HOSPITAL WASTE

MANAGEMENT

Submitted by-
Rajsandeep Singh
 INDEX
 Introduction
 Nature of quantum of hospital waste
 Types of waste
 Classification of hospital waste
 Quantum of waste
 Steps in waste management
 Categories of bio medical waste according to ministry
of environment and forest
 Bio-medical waste management
 Segregation and safe storage
 Colour coding and containers for disposal of bio-
medical waste
 Choice of bins or receptacles
 Handling and treating
 Disposable items
 Chemical disinfection
 Recommended dilution of chlorine releasing
compounds
 Sharps
 Liquid waste
 Radioactive medical waste
 Non-radioactive general waste
 Disposal of biodegradable waste
 Chemical hazardous waste
 Onsite transportation
 Discarding and disposal of disposable material
 Bibliography
 INTRODUCTION

 By hospital waste it means the

biomedical waste generated in
different departments of hospitals.
 Hospital waste has always been
considered as potential hazardous in
view of inherent potential for
dissemination of infection.
 NATURE OF QUANTUM OF
HOSPITAL WASTE
 Three major categories of health
care facilities exist in India.
1. Outpatient clinics
2. Outpatients and inpatient care
hospitals.
3. Sub divisional and district hospitals
medical college hospitals and
specialty hospitals in public sectors
and in private sector.
 TYPES OF WASTE
1. Medical waste – Any waste generated in
diagnosis treatment and immunization of
human beings.
2. Clinical waste – Waste coming out of
medical care provided in hospitals.
3. Pathological waste – Human tissues,
organs, body parts removed during
surgery or autopsy, biopsy samples and
body fluids.
4. Infectious waste – All kinds of waste
which may transmit viral, bacterial or
parasitic diseases.
 MEDICAL WASTE  CLINICAL WASTE
 PATHOLOGICAL  INFECTIOUS
WASTE WASTE
 CLASSIFICATION OF HOSPITAL
WASTE
1. Non Hazardous waste
a) Biodegradable Kitchen Waste – This
includes peels of fruits and
vegetable skin and left over food,
tea, drugs and other kitchen waste.
b) Non Biodegradable waste – This
category includes wrappings, foils,
plastic bags etc.
2. Hazardous waste
a) Potentially infectious waste
i. Dressings and swabs contaminated with blood, pus and
body fluids.
ii. Laboratory waste
iii. Instruments used in patient care: these range from
endoscopes, ultrasound probes, syringes and needles
etc.
iv. Potentially infected materials: Placenta tissues, tumors,
organs or limbs.
v. Potentially infected animals: used in research.
b) Potentially toxic waste
i) Radio active waste – used in diagnosis or treatment of
diseases.
ii) Chemical waste – may be toxic, corrosive, inflammable
or genotoxic. Their handling should ensure that human
and environmental problems do not arise.
iii) Pharmaceutical waste – This may enter hospital waste
because surplus stock, spillage or contamination is
detected or expiry date is over.
 QUANTUM OF WASTE
 The quantum of waste generate will vary
depending upon the type of health
problem, the type of care provided and
the hospital waste management practices.
In developed countries waste generated is
1 to 5 kgs of solid waste per day per head.
But in developing countries most patients
generate between 1 to 2 kgs of waste.
This difference is partly due to difference
in use of disposables in health care and
partly due to life style of the population.
 HEALTH HAZARDS ASSOCIATED WITH POOR HOSPITAL WASTE
MANAGEMENT
1. Injuries from sharps to all categories of hospital
personnel.
2. Nosocomial infection in patient from poor infection
control and poor hospital waste management.
3. Risk of infection outside hospital for waste handlers,
scavengers and (eventually) the general public.]
4. Risks associated with hazardous chemicals, drugs
handled by persons handling waste at all levels.
5. “Disposable” – Recycled – Repacked and sold without
being even washed. E.g. needles and syringes.
6. Outpatients attending health care facilities.
7. Medical and paramedical personnel providing health care
specially those handling contaminated body fluids.

