1. A General Procedure for Assessing and Improving of
Medical Waste Management
Dr. Said Ali El-Quliti
Professor, Dept. of Industrial Engineering,
King Abdulaziz University, Jeddah, and
Professor, Operations Research and Decision Support Dept.,
Faculty of Computers and Information, Cairo University

2. A General Procedure for
Assessing and Improving of
Medical Waste Management
Agenda

3. Agenda
1- Hazardous Medical Waste.
2- Types of Hazardous Medical Waste.
3- Dangers of Medical Wastes.
4- Disposal Methods for Medical Wastes.
5- General Guidelines (How to Deal with Medical Wastes).
6- Assessing the Medical Waste Management Systems.
6.1 Data Collected
6.2 Assessed Parameters:
• Typology of Respondents.
• Estimated Healthcare Wastes.
• Segregation and Classification of Medical Wastes.
• Medical Waste Storage Tools.
• Disposal Methods for Medical Wastes.
• Hours Spent in Management of Medical Wastes.
• Cleanliness of Health Facilities.
• Knowledge of Health Workers on Medical Wastes.
6.3 Final Evaluation of the System.

4. 1- Hazardous Medical Waste
• Medical Solid Waste are similar to
household wastes.
• Hazardous waste, represents 20% of medical
waste.
The UN, the World Bank and the World
Health Organization (WHO) define medical
waste as hazardous if:
toxic, infectious, incendiary, or cause allergies

5. 2- Types of Hazardous Medical Waste
a) Pathological, infectious or contaminated wastes,
b) Hazardous chemical wastes,
c) Radioactive wastes.

6. a) Pathological, infectious or
contaminated wastes
Pathological Waste
• Remnants of delivery rooms.
• Human organs and tissues.
• Eradicated tumors.
• Blood and body fluids.

7. Infectious Waste
• Infectious germs (bacteria - Viruses - parasites - fungi):
bacteriological farms, viral laboratories and remnants
of experimental animals.
• Waste of isolation patients (infectious diseases).
• Remnants of dialysis room.
• Remnants of the operating rooms:
Masks and shoe covers, gloves and so on.
• Remnants of the dental injection, cups, gloves and so on.
• Contaminated instruments such as the esterification of all kinds -
medical dressing, gauze and cotton - Transmission of blood
instruments.
• Gypsum, and leftover tools contaminated with patient's
body fluids and secretions.

8. Contaminated Wastes
Cause wounds, scratches or holes.
Such as:
Syringes,
Scalpels,
instruments of medical solutions,
broken glass,
ampoule,
Slides,
… and so on.

9. b) Hazardous Chemical Wastes
• Resulting from medical activities:
1. Formaldehyde.
2. Waste chemical substances used in X-rays.
3. Organic solvents such as methylene chloride - chloroform.
4. Organic chemical wastes such as some disinfectants
and detergents.
5. Inorganic chemical wastes, such as acids
and alkalis: sulfuric, hydrochloric and nitric acids.
6. Highly toxic heavy elements:
– Mercury compounds: produced from broken medical
instruments such as thermometers, damaged blood
pressure measuring devices, and the remnants of dental fillings.
– Ray films Waste (raw or used films)

10. c) Radioactive wastes
Include wastes containing radioactive
materials, such as:
• Radium needles - 226, and
• Cobalt tablets- 60 .

11. 3- Dangers of Medical Wastes
• They are filled with microbes and
viruses transmitting diseases, especially those
that are transmitted by blood.
• A reason for the breeding of insects, flies and rodents, and
the expansion of diseases to wider areas.
• The plastic materials (needles, syringes and bottles)
when burning leads to the emission of carcinogenic
substances such as dioxin.
• The wrong way to deal with medical wastes may lead to
infection with dangerous diseases as AIDS and Hepatitis
transmitted by blood.

12. 4- Disposal Methods for Medical Wastes
4-1 Sanitary Landfill
4-2 Burning
4-3 Sterilization
a) Sterilization by Steam and High Temperatures
b) Infrared (or Ultraviolet) radiation Sterilization System
4-4 Disposal of Radioactive Waste

13. 4-1 Sanitary Landfill
An earth pit isolated from ground water
to protect it from pollution.
The base is equipped with a network for water
discharging resulting from rain and
decomposition of organic materials.
A layer of gravel and sand is placed over
the network to facilitate entry of water into
the drainage network.
Waste is primary treated, distributed on the base
of the hole and pressed to reach the amount of 0.8 -
1.0 tons per m2.

14. Sanitary Landfill (Cont’d.)
Advantages:
1 - Low cost and ease of application, no high-tech.
2 - Absorb massive amounts of solid wastes.
3 - Replanting the area with trees.
4 - Access to methane.
Disadvantages:
1 - Leakage of air pollutant gases:
methane, carbon dioxide.
2 - Possibility of contamination of water sources by
waste water resulting from landfill.

15. 4-2 Burning
• Able to treat many types of medical
waste, except:
Radioactive materials, mercury and
compressed containers.
• The best way is to burn at a temperature of 1200
° C for two seconds only.
• Avoid burning in bad
incinerators or burn randomly, this leads to the
formation of dangerous dioxin.

16. Burning Method Disadvantages:
• Incineration is not a solution to the
problem, it is a simple transfer of
pollutants from waste itself to the smoke
and ash.
• The ash contaminates
soil and groundwater.

17. 4-3 Sterilization
The recent methods for safe disposal of medical
wastes. This method has become a trend in the world
Sterilization ways:
a) Sterilization by Steam and High Temperatures
• Environmentally safe for all medical
wastes except anatomical parts and animal
contaminated bodies because the steam can’t penetrate.
• Not suitable for handling hazardous radioactive
materials, or toxic wastes.

