csolid waste\u201d means any unwanted residual solid or semi-solid material\nresulting from industrial, commercial, agricultural or community operations,\nand includes, but is not limited to, garbage, rubber tires, combustible and noncombustible material, street dirt and debris; and\n\u201ctreat\u201d or \u201ctreatment\u201d, when used in connection with infectious waste, means\nany method, technique or process designed to render the waste non-infectious.\n3.\nApproval of infectious waste incinerator\n3.\nBefore any person constructs, installs or operates an infectious waste incinerator he\nshall obtain the approval of the MOH.\n4.\nRequirements of incinerators\n4.\nBefore approval is given under regulation 3, the CEHO shall be satisfied that the\nincinerator is \u2014\n(a)\ncapable of a minimum combustion temperature of one thousand eight\nhundred degrees Fahrenheit for single chambers;\n(b) in the case of multiple chamber units, capable of reaching a minimum of\none thousand four hundred degrees Fahrenheit for the primary chamber\nand one thousand eight hundred degrees Fahrenheit for the secondary\nchambers;\n(c)\nequipped with one-second residence time;\n(d) of a maximum fuel gas temperature of three hundred degrees Fahrenheit;\n\nPublic Health (Infectious Waste) Regulations\nRegulation 5\n\nc\nRevised as at 30th day of April, 2002\nPage 7\n\n(e)\nequipped\nwith\na\ncontinuous\nrecorder\nand\nlog\nmaintenance\nequipment; and\n(f)\nequipped with an annual source testing for dioxins.\n5.\nTraining of operators of incinerators\n5.\nAny person proposing to operate an infectious waste incinerator is required to\nundergo a course of training conducted by the Environmental Health Department of\nthe Ministry responsible for the Environment.\n6.\nStorage, packaging, transportation and disposal of infectious waste\n6.\n(1) Facilities for the storage (excluding storage by a generator), packaging,\ntransport and treatment of infectious waste shall be capable of dealing with at\nleast two hundred and twenty lbs. of such waste per month, must be classified\nas commercial facilities and approved by the MOH prior to commencement of\noperations, and annually thereafter.\n(2) Generators of infectious waste shall, within thirty days prior to the effective\ndate thereof, submit to the CEHO a plan for the management of the storage,\npackaging and transportation of infectious waste.\n(3) The transporter of infectious waste shall keep records for at least three\nyears of \u2014\n(a)\nthe amount of infectious waste transported from each generator per\nmonth;\n(b) the name and location of any storage facilities used;\n(c)\nthe period during which the infectious waste was stored; and\n(d) the dates when the infectious waste was picked up from each generator or\nstorage facility.\n(4) The operator of every disposal facility is required to submit to the CEHO\nquarterly reports of the volume of infectious waste managed by the facility.\n(5) Infectious waste may be disposed of in a sanitary landfill after it has been\ntreated. Incineration and steam sterilisation are the primary treatment methods,\nbut sharps must be rendered unrecognisable by the process of incineration or\ngrinding before being disposed of. Recognisable human tissue, organs and\nbody parts must be made unrecognisable by incineration, grinding or\ninterment.\n7.\nTransportation of infectious waste\n7.\nAny person who transports infectious waste shall \u2014\n(a)\nnot accept infectious waste which is not properly packaged and labelled;\n(b) transport infectious waste only in leak-resistant, fully covered vehicle\ncompartments;\n\nRegulation 8\nPublic Health (Infectious Waste) Regulations\n\nPage 8\nRevised as at 30th day of April, 2002\nc\n\n(c)\nsecure the load in such a manner as to prevent spilling;\n(d) transport untreated infectious waste in shipments consisting only of\nuntreated infectious waste;\n(e)\nnot grind or compact any infectious waste;\n(f)\ndeliver the waste only to a treatment facility approved by the MOH;\n(g) deliver infectious waste from the generator to the treatment facility\nwithin twenty-four hours;\n(h) disinfect, using surface disinfection procedures approved by the CEHO,\nany surface of any vehicle which comes into contact with infectious\nwaste, after unloading and before subsequent use. All fluids resulting\nfrom the disinfection procedure shall be treated and disposed of by a\nmethod approved by the CEHO;\n(i)\nwear clean coveralls or uniforms while loading and unloading infectious\nwaste; and\n(j)\nimmediately inform the CEHO of any accidental spilling which may\noccur during loading, transportation or unloading of infectious waste.