ROUTE OF TRANMISSION OF INFECTION FROM POTENTIALLY

INFECTIOUS WASTE.
1. Through non-intact skin and through mucous membranes as
splashing into the eyes.
2. Inhalation of dust particles containing germs and ingestion
through contaminated unwashed hands.
 Steps in Waste Management
1. Waste reduction and reuse- there is a growing trend in
health care settings to provide or use disposable
materials in all aspects of work. Some are quite
necessary but hospitals should select a mixture of
disposable and reusable materials. This will reduce
waste. E.g. they can choose products with less
packaging.
2. Waste Survey – This is an important component of waste
management scheme to
i) Differentiate types of waste
ii) Quantity of waste generated is determined
iii) Determine the points of generation and type of waste
generated at each point.
iv) Determine level of generation and disinfection within the
hospital.
v) To find out the type of disposal carried out.
WASTE REDUCTION
CATEGORIES OF BIOMEDICAL WASTE ACCORDING TO MINISTRY
OF ENVIRONMENT AND FOREST (CLASSIFICATION NOTIFIED IN
BIOMEDICAL HANDLING & MANAGEMENT RULES)

Category Type of waste Treatment and

disposal option

Category 1 Human Anatomical wastes Incineration / deep burial

Category 2 Animal waste (experimental Incineration / deep burial

animals used in research
waste generated by
veterinary hospitals.
Category 3 Microbiology and Bio- Local / Autoclaving/ Micro-
technology waste e.g. waving incineration
cultures, stocks or
specimens of micro-
organisms; live or
attenuated vaccines, cell
cultures etc.
Category 4 Waste sharps (needles, Disinfection (Chemical)
syringes, scalpels, blades, autolcaving/ Microwaving
glass etc.) and mutiliation/ shredding
Category 5 Discarded medicines and Incineration / Destruction
cytotoxic drugs (outdated and disposal in land fills.
contaminated and discarded
drugs and medicines).

Category 6 Soiled Wastes (items Incineration / Autoclaving /

contaminated with blood, Micro-waving
body fluids including cotton,
dressings, soiled plaster,
linens, bedding etc.

Category 7 Solid wastes (Disposable Disinfection by chemical

items other than the waste treatment/ Autoclaving /
sharps as tubing, catheters, Microwaving and
IV sets, etc.) mutilation / Shredding.

Category 8 Incineration ash (Ash from Disposal in municipal land

incineration of any Bio- fills.
medical waste)

Category 9 Chemical Wastes Chemical treatment and

(Chemicals used in discharge into drains for
biological production and liquid and secured land fills
those used in disinfection for solids.
such as insecticides.
MEDICAL WASTE INCINERATOR
BIO-MEDICAL WASTE
MANAGEMENT

Pyrolytic incinerator (py-

200) for rapidly
destroying all bio
medical waste material
generated.
The double chamber
incinerator can reduce
70 to 90 kg/hr bio
waste.
 SEGREGATION AND SAFE
STORAGE
Incorrect classification of waste can lead to
many problems at a later stage.
Segregation should be done at the point
of generation to keep general waste from
becoming infectious.
Thus by segregation hospital can
1. Reduce total treatment cost
2. Reduce the impacts of this waste on the
community.
3. Reduce the chances of infecting health
care workers.
 COLOUR CODING AND CONTAINERS FOR
DISPOSAL OF BIO-MEDICAL WASTE

