1. Presentation on Health Care
(PPPTTTTTANCES RELATED TO
HEALTH CARE WASTE
Phillup Love
phillup@dcrprocess.co.za
2. What it health care waste?
• Between 45% and 60% of the waste produced
by health care providers is “non-risk” or general
health care waste, comparable to domestic
waste.
• The remaining 35% to 40% of health care
waste is regarded as hazardous and may
create a variety of health risks.
3. Outline of the session
• Waste categories
• Health Care Waste (HCW) Generators
• Dioxin
• Sources of Dioxin Contamination
• Steps to Prevention
• Sharps
• How should Sharps Containers be Handled?
• Where should Sharps Containers be Located?
• Chemical waste
• Questions
4. Infectious Waste
Waste suspected to contain pathogens e.g. laboratory cultures; waste from
isolation wards; tissues (swabs), materials, or equipment that have been in
contact with infected patients; excreta
Microbiological
Waste
Waste originating from clinical or research laboratory procedures involving
communicable infectious agents.
Isolation Wastes
Biological waste and discarded materials contaminated with blood, excretion,
exudates, or secretion from humans or animals that are isolated to protect
others from highly communicable diseases
Pathological WasteHuman tissues or fluids e.g. body parts; blood and other body fluids; fetuses
Pharmaceutical
Waste
Pharmaceutical waste includes expired, unused, spilt, and contaminated
pharmaceutical products, drugs, vaccines, and sera that are no longer
required and need to be disposed of appropriately
Genotoxic Waste
Waste containing substances with genotoxic properties e.g. waste containing
cytostatic drugs and genotoxic chemicals
Chemical Waste
Waste containing chemical substances e.g. laboratory reagents; film
developer; disinfectants that are expired or no longer needed; solvents
Radioactive Waste
Waste containing radioactive substances e.g. unused liquids from
radiotherapy or laboratory research; contaminated glassware, packages, or
absorbent paper; urine and excreta from patients treated or tested with
unsealed radionuclides; sealed sources
5. Hospitals
• University hospitals
• General hospitals
• District hospitals
Other health care establishments
• Emergency medical care services
• Health-care centres and dispensaries
• Obstetric and maternity clinics
• Outpatient clinics
• Dialysis centres
• First-aid posts and sick bays
• Long-term health-care establishments and hospices
• Transfusion centres
• Military medical services
6. Related laboratories and research centres
• Medical and biomedical laboratories
• Biotechnology laboratories and institutions
• Medic Mortuary and autopsy centres
Animal research and testing
Blood banks and blood collection services
Nursing homes for the elderly
Clinical laboratories
7. Small health care establishments
• Physicians' offices
• Dental clinics
• Acupuncturists
• Chiropractors
Specialized health-care establishments and
institutions with low waste generation
• Convalescent nursing homes
• Psychiatric hospitals
• Disabled persons' institutions
Non-health activities involving intravenous or
subcutaneous interventions
• Cosmetic ear-piercing and tattoo parlours
• Illicit drug users, Funeral services, Ambulance services, Home
treatment, research centres
8. Dioxin
• A highly toxic and persistent family of chemicals
that is an unintentional bi-product of medical
waste incineration and PVC plastic production.
• Dioxins are highly toxic and can cause
reproductive and developmental problems,
damage the immune system, interfere with
hormones and also cause cancer.
9. SOURCES OF DIOXIN CONTAMINATION
• Dioxins are mainly bi-products of industrial processes including
smelting, chlorine bleaching of paper pulp and the manufacturing
of some herbicides and pesticides
• Uncontrolled waste incinerators (solid waste and hospital waste)
are often the worst culprits, due to incomplete burning
• Dioxins are found throughout the world in the environment. The
highest levels of these compounds are found in some soils,
sediments, and food, especially dairy products, meat, fish and
shellfish
• Very low levels are found in plants, water, and air. Extensive
stores of PCB-based waste industrial oils, many with high levels
of PCDFs, exist throughout the world.
10. Dioxin: Steps to Prevention
STEP 1
• Review Your Facility’s Definition of Regulated Medical Waste
STEP 2
• Define the Problem and Develop a Cost / Benefit Analysis
STEP 3
• Create a Team, Set Goals, and Develop an Action Plan
STEP 4
• Make Waste Segregation Simple
STEP 5
• Determine Optimal Container Placement and Use Good Signage
11. Dioxin: Steps to Prevention
STEP 6
• Train, Educate, Repeat
STEP 7
• Review Your Specialty HWRC Streams
STEP 8
• Be Ready to Identify and Solve Problems
STEP 9
• Consider All Your Waste Treatment Options
STEP 10
• Track Your Progress, Report Successes, and Reward Staff
12. Sharps
• Items that can induce sub-dermal inoculation of infectious agents
or that can easily penetrate the skin, including:
– Puncture waste bags and cardboard boxes
– Hypodermic needles
– Syringes
– Pasteur pipettes
– capillary tubes
– Broken glass from the laboratory including slides and slide
covers
– Razor blades
– Scalpel blades.
– Needleless injection devices
– Heel lancers and retractable
– Needles destruction technologies
13. Managing Sharps containers
• Each sharps container must either be labeled with the universal
biohazard symbol and the word "biohazard" or be color-coded red
• Sharps containers must be maintained upright throughout use,
replaced routinely, and not be allowed to overfill
• Must be placed in a secondary closable container, should leakage
be possible
• Constructed to contain all contents and prevent leakage during
handling, storage, transport, or shipping
• Labeled or color-coded according to the standard
• Reusable containers must not be opened, emptied, or cleaned
manually or in any other manner that would expose employees to
the risk of percutaneous injury
• Upon closure, duct tape may be used to secure the lid of a sharps
container, as long as the tape does not serve as the lid itself
14. Where should Sharps containers
be located?
• Sharps containers must be easily accessible to
employees and located as close as feasible to the
immediate area where sharps are used (e.g., patient
care areas)
• In areas, such as correctional facilities and psychiatric
units, there may be difficulty placing sharps containers in
the immediate use area. If a mobile cart is used in these
areas, an alternative would be to lock the sharps
container in the cart.
15. Chemical Waste
• Chemical waste consists of discarded solid, liquid, and gaseous
chemicals
• Chemical waste from health care may be hazardous or
nonhazardous; in the context of protecting health, it is considered
to be hazardous if it has at least one of the following properties:
- toxic | corrosive | flammable | reactive | genotoxic
• Nonhazardous chemical waste consists of chemicals with none of
the above properties, such as sugars, amino acids, and certain
organic and inorganic salts.
16. The types of hazardous chemicals used most
commonly in maintenance of health care centres
and hospitals and the most likely to be found in
waste are discussed below:
• Formaldehyde
• Photographic chemicals
• Solvents
17. ORGANIC CHEMICALS
• Disinfecting and cleaning solutions such as
phenol-based chemicals used for scrubbing floors,
perchlorethylene used in workshops and laundries
• Oils such as vacuum-pump oils, used engine oil
from vehicles (particularly if there is a vehicle
service station on the hospital premises)
• Insecticides, rodenticides
18. INORGANIC CHEMICALS
• Waste inorganic chemicals consist mainly of acids and
alkalis (e.g. sulphuric, hydrochloric, nitric, and chromic
acids, sodium hydroxide and ammonia solutions)
• They also include oxidants, such as potassium
permanganate (KMnO4) and potassium dichromate
(K2Cr2O7), and reducing agents, such as sodium
bisulfite (NaHSO3) and sodium sulfite (Na2SO3)