\n8.\nAutoclaving\n8.\nAutoclaves \u2014\n(a)\nshall operate at a minimum temperature of one hundred and twenty one\ndegrees Centigrade or two hundred and fifty degrees Fahrenheit at a\nminimum of fifteen pounds per square inch of gauge pressure;\n(b) shall operate at the specified temperature and pressure for half an hour or\nlonger, depending on the quantity and compaction of the load in order to\nachieve sterilisation of the entire load;\n(c)\nshall be operated with a maximum registering thermometer, except for\nfast exhaust loads: and\n(d) may be approved by the MOH in other combinations of operational\ntemperature, pressure and time if the equipment has been proven to\nachieve a reliable and complete kill of all infectious agents in waste at\ndesign capacity.\n9.\nChemical treatment for cultures\n9.\n(1) Approved treatment solutions are \u2014\n(a)\nchlorine compounds solutions, specifically hypochlorite and chlorinated\nisocyanurates, at a strength of fifteen per cent and pH range of six to\neight;\n(b) iodoform solutions, with 150 ppm of available iodine, and a pH range of\nneutral to acidic; and\n\nPublic Health (Infectious Waste) Regulations\nRegulation 10\n\nc\nRevised as at 30th day of April, 2002\nPage 9\n\n(c)\nany other solution approved by the CEHO.\n(2) All cultures shall be submerged for a minimum of ten minutes in the chemical.\n(3) Excess chemical solution shall be decanted from cultures before disposal.\n10.\nTreatment methods\n10. The operational requirements for the treatment of infectious waste are incineration,\nsteam sterilisation and any other method approved by the MOH.\n11.\nIncineration\n11. (1) In the procedure of incineration, the loading and unloading operations shall be\nperformed in such a manner as not to result in compaction or puncture of\ncontainers of infectious waste.\n(2) All incinerators shall follow specific quality control procedures, and shall not\nbe charged beyond the design capacity.\n(3) The following documents shall be kept at any incineration treatment facility \u2014\n(a)\napplicable public health regulations relating to infectious waste and air\npollution control;\n(b) the infectious waste permit of the facility;\n(c)\nmanufacturer\u2019s specifications and maintenance procedures;\n(d) infectious waste containment and clean up procedures;\n(e)\ncontingency plans and emergency co-ordinator\u2019s procedures;\n(f)\nquality control procedures; and\n(g) standard operating procedures,\nand the CEHO shall ensure that operators are trained in those areas before they\nbecome responsible for the operations.\n(4) Water used for cooling ash shall be recycled into the cooling tank and any\nexcess or overflow must be diverted into a storage system.\n(5) Treatment facilities shall use an enclosed system to transfer particulates\ncaptured by the air pollution control system into leakproof and enclosed\ncontainers.\n(6) Sludge of particulates shall be stored in leakproof containers and must contain\nno free liquid before disposal.\n(7) Access to the treatment facility shall be restricted to authorised personnel. For\nthe purposes of this subregulation, the facility shall include any buildings,\nstorage areas, decontamination areas or other areas where infectious waste\nmay be found.\n\nRegulation 12\nPublic Health (Infectious Waste) Regulations\n\nPage 10\nRevised as at 30th day of April, 2002\nc\n\n(8) Every treatment facility using incineration shall adopt and keep posted, in the\nimmediate area of the incinerator, standard written operating procedures which\nshall include \u2014\n(a)\noperating time;\n(b) operating temperature;\n(c)\noperating air flow; and\n(d) maximum load quantity.\n12.