Colour Type of Waste Treatment

code container category options
Yellow Plastic bags Human & Animal Incineration / deep
waste, microbial and burial
Bio technological
waste and soiled
wastes
Red Disinfected Microbiological and Autoclaving /
container or plastic biotechnological Microwaving /
bag waste soiled wastes Chemical treatment
and solid waste
Blue Plastic bag Waste sharps and Autoclaving /
/Puncture proof solid waste Microwaving /
container Destruction and
shredding.
Black Plastic bag Discarded Disposal in secured
medicines, cytotoxic landfills.
drugs, incineration
ash and chemical
wastes.
 CHOICE OF BINS OR RECEPTACLES
Hospital managers may prefer to use plastic or metal bins for
waste storage in order to save on the cost or paper work of
buying large number of one strip sacs.
If reusable containers are to be used, considerable thought
should be given to methods of cleaning and disinfecting
them in unpleasant task that would tend to be avoided
unless there is a high degree of motivation and supervision.
The containers should be smooth and well rounded from
inside to allow effective and complete cleaning.
The size and number of receptacles should be appropriate to
the amount of wastes produced, assuring the collection
takes place twice a day, or more often in operation theatres
or ICUs.
HANDLING AND TREATING
This term refers to the process that modifies the waste in some ways
before it is taken to its final resting place. It mainly requires
disinfection or decontamination by chemical disinfection of waste right
at the source, so that it is no longer the source of pathogenic
organisms. After this the residue can be handled safely, transported,
stored and disposed.
POINTS TO BE KEPT IN MIND WHILE DEALING
WITH INFECTIOUS WASTES
a) Infectious waste must be separated at the points of generation
itself.
b) Bins with lids lined with polythene bags, or with inner chamber
for bucket should be used.
c) A lidded bin will discourage inadvertent use by others.
d) The bins and bags should be labeled with biohazards symbol
and if required for the types of waste they have to be used for.
e) Personnel involved in infectious waste handling should be
provided with suitable protective with suitable protective wear
and should be properly trained.
f) Polythene bags placed in the bins have to be changed with
each shift or when they are 3/4 th full.
g) Polythene bags carrying waste have to sealed/tied at the top
whenever the waste is being transported within or outside the
hospital.
h) Infectious wastes from the wards, ICU, OT, OPD and the labs
should have a common specific bin allotted for them at the
final point of disposal. This bin should be covered and
protected from the public at all times.
 DISPOSABLE ITEMS
Items like single used products, syringes, IV bottle, catheters, sharps and
rubber gloves are often recycled and have the risk of being reused illegally,
therefore it is imperative that chemical disinfection be followed for them.
Disposables have to be dipped for a minimum duration of ½ - 1 hour in the
chemical disinfectant or autoclaved or microwaved.

CHEMICAL DISINFECTION
Chemical disinfection has a wide application in small health care
facilities.
•A good disinfectant is bleach.
•For chemically treating the waste and optimum concentration of
bleach has to be prepared.
•The concentration prescribed by WHO is 10gm of bleach in 1 litre
water.
•However it must be noticed that medical waste that have been
chemically disinfected should continue to be treated as hazardous,
unless careful bacteriological testing has shown disinfection to be
complete.
DISPOSABLE ITEMS
 RECOMMENDED DILUTION OF CHLORINE
RELEASING COMPOUNDS
Available Chlorine “Clean” condition “Dirty” condition

Required Chlorine 0.1% 1gm / litre 0.5% 5gm / litre

Sodium hypochlorite 20ml/litre 100 ml/litre

solution 5% available
chlorine
Calcium hypochlorite 70% 1.4 gm/litre 7.0 gm/litre
available chlorine

(NaOCl Powder) Sodium 1.7 gm/litre 8.5 gm/litre

dichlorosocyanurate

(NaOCl Tablets) Sodium 1 table/litre 4 tablets/litre

dichlorosocyanurate

Chloramine (25% available 20 gm/litre 20 gm/litre

chlorine)
 SHARPS
Major portion of the sharps are needles, which can be cut by a needle
cutter and contained in a bleaching powder solution or autoclaved or /
and shredded or destroyed.
Other than needles a small amount of sharp waste generated, may also be
contained in a separated bin meant for sharps or in the needle cutter
itself.

PRECAUTIONS IN THEIR HANDLING

a) All the health workers employed in /outside the hospital must be
vaccinated against Hepatitis B.
b) All the health care workers put on heavy-duty gloves while dealing
with infectious wastes specially sharps.
c) Sharps should not be left casually on counter tops, food trays or
beds as grievous injuries can result.
d) Recapping needle should be discouraged.
e) In situations when recapping is unavoidable, the single handed
method should be utilized.
 LIQUID WASTE
1. Hospital generates liquid waste which is either
infectious or chemical in nature.
2. To avoid exposure with the general public it is
necessary that the waste be properly treated.
3. Liquid pathological waste should be treated with a
chemical disinfectant. Subsequently treated with
reagent to neutralise it.
4. It can then by flushed into the sewer system.

