Infection Control

1. Managing Medical Waste
Session 5: Infection Control Basics

2. 5: Managing Medical Waste Slide 2
Learning Objectives
 Understand that most hospital waste materials are
not more dangerous than household waste, but
keeping used sharps and needles from staff and
public access is a priority
 Learn ways to minimise waste
 Know the criteria for safe management of sharps

3. Part I: Health Care Waste
Overview

4. 5: Managing Medical Waste Slide 4
Definitions of Waste
Health care waste
 All types of waste from all health care activities
Hazardous health care waste
 Waste that presents a health hazard of some kind
 Note: Most health care waste is no more hazardous than
household waste

5. 5: Managing Medical Waste Slide 5
Types of Hazards to Consider
 Flammable
 Toxic - mutagenic, cytotoxic,
teratogenic, etc
 Reactive
 Allergen, contact sensitiser
 Explosive
 Infectious
 Radioactive
 Corrosive
 Caustic
 Alcohol
 Cancer chemotherapy, tar-
based products
 Sulphuric acid, chlorine powder
 Glutaraldehyde
 Picric acid, fertiliser, ammonia
 TB cultures
 Barium enema, X-rays
 Bleach
 Lye

6. 5: Managing Medical Waste Slide 6
Hazardous Health Care Waste
Infectious hazard:
 Anatomic waste
 Laboratory cultures
 Sharps
 Live viruses
Corrosive, teratogenic,
reproductive hazard:
 Heavy metals
 Pesticides
 Cleaning products
 Pressurised containers
 Mercury
 Cancer therapy

7. 5: Managing Medical Waste Slide 7
Is Health Care Waste an Important Source of
Infectious Disease?
Yes!
 IF needles and syringes
are scavenged and re-
used, then many diseases
can be spread
 Keep used sharps and
syringes out of public
access
No!
 Most medical waste does
not have more germs than
household waste
 It causes visual pollution,
generates fear, but unless
re-use of sharps occurs,
medical waste causes
little disease

8. 5: Managing Medical Waste Slide 8
Then Why does this Waste Matter?
 Sharps injuries may harm workers and
communities
 Medical waste potentially impacts patients,
workers, community, and economy because of the
volume and permanence of waste

9. 5: Managing Medical Waste Slide 9
Health Care Institutions Generate about 3.5 kg of Waste
per Bed per Day
Health care waste may:
 Contain infectious organisms, including drug resistant ones
 Place cancer causing agents into air or ground water
 Cause radiation-related illnesses
 Contribute to global warming harm atmosphere (CFC
containing refrigerant gas)
 Cause injury (sharps, explosion)
 Cause congenital defects or stillbirth, prematurity, infertility

10. 5: Managing Medical Waste Slide 10
Which Waste to Address First?
 IC Committees should START with infectious
waste, especially used sharps and microbiological
culture waste

11. 5: Managing Medical Waste Slide 11
How to Safely Dispose of Infectious Sharps
 Do not recap sharps before disposal
 Dispose of sharps at the point of use in a leak proof
puncture proof container
 Avoid handling, emptying or transferring used sharps
between containers
 Autoclave highly infectious waste before disposal
 Control public access to syringes and medical equipment
 Shred, encapsulate and bury according to national
legislation

12. 5: Managing Medical Waste Slide 12
For Non-Infectious Hazardous Waste, the
Risks Depend on:
 Severity of acute or chronic exposure
 Duration of exposure
 Frequency of exposure
 Concentration agent (1% versus 50%)
 Individual vulnerability including pregnancy, weight
 Route of exposure (skin, respiratory, oral, etc.)
 Steps taken to protect (PPE, relieved from immediate
contact etc.)

13. 5: Managing Medical Waste Slide 13
Who is at Risk?
 Doctors - anesthesiologists, pathologists
 Nurses - oncology nurses, OT, ER
 Hospital support staff - X-ray assistants,
pharmacy, morgue, and lab staff
 Cleaning staff - those cleaning sewage lines
 General public - those using sharps found in the
waste

14. 5: Managing Medical Waste Slide 14
Common Hazards
 Anesthetic gases
 Glutaraldehyde
 Formaldehyde/formalin
 Cancer therapeutic agents
 Ethylene Oxide
 Radiation
 Asbestos
 Blood contaminated sharps
 Bleach
 Solvents (xylene, toluene,
acetone, ethanol)
 Pesticides, fungicides
 Heavy metals (mercury,
chronium, cobalt, cadmium,
arsenic, lead)
 Latex
 Strychnine and cyanide

