Register A

State rules on liquid blood to the sanitary sewer

Five states verified from quoted primary text, two qualified, forty-two published as unread — and the two clearest rules point in opposite directions.

Scope

This register covers one question and one layer of law: what a state’s own medical-waste statute or administrative code says about discharging untreated liquid blood, blood products or body fluids to a sanitary sewer. It is the second of three layers.

The first layer is federal, and it is a deferral. OSHA’s bloodborne pathogens standard has no drain provision and no sewer provision; its only disposal clause requires that disposal comply with applicable regulations of the United States, States and Territories, and political subdivisions.14 The Environmental Protection Agency has had no medical-waste authority since the Medical Waste Tracking Act expired on 21 June 1991, and its own page says medical waste is primarily regulated by state environmental and health departments.13 So the federal layer sends you to this one.

The third layer is the sewer-use ordinance of the utility that receives the discharge, and it binds independently. A generator can satisfy its state rule and still violate its publicly owned treatment works’ ordinance, because the two are drafted by different agencies for different reasons. That layer is Register B.

Not in scope here: what any particular facility may do; treated or disinfected waste routed to landfill; sharps; pathological waste; pharmaceutical sewering, which is separately prohibited for hazardous waste pharmaceuticals by 40 CFR § 266.505 and is routinely confused with blood.16

What the two clearest rules do

Read side by side, the two states whose text is least ambiguous point in opposite directions, and neither points where a reader would guess.

North Carolina runs backwards from intuition. The natural assumption is that small volumes are fine and large volumes are prohibited. North Carolina’s rule does the reverse: volumes greater than 20 millilitres in an individual container are affirmatively routed to the sanitary sewer — conditioned on notification to the local sewage treatment authority, not on a permit — with incineration or steam sterilisation offered as the alternative; volumes of 20 millilitres or less may also go to the sewer.5 The sewer is the enumerated route at both ends of the scale, and the threshold governs the paperwork, not the destination.

Ohio permits by default, and the permit is what takes the permission away. Its rule does not enumerate the sewer as one approved method among several. It grants the discharge unless a Clean Water Act permit issued to the receiving system says otherwise.2 That is the sharpest structural contrast with North Carolina anywhere in the text we have read, and it is why a national statement about “the rule” on this subject is not available to anybody.

Ohio’s sentence, and the word that is new in it

California’s carve-out, and the search trap in it

California’s provision is the most citable state sewer text in this register: its operative wording has been stable since 1 January 2015 and it sits as an express exception to a treat-before-disposal command.1

(b) Fluid blood or fluid blood products may be discharged to a public sewage system without treatment if its discharge is consistent with waste discharge requirements placed on the public sewage system by the California regional water quality control board with jurisdiction.

Read the full section

Three things about it are worth carrying away. First, the section never uses the word “sewer.” Its term is public sewage system. Anyone keyword-searching the California codes for “sewer” will conclude the state is silent, and the state is not silent. Second, the permission reaches fluid blood and fluid blood products and nothing else. It does not say “body fluids,” which is exactly what Ohio and Texas do say. A California canister holding irrigation fluid, urine or ascites is not squarely inside § 118215(b), and published summaries that render this state as permitting “body fluids” have widened the statute. Third, subdivision (b) conditions discharge only on the regional water quality control board’s waste discharge requirements, while the parallel provision for chemically disinfected laboratory waste at (c)(3) adds a second condition that (b) lacks — compliance with the requirements imposed by the owner or operator of the public sewage system. We report that asymmetry as what the text says. We do not read it as meaning a California hospital may ignore its sewer utility, because the Los Angeles city and county ordinances bind independently of the Health and Safety Code and are in Register B.

Notes on the two tables

Some of the forty have been characterised in secondary sources, and a few in our own working notes. None of them has a verdict here. Connecticut, Maryland and Pennsylvania each appear in circulating summaries with a one-line disposition, and New York, New Jersey and Illinois are named in half the surveys on this subject. We did not retrieve quotable primary text for any of them, so the rows say we have not read them and nothing else. A one-line disposition we cannot show you is the exact commodity this publication exists to replace, and printing our own would be a strange way to begin.

This register carries no Silent row, and two rows that nearly did. Washington and Virginia were opened, and in both our reading of the governing programme’s scope — Washington’s recodified chapter, Virginia’s domestic-sewage exclusion — is that no state discharge provision exists to quote. That is a reading, not a scan. Silent on this site is a claim about a keyword scan we ran ourselves and can publish with its terms, its character count and its date, of the kind we ran for the sewer authorities in Register B, and we hold no such scan for either state. So both ship Not checked and the reading stays here, in prose, labelled as a reading. We think the readings are right. A status chip is not the place to say so.

