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INSTRUCTOR GUIDE
MODULE 9: CLASSIFICATION OF HEALTHCARE WASTE
MODULE 10: SEGREGATION OF HEALTHCARE WASTE
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Review Questions (most of • How does your facility classify healthcare wastes? What are some examples of
these questions relate to sharps waste that pose a major risk in your own facility, or that you would expect to
waste segregation, which is pose problems in healthcare facilities, in general? What about chemical wastes?
the related topic of the next Pharmaceutical wastes? Radioactive wastes?
module) • What are some facility-specific classification and segregation guidelines? Does your
facility use color-coding?
• Does your facility have sufficient resources to handle waste properly and
effectively? How can your facility improvise if resources are lacking?
• Is the segregation of wastes monitored in your facility? If not, is there any
technique that exists for keeping track of waste segregation?
• What works within your facility to improve segregation? What doesn’t work?
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PRESENTATION
Slide 3: Learning Objectives Describe what participants will learn at the end of this module.
Slide 4: Steps in Healthcare This is the first of a series of modules about specific steps in healthcare waste management.
Waste Management This module focuses on classification.
Slide 5: General Principles When properly segregated, the typical breakdown of HCW is about 85% or more of general waste
(similar in risk to domestic waste), while the remaining 15% is usually hazardous waste. The
breakdown may vary by country/region/facility.
Slide 6: General Principles Sharps wastes pose the highest risk of disease transmission of all waste categories.
Slide 7: Why Segregate Describe some major points that answer the question: Why segregate HCW? Ask class for
Healthcare Waste? some ideas.
Note: You may want to skip this slide until the next module about waste segregation
Slide 8: General Principles HCW classifications are based on: national regulations or international guidelines
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Slide 10: Country-specific Waste Insert information about country-specific classifications under the existing laws and
Classifications regulations. You may add more slides if needed.
Slide 12: Infectious Wastes Infectious wastes are healthcare wastes that are suspected to containing pathogenic
organisms in quantities sufficient to cause diseases to an exposed host.
Slide 17: Sharps Waste Sharps waste includes any items that could cause cuts or puncture wounds, whether
infected or not
Slide 20: Chemical Wastes Hazardous chemical wastes are chemicals with at least of the following properties:
-Toxic
-Corrosive
-Flammable
-Reactive
-Oxidizing
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Slide 21: Chemical Wastes Provide some examples of hazardous and non-hazardous chemical wastes.
Slide 23: Radioactive Wastes Solid, liquid and gaseous materials contaminated with radionuclides; this category of waste
may not exist in primary healthcare facilities that do not deal with radiation therapy
Slide 24: Non-hazardous General Non-hazardous general wastes are those that have not been in contact with infectious
Waste agents, hazardous chemicals, or radioactive substances, and that does not pose a sharps
hazard.
Slide 25: Examples of Non- Give some examples of non-hazardous general wastes. The majority includes paper,
Hazardous General Wastes plastics, and cardboard.
Slide 27: Typical Waste Give some ballpark figures statistics for typical waste generation rates. These estimates
Characteristics vary by country, region, and facility type.
Note: Please wait to complete modules 9 and 10 before going over the discussion
questions.
What is recyclable?
Common accidents?
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PRESENTATION
Slide 3: Learning Objectives Describe what participants will learn at the end of this module.
Slide 4: Steps in Healthcare This module focuses on segregation.
Waste Management
Slide 5: General Principles When properly segregated, the typical breakdown of HCW is about 85% or more of general waste
(similar in risk to domestic waste), while the remaining 15% is usually hazardous waste. The
breakdown may vary by country/region/facility.
Slide 6: Why Segregate Describe some major points that answer the question: Why segregate HCW? Ask class for
Healthcare Waste? some ideas.
Slide 10: WHO-Recommended Use the given table to describe the WHO-recommended segregation scheme
Segregation Scheme
Slide 11: Example of a More
Complex Segregation Scheme
Slide 12: Minimum Level of
Segregation Recommended by
WHO
Slide 13: Specifications and Ask participants what they do in their own facility?
Alternatives for Low-Resource
Settings
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Slide 16: Color Coding for Bags Discuss acceptable options for commercial color-coded bags and sharps containers.
and Containers
For example,
Noninfectious - black
Infectious - yellow
Highly infectious - red
Sharps waste - yellow safety boxes
Slide 17: Bags for Waste -Bins should have the same colored bags/liners, preferably be 70 µm in thickness.
Collection (use this slide if red is -Bags and containers for infectious waste should be marked with the international
used for infectious waste) infectious substance symbol
-The color of containers/plastic bags used for collection of segregated biomedical waste
should be prominent and easily identifiable.
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Slide 18: Bags for Waste -Bins should have the same colored bags/liners, preferably be 70 µm in thickness.
Collection (use this slide if -Bags and containers for infectious waste should be marked with the international
yellow is used for infectious infectious substance symbol
waste) -The color of containers/plastic bags used for collection of segregated biomedical waste
should be prominent and easily identifiable.
Slide 19: Safety Boxes • Sharps should all be collected together, regardless of whether or not they are
contaminated.
• Containers should be puncture-proof (usually made of metal or high-density plastic)
and fitted with covers. They should be rigid and impermeable so that they safely
retain not only the sharps, but also any residual liquids from syringes.
• To discourage abuse, containers should be tamper-proof (difficult to open or break)
and needles and syringes should be rendered unusable.
• Where plastic or metal containers are unavailable or too costly, containers made of
dense cardboard are recommended (WHO, 1997); these fold for ease of transport
and may be supplied with a plastic lining.