\nSteam sterilisation or autoclaving\n12. (1) The following documents shall be kept at any steam sterilisation or auto\ncleaning treatment facility \u2014\n(a)\napplicable public health regulations regarding infectious waste;\n(b) manufacturer\u2019s specifications and maintenance procedures;\n(c)\ninfectious waste containment and clean up procedures;\n(d) contingency plans, located in a place accessible to operators of the\nautoclaves;\n(e)\nquality control procedures;\n(f)\nstandard operating procedures; and\n(g) posting of emergency telephone numbers including the fire department,\nthe local health department and the police department,\nand the MOH shall ensure that the operators are trained in each discipline prior\nto being put in charge of autoclave operations.\n(2) Every treatment facility which uses autoclaves shall adopt, and post in the\nimmediate locality of the autoclave, standard written operating procedures for\neach autoclave. Such operating procedures shall include \u2014\n(a)\nthe duration of sterilisation;\n(b) temperatures;\n(c)\npressure;\n(d) type of waste;\n(e)\ntype of container;\n(f)\nclosure of container;\n(g) maximum load quantity; and\n(h) water content.\n(3) Every package of waste in a load shall have heat sensitive tape or its\nequivalent to indicate the attainment of adequate sterilisation conditions. If the\nindicator fails to indicate that the required temperature was reached during the\nsterilisation process the waste will not be considered as satisfactorily treated.\n\nPublic Health (Infectious Waste) Regulations\nRegulation 13\n\nc\nRevised as at 30th day of April, 2002\nPage 11\n\n(4) After autoclaving, all sharps shall be dealt with in such a manner as to\neliminate the potential of those wastes causing lacerations or puncture wounds\nduring handling, transportation or disposal.\n(5) Only authorised persons shall be allowed access to the treatment facility.\n(6) Loading, unloading, processing and storage areas of infectious waste and ash,\nand decontamination areas shall be paved and have drainage into a disposal\nsystem. Facilities shall have appropriate slopes and drainage to avoid\nsettlement of water.\n(7) In this regulation-\n\u201ctreatment facility\u201d includes any building, storage area, staging area,\ndecontamination area and other areas where infectious waste may be\nfound.\n13.\nQuality control guidelines\n13. (1) The guidelines set out in this regulation shall be adhered to by treatment\nfacilities.\n(2) Incinerators shall \u2014\n(a)\ncontinuously monitor and record primary and secondary chamber\ntemperatures, using strip charts;\n(b) sample stack gas after adding spores of Bacillus Subtilis Var. Niger\n(Globigii) to a load of infectious waste before it is incinerated. Sampling\nshall be by the use of standard emission testing methods. The number of\nspores added to the waste and the sampling time, shall be adjusted to\nensure a theoretical challenge of at least one million spores in the\ncollected sample. Monitoring shall be repeated whenever substantial\nrepairs are made to the incinerator or when otherwise required by the\nCEHO or his authorised representative;\n(c)\nobtain representative samples of ash, using the Simple Random Sample\nMethod described in the EPA test methods for evaluating solid waste.\nThe samples shall be tested monthly for the EPA toxicity characteristics\nutilising an independent analytical laboratory which uses the\nmethodology provided in the EPA test methods for evaluating solid\nwaste; and\n(d) maintain a maintenance log.\n(3) Every autoclave shall \u2014\n(a)\ncalibrate all maximum registering thermometers at least every three\nmonths or when required by the CEHO or his authorised representative;\n(b) make a daily evaluation, under full load, of conditions for the\neffectiveness of sterilisation with spores of Bacillus Stearothermophilus\nplaced in a position in the autoclave determined to have the lowest\n\nRegulation 14\nPublic Health (Infectious Waste) Regulations\n\nPage 12\nRevised as at 30th day of April, 2002\nc\n\ntemperature during full load cycle according to the manufacturer\u2019s\nspecifications;\n(c)\nkeep a log at the unit which shall contain \u2014\n(i)\nthe date;\n(ii) the times the cycle started and ended;\n(iii) the name of the operator;\n(iv) the type and amount of waste treated;\n(v) the temperature of maximum registering thermometer; and\n(vi) post-sterilisation reading of the temperature-sensitive tape.