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HOSPITAL WASTE
MANAGEMENT

-Dr.Sharad H.Gajuryal,
JR,MD Hospital Administration
BPKIHS
1/28/2014

LET THE WASTE OF THE
“SICK” NOT CONTAMINATE
THE LIVES OF
“THE HEALTHY”.

K.park
2
OBJECTIVES
Definition
Classification of waste (WHO)
Source of Health Care Waste

Health care waste Management provision and study
(Nepal Context)
Magnitue of problem in developing and developed
countries
Problems associated with Health care waste
Generation/Segregation/Storage/Transportion/Treat
ment & Disposal of watse
Treatment technique & categorical treatment.
DEFINITION


Hospital waste are the waste produced in the
course of health care activities during
Treating,Diagnosing,and Immunizing Human
being or animals or while doing
Study/Research activities.

75-90% Non-Hazardous/General Waste
 10-15% -Hazardous

WHO CLASSIFICATION
Waste Categories

Description and Examples

1.General Waste

No risk to human health eg:office
paper,wrapper,kitchen waste,general
sweeping etc.

2.Pathological Waste

Human Tissue or fluid eg:body
parts,blood,body fluids etc.

3.Sharps

Sharp waste
eg:Needle,scaples,knives,blades etc.

4.Infectious waste

Which may transmit bacterial,viral or
parasitica disease to human
being,waste suspected to contain
pathogen eg:labrotory
culture,tissues(swabs)bandage etc.

5.Chemical waste

Eg:Labrotory reagent,disinfectants,Film
Developer

6.Radio-active waste

Eg: unused liquid from radiotherapy or
lab research,contaminated glasswares
etc.
Waste Categories

Description with examples

7.Pharmacutical Waste

Expired outdated drugs /chemicals

8.Pressurized container

Gas cylinder,aerosal cans etc

9.Genotoxic Waste

Waste Containing Cytotoxic
Drugs(often Used In Cancer Therapy)

As propageted by CDC,Atlanta under US
classification,Pathological waste,and Sharp waste
also come under ‘INFECTIOUS WASTE”
**Types and nature of hospital waste depends
upon the service available in hospital and nature
of the hospital.
SOURCE OF HEALTH CARE WASTE















Governmental Hospital
Private Hospital
Nursing Homes
Physician’s Office
Dentist Office
Dispenseries
Mortouries
Blood Bank and collection center
Animal Houses
Labrotories
Research Organizations
NEPAL CONTEXT


NHRC & WHO published-:National
guidelines for Health care waste
management” in 2002 on behalf of ministry of
health.



Kathmandu Metropolitan City also have
initiated an action plan in association with
USAID for management of health care
waste.


Kathmandu Metropolitan City & ENPHO
have organized a study on biomedical waste
in hospital located in kathmandu.



Results:1.72kg waste/day/patient



Out of which 26% of waste was infectious
and hazardous waste.
AVERAGE COMPOSITION OF HOSPITAL WASTE IN
HOSPITALS IN KATHMANDU
Types of Waste

Percentage

Medical General waste

62%

Infectious Hazardous waste

23%

Non-degradable medical waste (saline
Bottle)

12%

Bio-Medical sharp

3%

Source:KMC & ENPHO 2001
MAGNITUDE OF THE PROBLEM


GLOBALLY- Developed countries generate 1 to 5
kg/bed/day



Developing countries: meager data, but figures are lower.
1-2kg/pt./day



WHO Report: 85% non hazardous waste
: 10% infective waste
: 5% non-infectious but hazardous.
(Chemical, pharmaceutical and
radioactive)
11



INDIA:-No national level study
- local or regional level study shows hospitals
1/28/2014

CATEGORIES OF PERSONS EXPOSED
TO RISK OF INFECTION

Patients+Visitors

Medical &
Paramedical staff

Sanitation
workers

12
ROUTES OF
TRANSMISSION

1/28/2014

Inhalation of
dust particles
containing
germs

Intact or non
intact skin,
mucous
membranes
By ingestion
(contaminated
unwashed hands,
contaminated food
stuffs, water etc)

