Waste Management of Health Care Service at

INCQS/Fiocruz – Brazil
Guimarães, Anna Christina Rosa – INCQS/Fiocruz
Sabagh, Fernanda – INCQS/Fiocruz
Fialho, Miguel – INCQS/Fiocruz

Contact:
CIBio/INCQS – Instituto Nacional de Controle de Qualidade em Saúde – INCQS/Fiocruz
Adress: Av. Brasil 4365 – Rio de Janeiro – RJ – 21040-900
Fone: 55 21 38655151
Fax: 55 21 22900915
cibio@incqs.fiocruz.br

EXECUTIVE SUMMARY

The National Institute of Quality Control in Health (INCQS) is a technical-scientific unit of

Oswaldo Cruz Foundation (Fiocruz). It acts as the principal national body reference on technology
and normative issues related to quality control of products, supplies, services and environments in
the context of the National Health Surveillance. This study aims to evaluate the management of the
Waste of Health Care Services inside INCQS / Fiocruz emphasizing the aspect of biosafety;
analyzing if the process of segregation, handling and disposal of waste adopted at the Institute are in
accordance with current legislation. It was performed an inventory of waste generated using as a
tool the Computerized Waste Management System (SIGReSSa).This system was organized
internally according to the specific need of the Institute, with technical support of Computing
Service professionals. The system is easy to use and more reliable. It allows a daily management,
facilitating greater integration between the management figures (generators, biosafety professionals)
and the final destination. It allows full traceability of the material disposal, the registration by the
generator of the waste with the material specification, monitor the length of time that the waste
remains in the intermediate tank to its final destination and better sizing of waste in groups. The
proper segregation of waste at the time and place of its generation, allows the reduction of the
volume of waste requiring specific management, also reducing the cost of waste treatment. The
biosafety actions implemented over the years in INCQS aim the protection of operators and the
environment, and the proper disposal of waste generated.
Key words: Waste of Health Care Service; Biosafety in Health; Computerized System.

INTRODUCTION

The National Institute for Quality Control in Health (INCQS) is the leading national reference
laboratory in the technological and regulatory issues related to quality control of products and
supplies in the context of the Health Surveillance System, working directly with the National
Agency of Health Surveillance. The INCQS also operates in staff training in technology units of
national health surveillance. Since 2010, Brazil has a new legal framework for the formulation of
National Policy on Solid Waste (BRASIL 2010) establishing principles and responsibilities of each
entity involved – Government, Productive Sector, Society – and introducing proper environmentally
consumption patterns.
Although the Biosafety in Brazil was legally formulated to address the minimization of risks in
relation to genetically modified organisms (BRASIL 2005) its scope is much broader, since it
involves non-genetically modified organisms and their relationship to health promotion in the
environment and in the society.

In Brazil there are several problems that affect people's health such as water, soil and atmosphere
contamination and the proliferation of vectors derived from the precarious conditions of the waste
management (IBGE 2008).

The Waste of Health Care Services also called in Brazil as Residues of Health Care Service - RSS,
are those arising from activities performed in providing services to humans and animals health
care. Due to its characteristics, they require different processes in their handling. It can be
considered RSS waste from hospitals, medical clinics, teaching and research institutions, as well as
health care laboratories (BRASIL 2006).

Although the RSS represent a small portion of total solid waste generated in Brazil, its management
is important for public health and the environment. The management of the RSS may reduce the
costs of their treatment and final disposal. Brazilian agencies for health and environment establish
basic guidelines for implementation of measures to protect worker safety and management of RSS
(ANVISA 2004).

This study aims to assess whether the Waste of Health Care Services in INCQS is in accordance
with Brazilian law, and with this analysis to signal the actions that contributed to improving waste
management, focusing on Biosafety and the environment.

METHODS

To conduct the study, it has been developed procedures for handling and disposal of chemical and
biological wastes from activities of the Institute, with the Internal Biosafety Commission.

The Internal Biosafety Commission of INCQS (CIBio/INCQS) coordinates the actions of the
Biosafety from the Institute. CIBio/INCQS has among other objectives to ensure the management
of waste generated, and monitor the working conditions of the Institute. The management
methodology is based on Brazilian standards. And most importantly, meet the requirements of the
11.105/2005 Law, which states that for research on genetic engineering with Genetically Modified
Organisms and their derivatives, every institution should establish an internal committee of
Biosafety (BRASIL 2005).

To analyze qualitative data of Waste of Health Care Services generated in the Institute between
2009 and 2011, it was used the reports generated by Computerized Waste Management of Health
Services System – SIGReSSa (Figure 1).
 Figure 1 – Image of SIGReSSa

The computerized system SIGReSSa was developed at INCQS in 2007, enabling automation of
information of management of solid waste. Its relevance is to meet institutional demand in order to
minimize operational costs in the final disposal of waste. The commitment of the President of
FIOCRUZ to develop, deploy and implement the Environmental Management System integrated
with the Healthy Fiocruz Program, initiated the development of the first computerized module
capable of supplying the demand of INCQS. The SIGReSSa is a computerized system that allows
you to sort the waste, find the generator (department, block, room / lab), date the generation of
waste, specify and quantify, allowing an annual comparative survey of Waste of Health Care
Services.

RESULTS

The waste generated in health care services in INCQS are heterogeneous in character. Therefore,
careful sorting is required for segregation of waste in order to minimize the volume of potentially
infectious waste.

