HEALTH CARE WASTE

MANAGEMENT

Dr Shahzad Akhtar Aziz

Community Medicine Department
Biomedical / Health Care Waste

Waste generated by Health Care Facilities

during various diagnosis and treatment

procedures
 Fact sheet 2008
• Around 350,000 ton of medical waste is
annually produced from all sorts of health
care facilities in the country.
According to a report 25 ton of waste is
produced daily in Punjab.
• The rate of generation is 1.8 kilograms per
day per bed.
• The province houses 250 hospitals with a
total capacity of 41,000 beds
MAJOR SOURCES OF HCW

Hospitals

Clinics

Laboratories

Blood Banks

Nursing Homes

Mortuaries/Autopsy Centres

Research Centres
 TYPES OF HCW
 Risk waste 10 – 25%
 Non-risk waste 75 – 90%

In Large Hospitals
 0.5-2 kg of waste is generated per
bed per day
 0.1-0.5 kg is the risk waste
 RISK WASTE
Infectious Waste
15%
Pathological Waste
Sharps 01%
Pharmaceutical Waste
03%
Chemical Waste
Genotoxic
01%
Radioactive Waste
 INFECTIOUS WASTE
Waste contaminated by any type of bacterium,
virus, parasite or fungi :
Cultures from laboratory
Waste from surgery and autopsies
Waste from infected patients/Isolation
wards
Waste from infected haemodialysis
patients
Infected animals from laboratories
Any material having been in contact with
infected patients
PATHOLOGICAL WASTE

Tissue

Organs

Body parts

Fetuses

Blood and body fluids

 SHARPS
Needles
Syringes
Scalpels
Infusion sets
Saws and knives
Blades
Broken glass
Any other items that could cut or puncture
 PHARMACEUTICAL WASTE

Expired or unused pharmaceutical products

Spilled or contaminated pharmaceutical

products

Surplus drugs, vaccines or sera

Discarded items used in handling

pharmaceuticals e.g bottles, boxes, gloves,
masks, tubes or vials
 CHEMICAL WASTE
Chemicals from diagnostic/experimental work
and laboratory reagents
Cleaning processes

Film Developers

Housekeeping and disinfecting materials/

procedures
Mercury waste from broken clinical
equipment
 GENOTOXIC WASTE

• Cytotoxic drugs and outdated material

• Vomitus, faeces or urine from patients treated with

cytotoxic drugs or chemicals

• Contaminated materials from the preparation and

administration of the drugs such as syringes, vials, etc

WASTE
WASTE
WASTE
WASTE
 RADIOACTIVE WASTE

Liquid, solid and gaseous waste

contaminated with radionuclides generated

from various imaging and tumor localization

and investigation/ therapeutic procedures

 NON RISK WASTE

Constitutes 80% of the total HCW

Comparable to normal domestic garbage

Paper and cardboard

Packaging

Food waste

Aerosols
 RISKS FROM HCW

Hepatitis B & C

AIDS

GIT Infections

Respiratory Infections

Skin Infections

Injury by contaminated sharps

 Hazardous effects of various
Pharmaceuticals, Cytotoxic Drugs, Chemicals
and Radioactive Waste :
Acute or chronic intoxication
 Injuries
 Burns
 Sensitivity reactions
 Genetic effects
Illegal reuse of discarded syringes, IV tubes,
blood bags
WASTE MANAGEMENT TEAM
MS
Head of each Hospital Department
Infection Control Officer
Chief Pharmacist
Radiologist
Matron
Head of Administration
Hospital Engineer
Waste Management Officer (WMO)
 WASTE MANAGEMENT PLAN
Disposal points for every ward and
department, separate for risk and non- risk
waste
Site of Central Storage, separate for risk and
non-risk waste
Types of containers, trolleys and the
number required
Frequency of collection from each ward and
department
 Sharps containers to be used and the

number required

Annual cost estimate of containers, colored

plastic bags, trolleys and sharps containers

Responsibilities and duties of different

categories of hospital staff

Estimate of the number of staff required for

waste collection
 Procedures for the segregation, storage

and handling of waste

Special instructions in the event of

incinerator breakdown

Training courses and programs

Emergency procedures
WASTE MANAGEMENT STEPS

 Waste Segregation
 Collection
 Transportation
 Storage
 Waste Disposal
 WASTE SEGREGATION
Segregation must take place at source
Ward
Theatre
Laboratory
Delivery Room
Must be carried out by the person producing
the waste : Nurse, doctor/specialist
Must remain intact from the point of
production throughout the entire waste
stream to the point of final disposal
 COLOUR CODING