\n(4) All quality control measures shall be kept in a quality control log for a\nminimum period of three years.\n14.\nAnnual report\n14. An annual report of the activities of an infectious waste facility shall be submitted to\nthe MOH not later than 1st February in each year. Such a report shall contain\nmonthly totals in the different categories of waste, and such other information as the\nMOH may think necessary.\n15.\nSpill containment and clean up kit\n15. (1) Every infectious waste treatment facility shall keep a spill containment and\nclean up kit within the vicinity of any area where infectious waste is managed\nand the location of the kit shall be such as to facilitate rapid and efficient clean\nup of spills anywhere within the area.\n(2) The minimum requirements for a clean up kit are \u2014\n(a)\nmaterial designed to absorb liquids, such material being of an absorptive\nrating of ten gallons of liquid;\n(b) one gallon of an approved chemical disinfectant in a sprayer capable of\ndispensing its charge in a mist and in a stream at a safe distance. The\ndisinfectant shall be of hospital grade and effective against mycobacteria;\n(c)\ntwo new sets of liquid impermeable and disposable \u2014\n(i)\noveralls;\n(ii) gloves;\n(iii) boots;\n(iv) caps;\n(v) protective eye wear; and\n(vi) protective breathing devices; and\n(d) a first aid kit, fire extinguisher, boundary tape, lights and other\nappropriate safety equipment.\n\nPublic Health (Infectious Waste) Regulations\nRegulation 16\n\nc\nRevised as at 30th day of April, 2002\nPage 13\n\n(3) Overalls, boots, and caps shall be oversized or fitted to infectious waste\nworkers. Boots may be of thick rubber and gloves may be of heavy neoprene\nor the equivalent. Breathing protection devices shall be graded superior in\nfiltering particulates and mists. Tape for sealing wrists and ankles shall also be\nin the kit.\n16.\nDisinfectants\n16. The disinfectants used in cleaning up a spill shall be used at the specified\nconcentrations for a minimum of ten minutes for continuous rinsing or submersion.\nThe following disinfectants are approved for use at their expressed\nconcentrations \u2014\n(a)\nhypochlorite solution with 500 ppm available chlorine with a pH range of\nsix to eight;\n(b) iodoform solution with 150 ppm available iodine with a pH of neutral to\nacidic;\n(c)\ngluteraldehyde two per cent solution with pH seven to eight; and\n(d) other disinfectant approved by the CEHO.\n17.\nMinimum clean up procedures\n17. Every infectious waste facility shall implement the following minimum procedures\nsubsequent to a spill of infectious waste or to its discovery \u2014\n(a)\nensure that the clean up crew wear protective clothing during the entire\nclean up operation;\n(b) limit access to the area of spill to authorised personnel only;\n(c)\nspray broken containers of infectious waste with disinfectant;\n(d) place broken containers and spillage in over-pack bags in the clean up kit\nto minimise exposure;\n(e)\ndisinfect the area and take such other clean up steps as may be\nappropriate to the circumstances;\n(f)\nclean and disinfect non-disposable items;\n(g) clean and disinfect clean up outfits before storing them;\n(h) remove protective equipment and place disposable items in a clean\nup bag;\n(i)\ntake any necessary steps to replenish containment and clean up kit with\nitems which have been used;\n(j)\nmake an immediate report of the spill or accident to the CEHO;\n(k) if necessary, call the CEHO for emergency help; and\n(l)\nwithin twenty-four hours of its occurrence, report every infectious waste\nspill or accident to the CEHO, using the spill or accident form prescribed\n\nRegulation 18\nPublic Health (Infectious Waste) Regulations\n\nPage 14\nRevised as at 30th day of April, 2002\nc\n\nby the CEHO. The report should include any spill of infectious waste\noutside the limited access area.\n18.