RADIOACTIVE MEDICAL WASTE

Use of nuclear medicine classified into two parts –
“detection and treatment of diseases”.
Hospitals providing nuclear medicine have not only
to check for radiation but also to ensure that
instruments are properly maintained properly
protective wear is provided not only to the
physicians and other employees but also to the
patients.
  PLASTIC CONTAINER
FOR BULK LIQUID
WASTE

 1 to 2 CUBIC FOOT
BOXES FOR
RADIOACTIVE WASTE
 NON-RADIOACTIVE GENERAL WASTE
 The general office waste comprising of the waste papers
can be clubbed with other recyclable materials to be sent
for recycling.
 Kitchen waste can be utilized in many different ways –
according to the quantity of waste. In large hospitals
technology like bio digestion can be installed. In smaller
establishments, kitchen waste can be composted.
 Non-biodegradable waste can be disposed off in municipal
bins.

DISPOSAL OF BIODEGRADABLE WASTE

• It is comparatively easy to handle.

• It can be accomplished by Bio-digestion (using bacteria or

earth worms) or
• By Pit composting.
• After complete the composition it can be sued biofertilizer.
 CHEMICAL HAZARDOUS WASTE
 These may include solvents, chemotherapy waste, pathogenic
chemicals, formaldehyde waste, radioactive waste, heavy metals
like mercury and in instruments, other toxins and corrosives and
waste anaesthetic gases.
 Minimisation of the waste, careful segregation, safe disposal of the
waste which can not be recycled.

ONSITE TRANSPORTATION
• All bags should be fastened and small trolleys can be used in large
facilities.
• Trolleys and carts should be large enough so that waste is not
piled upon them.
Some of the alternate technologies being promoted in India are :
1. Autoclave
2. Microwave
3. Chemical disinfection
4. Incineration
 APOTEFROTIRAS:-
special refrigerator vehicles
1. Autoclave
a) Gravity displacement autoclaves – Disadvantage is that
they may be air pockets left within the waste, which is
being autoclaved.
b) Pre-vacuum autoclaved.
2. Microwave
Microwaves caused molecules within the waste material
to vibrate and generates heat within the material itself.
3. Chemical Disinfection
It is cost effective and some of the commonly used
disinfectants for waste are:
a) Sodium Hypochlorite
b) Bleach
This should not be used for all medical wastes and only
plastic, rubber and metals should be disinfected.
It is not advisable to disinfect cloth based medical waste
because it is difficult to handle wet waste and it also adds
to the weight and volume of the waste.
Pathological waste, also, can not be disinfected in this
manner unless it is crushed, which may cause aesthetic
problems.
HOSPITAL AUTOCLAVE
MICROWAVE PROCESS
DISCARDING AND DISPOSAL OF
DISPOSABLE MATERIAL
The awareness of the danger of acquiring
HIV and HBV infection while handling
blood and blood contaminated material
has resulted in sudden increase in the
usage of pre-sterlised disposable material.
There is high possibility that unscrupulous
persons may start re-cycling the
disposable material resulting in their reuse
without even proper sterilization. Thus
disposable material should be given high
priority by ensuring its destruction and
eliminating reuse.
DISPOSAL OF DISPOSABLE
MATERIAL
 CONCLUSION
 Hospital waste in addition to posing risk to
patients and personal who handle these
waste, is also threat to public health and
environment. It is emerging as a health
hazard to community at large.
 Keeping in views, inappropriate
management of biomedical waste, Ministry
of environment and forest notified the
BMW rules 1998.
 The rules are meant to protect
society, patient and health care
workers.
 The most imperative component of
waste management plan is to
develop a system and culture
through education, training and
persistent motivation of health care
staff.
 REFERENCES
 1. BMW Management rules,1998
 2. Singh IB, Sharma RK
 3. www.wilkepedia.com
 4. www.pubmed.com