15. 5: Managing Medical Waste Slide 15
12 Steps to Manage Hazardous Wastes
before Disposal
1. Know what hazards you
have
2. Purchase smallest
quantity needed, and
don’t purchase
hazardous materials if
safe alternative exists
**Use mercury-free thermometers

16. 5: Managing Medical Waste Slide 16
12 Steps to Manage Hazardous Wastes
(cont’d)
3. Limit use and access
to trained persons with
personal protective
gear

17. 5: Managing Medical Waste Slide 17
4. Use Engineering Controls such as Ventilation,
Hoods for Select Hazards

18. 5: Managing Medical Waste Slide 18
5. Get Rid of Unnecessary Stuff
 Don’t accumulate unneeded products
 Don’t let peroxides and oxidising agents turn into
bombs
Photo of bomb robot called
into hospital to dispose of
picric acid.

19. 5: Managing Medical Waste Slide 19
6. Label with Agent, Concentration and
Hazard Warnings
 Examples of hazard labels:

20. 5: Managing Medical Waste Slide 20
7. Communicate about Workplace Hazards
 Job description
 Posters on doors
 Labels on hazards
 Give feedback on use of PPE
and disposal in evaluation
 Role model safe use and
disposal
 Contact point who is
responsible

21. 5: Managing Medical Waste Slide 21
8. Recycle Products When Possible

22. 5: Managing Medical Waste Slide 22

23. 5: Managing Medical Waste Slide 23
Group Discussion: Recycling
 Why should recycling be promoted?
 Which products can be safely and cost effectively
recycled in your facility?

24. 5: Managing Medical Waste Slide 24
9. Segregate Hazards at the Source
 Separate sharps and infectious waste where they
are used
 This prevents injuries that can occur when people sort
the trash after it is disposed
 Janitors can reinforce separation of sharps waste
disposal by reporting sharps in garbage to
Hospital Infection Control Committee members

25. 5: Managing Medical Waste Slide 25
10. Have Written Policies on Waste Disposal
 Sharps and infectious waste
 Chemotherapy (cancer)
 Heavy metals (batteries)
 Chemicals
Post brief, colorful instructions on walls to remind workers

26. 5: Managing Medical Waste Slide 26
11. Minimise the Handling of Wastes
 Try to eliminate steps that require hazardous
wastes to be touched, sorted, transferred from
containers, or handled directly

27. 5: Managing Medical Waste Slide 27
12. Conduct Walk-Around Interviews
 Ask about the hazardous substances staff work
with, how they dispose of them, and what they
need to be able to dispose of them properly
 Have a no-blame philosophy that strives to solve
problems, NOT to assign blame

28. Part II: Waste Management
Methods

29. 5: Managing Medical Waste Slide 29
Options for Specific Types of Waste
 Pharmaceutical
 Cytotoxic
 Other chemical wastes
 Heavy metals
 Pressurised containers
 Radiation
 Infectious

30. 5: Managing Medical Waste Slide 30
Pharmaceutical Waste
Small amounts:
 Disperse in landfill sites, encapsulate or bury on site
 Discharge to sewer
 Incinerate
Large amounts
 Incinerate at high temperatures or encapsulate
 LANDFILL IS NOT RECOMMENDED

31. 5: Managing Medical Waste Slide 31
Cytotoxic Waste
 NEVER LANDFILL or DISPOSE TO SEWER
Disposal Options:
 Return to supplier
 Incinerate at high temperature
 Chemical degradation

32. 5: Managing Medical Waste Slide 32
Chemical Waste - Further Recommendations
 Keep different hazardous chemicals separate
 Do not dispose into the sewers or street
 Do not encapsulate large amounts of disinfectants
as they are corrosive and flammable
 Do not bury large amounts of chemicals

33. 5: Managing Medical Waste Slide 33
Wastes with Heavy Metals
 Wastes with mercury, cadmium, lead, arsenic, strychnine,
are poisonous (e.g., thermometers, batteries, lead paints,
dyes)
 Never incinerate or burn
 Never dispose of in municipal landfills
Best solution: Avoid purchase
OR
 Recycle in specialised cottage industry or export to countries with
specialised facilities
 Encapsulation

34. 5: Managing Medical Waste Slide 34
Pressurised Gas Containers
 NEVER INCINERATE
 Return undamaged gas cylinders and cartridges to
the manufacturer for reuse
 Damaged containers: empty completely and
crush, landfill

35. 5: Managing Medical Waste Slide 35
Radioactive Waste
Use requires a national strategy including:
 Appropriate legislation
 A competent regulatory organisation
 Trained radiation protection officer to monitor exposures
 Return to the manufacturer
Safe handling and disposal of radioactive waste
requires a rigorous and relatively complex
management scheme