\nStandards for the packaging of infectious waste\n18. (1) Packaging of infectious waste shall conform to the requirements specified in\nthis regulation.\n(2) Bags shall be red in colour or conspicuously labelled with the international\nbiohazard symbol. The bags shall be made of material of sufficient single\nthickness to resist tearing or bursting under normal conditions of handling. The\ninternational biohazard symbol on the bags shall be a minimum of five inches\nin diameter.\n(3) Bags shall be impervious to moisture, and, when containing waste, shall be\nsecurely tied or sealed so as to prevent breakage or expulsion of waste during\nstorage, handling or transport.\n(4) Containers for infectious waste shall be labelled with the international\nbiohazard symbol with the words \u201cINFECTIOUS WASTE\u201d printed on them\nand visible from any direction when the containers are upright.\n(5) Containers shall \u2014\n(a)\nbe kept clean on the outside;\n(b) be leakproof;\n(c)\nhave tight fitting covers;\n(d) be of sufficient strength to withstand the wear and tear of handling during\ntransport without compromising their integrity; and\n(e)\nbe capable of being re-used after chemical disinfection,\nand, in the case of sharps, containers shall be rigid, puncture resistant,\nleakproof and tightly closed to prevent loss of contents.\n19.\nUse of chutes forbidden\n19. The use of chutes is strictly forbidden in the transfer of infectious waste.\n20.\nStorage of infectious waste\n20. (1) Generators, transporters and treatment facilities storing infectious waste\nshall \u2014\n(a)\nstore infectious waste in a safe manner and place;\n(b) maintain the waste in a non-putrescent state, using refrigeration or\nfreezing, if necessary;\n(c)\nlock the outside of storage areas which contain infectious waste to\nprevent unauthorised access;\n\nPublic Health (Infectious Waste) Regulations\nRegulation 21\n\nc\nRevised as at 30th day of April, 2002\nPage 15\n\n(d) designate and label storage areas by posting a sign marked \u201cWARNING -\nINFECTIOUS WASTE\u201d in a conspicuous place and also displaying the\ninternational biohazard symbol at all points of access; and\n(e)\ncause infectious waste to be stored in such a manner that animals have no\naccess to it, and it does not provide a breeding place or source of food for\ninsects or rodents.\n(2) Generators shall not store infectious waste on their premises longer than seven\ndays at a time, except that sharps containers, currently in use, are exempt from\nthis provision if their generators satisfy subregulation (1).\n(3) Treatment facilities shall not store infectious waste longer than fourteen days\nat a time. Such facilities shall formulate a contingency plan, a copy of which\nshall be given to the MOH. A contingency plan shall \u2014\n(a)\nmeet all the requirements of subregulation (1) in relation to the removal\nof infectious waste to an alternative treatment facility;\n(b) be maintained at the treatment facility; and\n(c)\ndesignate an emergency co-ordinator and an alternate emergency coordinator.\nThe contingency plan shall be implemented if treatment facility exceeds or is\nreasonably expected to exceed the storage capacity of the treatment facility.\n21.\nRegistration of generators of infectious waste\n21. (1) Every health practitioner in active practice and practising alone, every medical\ninstitution and every other generator shall register with the MOH as a\ngenerator of infectious waste. In the case of a new generator, he or it shall\nregister within thirty days of opening operations.\n(2) An application for registration shall relate to each premises owned or operated\nby the generator and the validity of a generator\u2019s certificate shall be for a\nperiod of one year.\n(3) Any person who, by reason of his state of health, uses disposable sharps for\nhome testing or for self-administration of injectables (such as insulin) shall not\nbe required to register as a generator; but in any such case the health\npractitioner or pharmacy from whom or from which the sharps were acquired\nshall ensure the safe disposal of such sharps according to these regulations.\n22.\nFees\n22. (1) The fee for registration under regulation 21(1) is one hundred dollars payable\nupon first registration and thereafter on the anniversary of such registration.