The danger of the waste, according to the Brazilian Association of Technical Standards, is
associated with its physical, chemical or infectious characteristics, which may be a risk to public
health. The wastes of the Institute are registered in the computerized system SIGReSSa and
according to these characteristics, the information about the waste generated is supplied by the
generator of the waste safely in editing and saving the data.

According to reports from SIGReSSa, the Waste of Health Care Services generated at INCQS in
the year 2011 is characterized as biological waste (Chart 1). In their laboratory activities, the
Institute does not generate waste such as: human anatomical parts, materials with suspicion of
prions, as well as not producing radioactive waste.
 Chart 1 - Distribution of the waste of INCQS in 2011

At INCQS, we verified the adequate conditioning of waste generated, and the biological wastes are
packed in 30 liters white bags. The infectious and sharps residues disposed are in rigid containers,
resistant to breakage even after wet heat sterilization (Figure 2). The filling limits are respected in
every pack (2/3 of capacity).

Figure 2 - Images of the packaging of biological waste.

Since 2007, INCQS adopted the standard identification by the use of symbology, using labels on
packages containing the waste (Figure 3). The description of the content, classification and
identification of the responsible for the disposal; optimized segregation and destination, making the
handling and collection of waste safer and economical.
 Figure 3 - Standard labels used in INCQS for identification of packages containing the Waste of Health Care
Service

For the stage of handling, closing the packages and transportation of chemical waste containers are
available at INCQS safety equipment as standard by the Brazilian Association of Technical
Standards, such as resistant fabric uniform, gloves, boots, caps, masks, goggles and apron.
The Table 1 presents the percentage distribution of the Waste of Health Care Services by
Organizational Unit of the Institute in 2011, allowing characterization of the waste generators in the
Institute.

Table 1 - Distribution of Waste of Health Care Services for Organizational Units in 2011
Organizational Unit Category Percentage
(%)

Health supplies
Unit A 4,76

Immunobiologic
Unit B
Biological samples 12,89
Unit C
Immunobiologic 4,51

Unit D
Biological samples 36,86

Unit E
Infectious cultures 17,14

Unit F
Chemical residue 23,84

As for the final disposal of the Institute, there is greater proportion of waste being treated by
incineration, between the years 2009 and 2011 (Chart 2). It is understood by the final destination of
RSS containment of waste in landfills, after undergoing a treatment such as sterilization or
incineration.
 Chart 2 - Distribution of Waste Services Health INCQS for disposal from 2009 to 2011

In Brazil, incineration is the method indicated for the treatment of hazardous chemical waste (liquid
or solid) and not amenable to conventional treatments, such as organometallic compounds and
heavy metals. However, these toxic gases from incinerators must undergo filtration, and the
company, accredited to the environmental agency. The final disposition of the Waste of Health
Care Services should be performed in controlled landfill which project strictly follows the Standard
of the Brazilian Association of Technical Standards, which determines the methods and procedures
for submitting solid waste in landfills.

With the characterization, classification and diagnosis of waste management activities, it was
possible to develop the integrated plan for waste management of INCQS. This document describes
the actions relating to waste management noting their characteristics and risks to workers.
Reduction, segregation and recycling are its principles.

The adoption of a management plan demanded a change in posture technique of the Institution,
interacting with all sectors, realizing that the technical coach is responsible for the waste generation
to final destination.

Since 2003, INCQS adopted a program to reduce solid waste generation based on the definition of
logistics made by the Council of Logistics Management, which defines reverse logistics as "the
planning, implementation and control of efficiency, effective cost of flow of raw materials,
inventory process, finished goods and related information from point of consumption to the point of
origin for the purpose of recapturing value or adapt their destination" (LACERDA 2009). This
definition was adapted to the Institute, aligned with the institutional mission, creating a process
within the chain of sustainability in order to participate in the environmental and social context,
reducing the accumulation of waste resulting from technical activities, to protect public health and
economy of natural resources.

Based on the environmental policies of the Oswaldo Cruz Foundation - Fiocruz (CARDOSO 2005)
taking into account the responsibilities of INCQS and the multidisciplinarity of their duties,
recognizing that the waste of health care constitutes a serious environmental and health problem,
the adoption of a basic policy for solid waste management of the Institute has become essential.
CONCLUSION

The biosafety actions implemented over the years at INCQS aimed protecting the operators and the
environment, as regards the proper use of equipment for individual and collective protection and
final disposal of waste generated. This fact demonstrates the strategic importance of CIBio and its
potential to benefit the quality of services provided by the Institute and to minimize the risks of
worker health and the environment.

Most waste generated at INCQS is being segregated at the source, minimizing its quantity; biowaste
is routinely treated before the final disposal, reducing the risk of spreading diseases.
The safe management and well planned is a strategic factor for the Institute, as it respects the
environment and employees, contributing to improve the quality of the general population, as it´s
the mission of this institution.

In "Diagnosis of Municipal Solid Waste Management in Latin America and the Caribbean"
(PAHO/WHO 1998) Brazil was already included as a country which had Federal regulatory unit to
waste and administrative framework of state and municipal scope of management responsibilities
and laws. Even though the problems arising from solid waste in Latin America continue without
present and appropriate solution, several Brazilian institutions committed to health, such as Fiocruz,
have contributed to the adoption of environmentally appropriate behavior from the treatment at the
source of waste.

ACKNOWLEDGMENTS

The authors thank the Director of INCQS and the enormous contribution and enthusiasm of the
Head of Internal Biosafety Commission of INCQS Cristina Maia Cruz.

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