36. 5: Managing Medical Waste Slide 36
Simple Chemical Disinfection
 Requires shredding of waste
 May introduce strong chemicals into the environment
(chorine bleach turns into dioxin when burned)
 Efficiency varies
 Only the surface is disinfected
 Does not disinfect human tissue
 Special disposal required to avoid pollution

37. 5: Managing Medical Waste Slide 37
Waste Disposal Options Include
 Disinfection – Autoclaving/ Microwaving, treatment,
shredding
 Land Disposal
 Burial
 Encapsulation
 Incineration
 Inertisation
 Managed Land-fill
 On-site disposal

38. 5: Managing Medical Waste Slide 38
Infectious Waste: Autoclaving
 Pressure and temperature
 Holding time
 Sterility indicators
 Type of waste
 Followed by shredding / burial / recycled

39. 5: Managing Medical Waste Slide 39
Commercial Disinfection Systems
Shred waste, treat chemically, encapsulate
Possible advantages:
 Encapsulated residue can be placed in landfill
 Environmentally friendly
 Easy to operate
Possible disadvantages:
 Requires specialised operators
 May be expensive

40. 5: Managing Medical Waste Slide 40
Burying Inside Hospital Premises
Apply the following rules:
 Access to the site restricted and controlled
If waste is retained on site, ensure rapid burial to isolate from animal or
human contact
 Only hazardous HC Waste to be buried
Management controls on what is dumped
 Each deposit covered with soil
 Site lined with low permeable material-concrete
 Groundwater pollution must be avoided
Not recommended for untreated hazardous waste

41. 5: Managing Medical Waste Slide 41
Disposal to Land by Encapsulation
 Fill metal or plastic containers to 3/4, add:
 plastic foam
 bituminous sand
 cement mortar
 clay material
 When dry, label and seal containers and landfill
 May be used for sharps, chemicals, drugs etc.

42. 5: Managing Medical Waste Slide 42
Incineration
Combustible waste turned to ash at temps >800 C
 Reduces volume and weight
 Residues are transferred to final disposal site
 Treatment efficiency depends on incineration temperature
and type of incinerator
 Not all wastes can be incinerated
 Costs vary greatly according to type of incinerator
 Produces combustion gases

43. 5: Managing Medical Waste Slide 43
Do not Incinerate
Do not incinerate the following:
 Plastics especially halogenated plastics (e.g. PVC)
 Pressurised gas containers
 Large amounts of reactive chemical waste
 Radioactive waste
 Silver salts or radiographic waste
 Mercury or cadmium
 Ampoules of heavy metals

44. 5: Managing Medical Waste Slide 44
Advantages of Incineration of HC Waste:
 Good disinfection efficiency
 Drastic reduction of weight and volume
 Good for chemical + pharmaceutical waste

45. 5: Managing Medical Waste Slide 45
Disadvantages of Incineration of HC Waste:
 Doesn’t destroy chemical waste at lower
temperature for rotary kiln
 Toxic air emissions if no control devices in place
 Maintaining temperature levels (and efficiency) in
field incinerators is difficult, need to balance loads
with non-hazardous materials
 High costs for high temperature incineration

46. 5: Managing Medical Waste Slide 46
Land-fill in Municipal Landfills
If hazardous health-care waste cannot be treated
or disposed elsewhere:
 Designate a site for hazardous HC Waste
 Limit access to this place
 Bury the waste rapidly to avoid human or animal
contact
 Investigate more suitable treatment methods

47. 5: Managing Medical Waste Slide 47
Because no Disposal Method is Easy or
Completely Safe…
Prevention is best!
 Eliminate purchase by buying safer alternatives
 Recycle
 Use smallest quantities possible, use with engineering
controls and Personal Protective Equipment
 Segregate hazards into separate waste streams at source
 Supervise disposal using best available ecologic option

48. 5: Managing Medical Waste Slide 48
For More Information:
 Safe Management of wastes from health-care
activities. Edited by A Prüss, E Giroult, P
Rushbrook. Geneva World Health Organisation.
1999. 228 p. Available online. Includes a teachers
guide
 www.healthcarewaste.org. A website managed by
the working group on waste

49. 5: Managing Medical Waste Slide 49
More Free References
 http://www.healthcarewaste.org, Health Care
Waste Management at a Glance
 “First, do no harm.” WHO/V&B/02.26
 Available at
www.healthcarewaste.org/linked/onlinedocs/4-bd-
704.pdf. Contains information about the disposal
options for sharps

50. Thank You!