Risk Waste

Yellow Plastic Bags / Containers

Non Risk Waste

Black Plastic Bags

 COLOUR CODING

Risk Waste

Yellow Plastic Bags

Yellow containers of metal or tough

plastic with pedal-type or swing lid

No open containers - To prevent

spillage, air­borne contamination
 Pharmaceutical Waste

Small quantities : Placed in Yellow

plastic bags

Large quantities: Returned to

suppliers

Chemical Waste: Put in chemical resistant

containers and sent to specialized

treatment facilities
 Sharps: Purpose-designed Yellow

containers which are resistant to

penetration and leakage

 WASTE COLLECTION
 Waste should not accumulate at the point of
production

 Route for the collection of waste should be

established in the Waste Management Plan

 Collected at least once daily, but more often if

necessary

 Sanitary staff / sweepers must wear protective

clothing at all times when handling waste
 WASTE TRANSPORTATION

Transported in specified covered trolleys

Careful handling to minimize the risks of

punctures or tears

Risk Waste (Yellow Bags) should be

transported completely separately from all

other waste (Black Bags)

 WASTE STORAGE
 Separate Storage Area for yellow bagged
waste
 Located close to the incinerator
 Must not be close to any food storage or
food preparation areas
 Large enough to cover for incinerator
breakdowns
 Base should be impermeable with good
drainage
 Should have water supply
 Should be easy to clean / disinfect
 Secure from unauthorized access and locked
except during loading and unloading
Easily accessible by authorized staff and
collection vehicles
Inaccessible to animals, insects and birds
Supply of cleaning equipment, protective
clothing and waste bags should be located
nearby
No waste should be stored for longer than 24
hours
 WASTE DISPOSAL
OPTIONS

 Incineration

 Landfill

 Chemical Disinfection

 Wet Thermal Treatment

 Microwave Irradiation
INCINERATION

 An effective way of disposing of hospital

waste

 Temperature should be high enough to

ensure complete combustion

 Residues should be totally sterile

Emissions should meet acceptable

standards

 Ash should be placed in robust, non-

combustible containers and

 Sent to Municipal Authority’s designated

biomedical risk- waste site

 TYPES OF INCINERATORS

 Rotary kiln (1200 – 1600 C )

 Best
 High investment and operating cost
 Double chamber Pyrolytic Incinerator
 Temperature 800 – 900 C
 Single Chamber Incinerator (300 – 400 C )
 Drum or Brick Incinerator (< 300 C )
WASTES NOT TO BE INCINERATED

 Pressurized gas containers

 Large amounts of reactive chemical waste

 Radioactive waste

 Silver salts or radiographic waste

 Halogenated plastics (e.g. PVC)

 Mercury or cadmium

 Ampoules of heavy metals

 LANDFILL

Should be considered when adequate

incineration facilities are not available

Should be sited away from any possible

pollution of groundwater and rivers

Access to the site must be restricted to

authorized personnel only

 Only biomedical risk waste should be buried

in a landfill designed for this purpose to

maximize the life of site

Burying site should be covered with a layer of

earth each day to prevent dogs, birds,

insects and rodents proliferation

 Remote Health Care Facilities
 A trench 2 meter long,1 meter wide and 1.5
meter deep may be used for burial of
biomedical waste

 Waste should be placed to a depth of 1

meter and then a layer of earth should be
applied
 CHEMICAL DISINFECTION
Highly efficient disinfection under good
operating conditions
Expensive
Requirement of highly qualified technicians
for operation of the process
Use of hazardous substances which require
comprehensive safety measures
Inadequate for pharmaceutical, chemical and
some types of infectious waste
 WET- THERMAL TREATMENT
Environmentally friendly

Relatively low investment and operation

costs
Frequent breakdowns of shredders

Operation requires qualified technicians

Inadequate for anatomic waste,

pharmaceutical and chemical waste or waste
which is not easily penetrable by steam
 MICROWAVE IRRADIATION

 Good disinfecting efficiency under

appropriate operational conditions

 Environmentally friendly

 High investment and operation costs

 Operation and maintenance problems

 SAFETY OF SANITARY STAFF

Basic personal hygiene

Convenient washing facilities

Immunization

Protective Clothing: Face Masks, Plastic

Aprons, Thick Gloves, Leg Protectors

and Gum Boots etc

Incinerators: a solution or a threat?
• Waste is burnt at very high temperatures, that produce
emissions full of acidic gases, heavy metals, toxic
organisms and dioxins. There is a lot of ash produced by
an incinerator as well.
Incinerators for medical and municipal waste have been
linked to severe public health threats and pollution. The
combination of intense public opposition to incineration
and increasingly strict environmental pollution regulation
has forced the closure or cancellation of many
incinerators in industrialised countries.
Incinerators are fast becoming an obsolete technology in
many developed countries as they are moving towards
safer and more economical alternative approaches to
medical and municipal waste management.
Incinerators: a solution or a threat?
• Researchers came to the conclusion that Dioxin, as well
as mercury and other toxic substances, are emitted
when waste is burnt in an incinerator. Dioxin and related
chlorinated organic compounds are extremely potent
toxic substances that produce a remarkable variety of
adverse effects in human and animals at extremely low
doses.
Mercury is also bio-accumulative and is toxic to the
kidneys and nervous system. Readily converted to its
organic form in the environment, mercury interferes with
normal brain development.