13
PROBLEM ASSOCIATED WITH BIOMEDICAL
WASTE
ORGANISM

DISEASES CAUSED

RELATED WASTE ITEM

VIRUSES
HIV, Hepatitis B, Hepatitis
A,C, Arboviruses,
Enteroviruses,Herpes
Virus

AIDS, Infectious Hepatitis,
Infectious Hepatitis,
Dengue, Japanese
encephalitis, Ocular
infection,Genital Infection

Infected needles, body
Fluids, Human excreta,
Blood, body fluids.Eye
secrection,genital
Secretion

BACTERIA
Salmonella typhi,
Vibrio cholerae,
Clostridium Tetani,
Pseudomonas,
Streptococcus

Typhoid, Cholera, Tetanus
Wound infections,
septicemia, rheumatic
fever, endocarditis, skin
and soft tissue infections

Human excreta and
body fluid in landfills and
hospital wards, Sharps
such as needles, surgical
blades in hospital waste.

PARASITES
Wucheraria Bancrofti,
Plasmodium

Cutaneous leishmaniasis,
Filariasis
Kala Azar, Malaria

Human excreta, blood and
body fluids in poorly
managed sewage system
GENERATION,SEGREGATION,COLLECTION,STO
RAGE,TRANSPORTATION AND TREATMENT OF
WASTE
SOPs for this system may differ from Hospital to Hospital/Nation wise.



1.Generation:
Type

Site of Generation

Disposal By

Non-Hazardous
waste/General waste

Office,Kitchen,Admini
stration,Hostels,Store
s,Rest rooms etc

Muncipal/Public
Authority

Hazardous (Infectious
& toxic waste)

Wards,Treatment
room, Dressing room,
OT, ICU,Labour room,
Labrotory, Dialysis
room, CT scan,
Radio-imaging etc

Hospital itself


2.Segregation:
Done at point of Generation of waste and put
in separate coloured bags.Color coding
varies from nation to nation.For eg. In AIIMS
hospital,New delhi, Following color code
bags are practised.
1/28/2014

GENERAL WASTE

17
1/28/2014

INFECTIOUS WASTE/PATHOLOGICAL WASTE

18
1/28/2014

SHARP AND DISPOSABLE WASTES

19
3.Collection of waste:
 Centralized sanitation staffs or any other
sanitation staffs should collect the waste
during morning afternoon or evening under
the supervision of nursing staff and sanitation
supervisor; documentation should be done in
register; Garbage bin should be cleaned and
disinfected regularly.

4. Storage of Waste:
 Waste should not be stored in the generation
area for more than a period of 4-6 hours.
 It is responsibility of paramedic/sanitation
staff to check for segregation
 Waste collected in various areas should be
trasported for disposal/Treatment.



Transportation:



There should be separate corridor and lift in hospital
to carry and transport waste.
General waste are deposited at municipal dumps.
Waste for autoclaving and incineration are dumped at
separate site for external trasport (should have
separate coloured plastic bag for these waste)
Transportation should be done in sealed
container/sanitation supervisor should ensure for
leakage.







Treatment & Disposal:



General waste should be dumped at municipal
dumping site. Sanitation officer should be
responsible for proper coordination between
municipal and hospital.



Use of label/symbole is useful in identifying
waste for treatment .eg: Risk of corrosion,
Danger of Infection, Toxic hazards, Glass
Hazards, Radioactive materials etc.
LABEL FOR BIO-MEDICAL
WASTE CONTAINERS/BAGS
BIOHAZARD SYMBOL

CYTOTOXIC HAZARD SYMBOL

CYTOTOXIC
BIOHAZARD
HANDLE WITH CARE
Note : Label shall be non-washable and prominently visible.
TREATMENT & DISPOSAL TECHNOLOGIES
1.Incineration
 2.Chemical Disinfection
 3.Wet and dry thermal treatment
 4.Microwave irradiation
 5.Land disposal
 6.Inertization

Inceneration:
 High tempreture dry oxidation process that
reduce organic and combustible waste into
inorganic incombustible matter. Resulting in
significant reduction in waste volume and
weight.


--Process is selected to treat waste that cannot be
recycled,reused or can be disposed in land.