Silence is not permission. This is the point on which the published guidance is least useful. The CDC’s environmental infection control guideline gives the affirmative recommendation, at Category II — its own weakest actionable tier.15

Sanitary sewers may be used for the safe disposal of blood, suctioned fluids, ground tissues, excretions, and secretions, provided that local sewage discharge requirements are met and that the state has declared this to be an acceptable method of disposal.

Retrieval URL not recorded; the full citation is in Sources below.

Read the last clause. The recommendation is conditioned on local sewage discharge requirements being met and on the state having declared the method acceptable. In a state that has declared nothing, there is no declaration to rely on, and the recommendation does not execute itself. We have not seen that point made in any published source, and it is why the difference between a Not checked row and a Verified row has practical teeth rather than merely bibliographic teeth.

Georgia is out of scope

Georgia is outside the scope of this register. Secondary sources repeatedly assert a Georgia sewer provision; we could not confirm one in primary text, and the databases we tried returned 403. We offer no verdict on Georgia, in either direction, and Georgia has no row in either table above. It is not silent, it is not permitting and it is not restricting, as far as anything published here is concerned — it is unread, and we would rather say that in a sentence than encode a guess as a status chip.

One thing to keep separate, because the two are constantly conflated: Georgia’s surgical smoke statute is confirmed in primary text and does have a row, in Register C. The two subjects have nothing to do with each other beyond sharing a state.

How a row here is built

A state gets a verdict when we hold the words. Every row marked Verified or Qualified carries a verbatim quotation from text we retrieved from an official publisher, pulled as raw HTML or PDF, de-tagged locally and read. A state whose text we could not retrieve ships Not checked even where we are fairly confident what it says. Silent is reserved for a keyword scan we ran ourselves and can publish with its terms, its character count and its date; no state in this register has one yet, which is why no row here carries it.

The difference between Verified and Qualified is a live caveat, not a difference in our confidence in the transcription. Ohio is qualified because it was renumbered and the new text changed. Texas is qualified because the state took its machine-readable code viewer offline and we are quoting a 2024 capture. Florida is qualified because the agency’s own website recites a different subsection than the one that governs. Each of those is a fact about the record, and each is written in the row rather than in a footnote at the bottom of the page.

What would change these rows

• Texas. The Texas Register sweep is complete — 109 of 109 issues from 2024-07-05 to 2026-08-07, with no proposed, adopted or withdrawn action on §§ 1.131–1.137 — so the caveat on this row is no longer an unswept window. What remains is that the state’s replacement Administrative Code portal serves a JavaScript shell rather than retrievable text, so the rule as it stands today cannot be read by us at all. Anyone who can reach that portal in a real browser can read the Source Note in about two minutes. If it still ends at 2018-05-24, this row is confirmed; if it does not, the row is wrong and we will correct it.
• Florida. Chapter 64E-16 entered rule development on 1 April 2026. An adopted amendment, or a Department of Health page that finally recites subsection (5), moves this row.
• Ohio. Any Ohio EPA guidance, permit condition or adjudication addressing whether a mixed suction canister consists exclusively of blood, blood products, body fluids and excreta would answer the open question in that row. We are actively looking for one.
• The forty. Each of them moves the moment somebody retrieves the operative text. If you have the primary citation for a state in Table 2 — the rule number and the sentence, not a summary of it — send it to [email protected] and it will be read, quoted and credited.
• Georgia. A retrievable Georgia code section on sewer discharge of medical waste would put Georgia in the table. Until then it stays in prose.

Where this could be wrong

The strongest objection to this register is that it is small enough to mislead by composition. Nine states out of fifty is not a survey, and the nine are not a random nine: they are the ones whose publishers let us in. States with hostile or broken code websites are systematically underrepresented here, and Texas is the visible example of what that costs: its rule is verified only because we could sweep two years of the state gazette for amendments, since its own government no longer publishes the rule itself in a form anyone can read. A reader who treats Table 1 as a sample of American practice will draw the wrong inference; the honest reading is that it is a sample of American government web infrastructure.

The second objection is the retrieval-date convention. Every row in Table 1 is dated 2026-08-06 because that is when the research pass behind this register completed. For California and Ohio we hold the HTTP status and the publisher’s own effective-date stamp, so the date means what it appears to mean. For Massachusetts, Rhode Island, Florida and Washington our log recorded the publisher and the date but not the address, and the date is therefore the date of the pass rather than a timestamp we can show you. We could have hidden that by omitting the dates. We would rather print the weaker provenance and label it.