\n(2) Every generator shall pay a fee of two dollars per pound for the collection,\ntransportation and disposal of infectious waste.\n\nRegulation 23\nPublic Health (Infectious Waste) Regulations\n\nPage 16\nRevised as at 30th day of April, 2002\nc\n\n(3) The fee for an approval of the MOH under regulation 6(1) is two hundred and\nfifty dollars per annum.\n23.\nRegistration of vehicles\n23. (1) Every transporter of infectious waste shall register with the MOH the vehicle\nused to transport infectious waste.\n(2) A registered transporter shall obtain an amended infectious waste permit from\nthe MOH whenever motor vehicles listed under the current registration\ncertificate are either removed from service, or replaced, or more vehicles are\nadded for use by the transporter to transport infectious waste. Application for\nan amended permit shall be made on a form prescribed by the MOH, not more\nthan thirty days before the proposed utilisation for transport of infectious\nwaste. If the number of motor vehicles in the fleet decreases, the MOH shall\nnot refund to the transporter any portion of a registration or renewal fee\napplicable to a motor vehicle transferred or otherwise removed from use for\ntransporting such waste. If the number of motor vehicles in the transporter\u2019s\nfleet increases, the application for the amended infectious waste permit shall\nbe accompanied by a fee prorated on an annual basis according to the time\nremaining in the registration cycle.\n(3) It is an offence to use an unregistered motor vehicle to transport infectious\nwaste.\n24.\nOffences and penalties\n24. Any person who is in breach of these regulations is guilty of an offence and liable\non summary conviction to the penalty laid down in section 70(2).\nPublication in consolidated and revised form authorised by the Governor in Council\nthis 30th. day of April, 2002.\nCarmena Watler\nClerk of Executive Council","akn_extracted_at":"2026-06-22 15:39:55.260034+00","cms_id":"1991-0002","law_type":"subordinate","year":"1991","number":"2","title":"Public Health (Infectious Waste) Regulations","status":"in_force"},"provenance":{"files":[{"file_id":"6023","expr_id":"758","kind":"akn_xml","filename":"1991-0002_2002 Revision.akn.xml","source_url":null,"storage_path":"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/1991\/1991-0002\/1991-0002_2002 Revision.akn.xml","content_md5":"c6c6a0d5ea8f7a142b507b756c1cd08a","byte_size":"30039","http_last_modified":null,"fetched_at":"2026-06-22 15:39:55.467164+00"},{"file_id":"1515","expr_id":"758","kind":"pristine_pdf","filename":"1991-0002_2002 Revision.pdf","source_url":"\/cms\/images\/LEGISLATION\/SUBORDINATE\/1991\/1991-0002\/1991-0002_2002 Revision.pdf","storage_path":"\/Users\/q\/kyleg-data\/pristine\/SUBORDINATE\/1991\/1991-0002\/1991-0002_2002 Revision.pdf","content_md5":"1174fae6ce4a210dc35dbb35aa9210d4","byte_size":"416808","http_last_modified":null,"fetched_at":"2026-06-21 23:09:37.367486+00"},{"file_id":"1516","expr_id":"758","kind":"working_pdf","filename":"1991-0002_2002 Revision.pdf","source_url":"\/cms\/images\/LEGISLATION\/SUBORDINATE\/1991\/1991-0002\/1991-0002_2002 Revision.pdf","storage_path":"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/1991\/1991-0002\/1991-0002_2002 Revision.pdf","content_md5":"1174fae6ce4a210dc35dbb35aa9210d4","byte_size":"416808","http_last_modified":null,"fetched_at":"2026-06-21 23:09:37.367486+00"}],"paragraph_count":16,"latest_history":null},"quality":{"expr_id":"758","doc_id":"758","quality_state":"needs_review","quality_score":"84","needs_human_review":"t","deterministic_categories":"{duplicate_text,page_header_footer_noise}","llm_categories":"{truncated_text,other}","repair_actions":"{collapse_duplicate_text,manual_review,reextract_full_text,strip_page_furniture}","finding_severity_counts":"{\"low\": 1, \"medium\": 1}","finding_summary":"Sample ends abruptly mid-definition; stray 'c' characters suggest minor OCR issues. Human review recommended to confirm completeness and clean up artifacts.","assessed_at":"2026-06-22 15:29:46.022973+00","updated_at":"2026-06-22 15:29:46.022973+00"}}