Types if Incinerators:

-Double chambered(for infectious waste)
 Single chambered (if double chamber not
affordable)
 --Rotatory Kilns(for genotoxic waste)



2.Chemical disinfection:



Commonly Used for treatment of liquid
infectious waste eg.blood,urine,stool and
hospital sewage



Chemicals are added to waste to kill or
inactivate the pathogen it contains.
3.Wet and Dry thermal treatment:


Wet thermal treatment/steam disinfection is based on
exposure if infecious waste to high tempreture and
high pressure steam similar to process of
autoclaving, inapropriate for treating anatomical
waste, chemical and pharmaceutical waste.



Screw feed technology: Dry thermal treatment in
which waste is shredded and heated in rotating
auger.80% volume and 20-35 weight is reduced,
suitable for infectius waste and sharps.


Microwave irradiation



Microwave of frequency 2450MHZ and wave
length 12.24cm used to destroy the
microorganism. water contained in the waste
is rapidly heated by microwave and
infectious components are destroyed by heat
conduction.


Land Disposal:

A.Open Dumps: risk for public health
 B.Sanitary landfills: designed and
constructed to prevent contamination of
soil,surface,ground water and direct contact
with public.



5.Inertization



Process of mixing waste with cement and other
substances before disposal in order to minimize
the risk of toxic substance migrating into surface
water or ground water and to prevent
scavenging.



Proportion of 65% waste 15%lime 15% cement
and 5% water is used.
CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I
WASTE
CATEGORY
Category No. 1

Category No. 2

Category No. 3

TYPE OF WASTE
Human Anatomical Waste (Human
tissues, organs, body parts)

TREATMENT AND
DISPOSAL OPTION
Incineration@ / deep
burial*

Animal Waste
(Animal tissues, organs, body parts,
carcasses, bleeding parts, fluid, blood
and experimental animals used in
Incineration@ / deep
research, waste generated by
burial*
veterinary hospitals and colleges,
discharge from hospitals, animal
houses)
Microbiology & Biotechnology Waste
(Wastes from laboratory cultures,
stocks or specimen of live micro
organisms or attenuated vaccines,
Local autoclaving/
human and animal cell cultures used in
microwaving /
research and infectious agents from
incineration@
research and industrial laboratories,
wastes from production of biologicals,
toxins and devices used for transfer of
cultures)

35
Category No. 4

Waste Sharps (Needles, syringes,
scalpels, blades, glass, etc. that may
cause puncture and cuts. This
includes both used and unused
sharps)

Category No. 5

Discarded Medicine and Cytotoxic
Incineration@ /
drugs (Wastes comprising of outdated, destruction and drugs
contaminated and discarded
disposal in secured
medicines)
landfills

Category No. 6

Soiled Waste (Items contaminated with
body fluids including cotton,
Incineration@ /
dressings, soiled plaster casts, lines, autoclaving /
bedding and other materials
microwaving
contaminated with blood.)

Category No. 7

Solid Waste (Waste generated from
disposable items other than the waste
sharps such as tubing, catheters,
intravenous sets, etc.)

Disinfecting (chemical
treatment@@ /
autoclaving /
microwaving

Disinfecting by chemical
treatment@@ /
autoclaving /
microwaving

36
Category No. 8

Liquid Waste (Waste generated from
the laboratory and washing,
cleaning, house keeping and
disinfecting activities)

Disinfecting by
chemical treatment@@
and discharge into
drains

Category No. 9

Incineration Ash (Ash from
incineration of any biomedical
waste)

Disposal in municipal
landfill

Chemical treatment
Chemical Waste (Chemicals used in
@@ and discharge into
production of biologicals, chemicals
Category No.10
drains for liquids and
used in disinfecting, as insecticides,
secured landfill for
etc.)
solids.