18. b) Infrared (or Ultraviolet) radiation
Sterilization System
Each hospital or clinic is provided with an empty
plastic box,
When filled, put into the sterilization unit, it comes
out in the form of ordinary waste.

19. 4-4 Disposal of Radioactive Wastes
1. Keeping the radioactive material in an
insulated and sealed bowl , then set
aside to lose half-radioactive-life.
2. Kept in a more compact and insulating
box, and then buried in the soil.

20. 5- General Guidelines
(How to deal with medical wastes)
1.Segregation of medical and non-medical
wastes within the health facility until
dealt with according to seriousness.

21. 2- Color Coding

22. General Guidelines (Cont’d.)
3- Collection of sharp and contaminated
materials in small containers with lid (Yellow
containers), containers are of reinforced
plastic and should not be filled fully.
Then send to treatment , rather than throw
in the regular garbage bags.
Containers should be far
from beds of patients.

23. General Guidelines (Cont’d.)
4- Location of the temporary waste collection
area in health facilities away from food
stores, restaurant and kitchen.
Not to store medical wastes in open
spaces, preferably in an enclosed ventilated
space.

24. General Guidelines (Cont’d.)
5- Use and Reformation of modern waste
disposal instruments (like incinerators and
sterilizers) in hospitals and regularly
maintaining or replacing.

25. General Guidelines (Cont’d.)
6- Use advanced recent methods to treat some
wastes instead of burning, such as
sterilization before putting them in bags and
dispose.

26. General Guidelines (Cont’d.)
7- Liquid wastes (solvents) should not
be thrown in public network before
primary treatment, to avoid damage of
the network and the environment.

27. General Guidelines (Cont’d.)
8- Put unusable units of blood (expired or virus
infected blood) in reinforced
yellow bags until properly disposed.

28. General Guidelines (Cont’d.)
9- Expired drugs or bad stored should be
returned to the supplier.
Not disposed with household garbage.

29. General Guidelines (Cont’d.)
10- Arrange awareness and training programs,
on the dangers and managing of medical
wastes for: workers, nursing staff and
administrators of health facilities.

30. 6- Assessing the Medical Waste
Management Systems
6.1 Data Collection.
6.2 Assessed Parameters.
6.3 Final Evaluation of the System.

31. 6.1 Data Collection
• Primary data: interviews,
and observations.
• Secondary data: documents.
• to examine the performance of medical
waste management tools in:
collecting, storing, transporting and
treating the medical wastes, and to
examine knowledge of health workers.

32. 6.2 Assessed Parameters:
• Typology of Respondents.
• Amount of Healthcare Wastes.
• Segregation of Medical Wastes.
• Medical Waste Storage Tools.
• Disposal Methods for Medical Wastes.
• Hours Spent in Management of Medical Wastes.
• Cleanliness of Health Facilities.
• Knowledge of Health Workers on Medical Wastes.

33. Typology of Respondents
Typology Category Typology Response (%)
Characteristics
Age (Years) 21 – 30
31 – 40
41 – 50
50 +
Education Level Primary
Secondary
Diploma
B.Sc. degree
Graduate studies
Working experience 1-3
(Years) 4 - 10
11 – 15
15+

34. Amount of Healthcare Wastes
Level of Health Waste Sharps Garbage from
facility excluding (Container) wards
sharps
Hospital
(kg/bed/day)
Health Centers
(kg/person/day)
Dispensaries
(kg/person/day)

35. Segregation of Medical Wastes
Status for segregation of
Total
Healthcare medical wastes
level Segregated Mixed %
Hospitals 100
Health centers 100
Dispensaries 100
Total 100

36. Classification of Medical Wastes
Status of medical
Health facility waste tools Total
level Color coded Not color coded %
Hospitals 100
Health centers 100
Dispensaries 100
Total 100

37. Medical Waste Storage Tools
Plastic Metal Non Waste
Safety Pit
boxes
Available
%
Functioning
%

38. Status of Medical Waste Disposal Tools
Level of Health Status (%)
facility Good Fair Bad
Hospital
Health Centre
Dispensaries

39. Disposal Methods for Medical Wastes
Level of Sanitary Burning Sterilization Disposal of Temporary
Health facility Landfill Radioactive Waste
Waste Collection
Area
Hospital
Health Centre
Dispensaries

40. Hours Spent in Management of
Medical Wastes
Hours spent in
management of medical
wastes (%) Total
Health
facility level 1-2 3-5 6-8
hours hours hours
Hospitals 100
Health
centers 100
Dispensary 100
Total 100

41. Cleanliness of Health Facilities
Cleanliness Total
Healthcare level High Moderate Poor (%)
Hospital 100
Health centre 100
Dispensary 100
Total 100

42. Knowledge of Health Workers on
Medical Wastes
Knowledge Level Total
Healthcare
level High Moderate Poor %
Hospital 100
Health centre 100
Dispensary 100
Total 100

43. 6.3 Final Evaluation of the System
Hospital: ……………………………..
Degrees Weight Marks
1 Typology of Respondents.
2 Estimated Healthcare Wastes.
3 Segregation and Classification of Medical Wastes.
4 Medical Waste Storage Tools.
5 Disposal Methods for Medical Wastes.
6 Hours Spent in Management of Medical Wastes.
7 Cleanliness of Health Facilities.
8 Knowledge of Health Workers on Medical Wastes.
Total

44. Final Assessment of Medical
Waste Management System
City Evaluation
Hospital Health centre Dispensary Others
1
2
3
…
…
…
Total
Final City Evaluation
Recommendations for Improving