Slide 20: Class Discussion: What Generate discussion with class participants
Goes Where?
Slide 21: Class Discussion: What
Goes Where?
Slide 22: Class Discussion: What Non-hazardous general wastes are those that have not been in contact with infectious
goes where? agents, hazardous chemicals, or radioactive substances, and that does not pose a sharps
hazard. Is the child sick because of a bone fracture or a brain concussion, or due to an
infection? If the child has a fracture, will the lollipop or spoon be contagious? If the child
has an infection, how is the infectious agent transmitted – through contact with infected
skin, contact with infected stool, contact with mucous membranes, contact with wound
drainage, exposure to respiratory secretions, exposure to infected droplets from coughing
or sneezing, exposure to pathogenic airborne particles, etc.? How can transmission-based
precautions be used to determine where the waste item goes?
Slide 23: Where Do You Place Go through a list of where bins should be properly placed for specific scenarios
Bins?
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Slide 28: Problems of Photo shows sharps in infectious (yellow) bag. Sharps should be in sharps containers.
Segregation
Slide 29: What is Wrong With Black bag wrongly used for general waste (drinking cups, food scraps, discarded food
This Picture? packaging, paper, empty blister pack, empty food wrapper) and for sharps waste
(syringes).
Slide 30: What is Wrong With Black bag wrongly used for general waste (empty water bottle, packaging, discarded cloth)
This Picture? and also for infectious waste (bloody bandages, contaminated gloves).
Slide 31: What is Wrong With Black bag wrongly used for infectious waste (bloody bandages), sharps waste (syringes,
This Picture? presumably the needle from the intravenous (IV) set), and general waste (empty sterile
solution bottles, empty IV tubing without visible blood, food waste such as banana and
lemon peels, empty food containers, sterile packaging).
Slide 32: What is Wrong With General waste (sterile packaging) discarded in the infectious waste bag. Sharps discarded
This Picture? in the infectious waste bag.
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Slide 33: What is Wrong With Clean packaging was discarded in an infectious waste bag.
This Picture?
Slide 34: Problem of Overfilling Red bag is overfilled. It is placed inside a black bag (probably because of leaks). Leaking
and Mixing Colors infectious waste bags should be put in bags with the infectious waste color.
Slide 35: What is Wrong With You may add pictures with examples from your country or the facility.
This Picture?
Slide 36: Problems of Batteries should not be discarded as regular waste.
Segregation
Ask class: What would you do with a broken thermometer?
Slide 37: Dealing With Talk about what to do (and what not to do) if errors are made during segregation.
Segregation Errors
Is there monitoring?
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Note: You should wait until after Module 9 and Module 10 are presented to have participants do exercise.
The purpose of this activity is to educate participants about classification and segregation of wastes (how to select the right
containers)
Instructor: Break class into groups of three or more, and distribute exercise at beginning of class. You may group participants
by facility, department, or job type. Participants will complete the activity in groups and then present their answers.
Instructor should record participant/group responses on a wipe board, flip chart, or transparency, categorize their responses.
In the de-brief following the presentation, you will go over the activity once again.
Instruct should ask participants how they would classify the following items and record responses by group.
o Sharps
o Infectious
o Pathological
o Pharmaceutical
o Chemical
o Radioactive
o General (non-hazardous)
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Answer Key:
1 – infectious
2 – depends on whether there is a needle attached; the needle would be sharps waste, empty IV bag would be general waste
4 - chemical
5 – sharps
6 – general waste unless the diaper comes from an infected patient in an isolation ward
8 – in countries where there is good waste handling and sanitary landfills – general waste, otherwise infectious waste
9 – sharps
10 – chemical or general waste depending on the type of disinfectant and the country’s laws and regulations
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11 – general, unless patient in is isolation ward with potential for contact transmission
12 – general waste
13 – pharmaceutical
14 – general, possibly pharmaceutical depending on the type of solution and the country’s laws and regulations
15 – chemical
1. Each group will be given surrogate waste items (such as sharps, anatomical wastes, paper, gloves, needles, diapers,
bottles, etc) and color-coded containers (based on what is available by country laws). Note: Do not use real infectious
waste items for this exercise! For example, for contaminated bandages, use new bandages smeared with red paint or
tomato sauce. For contaminated gloves, use new gloves covered with tomato sauce or mineral oil to represent body
fluids. For syringes, use unused syringes. For chemical waste, use water or juice in a container with a fake chemical
label. For anatomical waste, use uncooked meat or other suitable surrogate. Select waste items that the participants
would normally deal with in their specific job functions. The participants should be told that these are surrogate items
(fake replacements to represent waste items) but the participants should use the correct PPE and place the surrogate
items in containers that are appropriate as if those items are real.
2. Each person takes a turn taking a waste item and placing it in the proper container.
3. With each turn, the group checks if everyone agrees with the placement.
4. If not, each participant explains why he or she disagrees with the placement until consensus is reached.
5. If no consensus is reached, the group brings the waste item to the attention of the whole class.
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Waste type Yellow Red bins Blue Bins Puncture Proof General Waste
bins Container
The purpose of this activity is for the participants to learn to design simple but effective posters related to segregation.
Instructor may ask each group to:
• Select an area of the facility
• Identify the hazards, and/or a particular group of employees they want to educate. (For example, do you want to create
a poster or sign in your local language to help the waste handlers in the wards)
• Create an informational posters, or signage, specific to waste segregation.
• Each group presents their hand-drawn poster to the class for discussion.
De-brief
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