37
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Hospital waste management

  • 2. 1/28/2014 LET THE WASTE OF THE “SICK” NOT CONTAMINATE THE LIVES OF “THE HEALTHY”. K.park 2
  • 3. OBJECTIVES Definition Classification of waste (WHO) Source of Health Care Waste Health care waste Management provision and study (Nepal Context) Magnitue of problem in developing and developed countries Problems associated with Health care waste Generation/Segregation/Storage/Transportion/Treat ment & Disposal of watse Treatment technique & categorical treatment.
  • 4. DEFINITION  Hospital waste are the waste produced in the course of health care activities during Treating,Diagnosing,and Immunizing Human being or animals or while doing Study/Research activities. 75-90% Non-Hazardous/General Waste  10-15% -Hazardous 
  • 5. WHO CLASSIFICATION Waste Categories Description and Examples 1.General Waste No risk to human health eg:office paper,wrapper,kitchen waste,general sweeping etc. 2.Pathological Waste Human Tissue or fluid eg:body parts,blood,body fluids etc. 3.Sharps Sharp waste eg:Needle,scaples,knives,blades etc. 4.Infectious waste Which may transmit bacterial,viral or parasitica disease to human being,waste suspected to contain pathogen eg:labrotory culture,tissues(swabs)bandage etc. 5.Chemical waste Eg:Labrotory reagent,disinfectants,Film Developer 6.Radio-active waste Eg: unused liquid from radiotherapy or lab research,contaminated glasswares etc.
  • 6. Waste Categories Description with examples 7.Pharmacutical Waste Expired outdated drugs /chemicals 8.Pressurized container Gas cylinder,aerosal cans etc 9.Genotoxic Waste Waste Containing Cytotoxic Drugs(often Used In Cancer Therapy) As propageted by CDC,Atlanta under US classification,Pathological waste,and Sharp waste also come under ‘INFECTIOUS WASTE” **Types and nature of hospital waste depends upon the service available in hospital and nature of the hospital.
  • 7. SOURCE OF HEALTH CARE WASTE            Governmental Hospital Private Hospital Nursing Homes Physician’s Office Dentist Office Dispenseries Mortouries Blood Bank and collection center Animal Houses Labrotories Research Organizations
  • 8. NEPAL CONTEXT  NHRC & WHO published-:National guidelines for Health care waste management” in 2002 on behalf of ministry of health.  Kathmandu Metropolitan City also have initiated an action plan in association with USAID for management of health care waste.
  • 9.  Kathmandu Metropolitan City & ENPHO have organized a study on biomedical waste in hospital located in kathmandu.  Results:1.72kg waste/day/patient  Out of which 26% of waste was infectious and hazardous waste.
  • 10. AVERAGE COMPOSITION OF HOSPITAL WASTE IN HOSPITALS IN KATHMANDU Types of Waste Percentage Medical General waste 62% Infectious Hazardous waste 23% Non-degradable medical waste (saline Bottle) 12% Bio-Medical sharp 3% Source:KMC & ENPHO 2001
  • 11. MAGNITUDE OF THE PROBLEM  GLOBALLY- Developed countries generate 1 to 5 kg/bed/day  Developing countries: meager data, but figures are lower. 1-2kg/pt./day  WHO Report: 85% non hazardous waste : 10% infective waste : 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive) 11  INDIA:-No national level study - local or regional level study shows hospitals
  • 12. 1/28/2014 CATEGORIES OF PERSONS EXPOSED TO RISK OF INFECTION Patients+Visitors Medical & Paramedical staff Sanitation workers 12
  • 13. ROUTES OF TRANSMISSION 1/28/2014 Inhalation of dust particles containing germs Intact or non intact skin, mucous membranes By ingestion (contaminated unwashed hands, contaminated food stuffs, water etc) 13
  • 14. PROBLEM ASSOCIATED WITH BIOMEDICAL WASTE ORGANISM DISEASES CAUSED RELATED WASTE ITEM VIRUSES HIV, Hepatitis B, Hepatitis A,C, Arboviruses, Enteroviruses,Herpes Virus AIDS, Infectious Hepatitis, Infectious Hepatitis, Dengue, Japanese encephalitis, Ocular infection,Genital Infection Infected needles, body Fluids, Human excreta, Blood, body fluids.Eye secrection,genital Secretion BACTERIA Salmonella typhi, Vibrio cholerae, Clostridium Tetani, Pseudomonas, Streptococcus Typhoid, Cholera, Tetanus Wound infections, septicemia, rheumatic fever, endocarditis, skin and soft tissue infections Human excreta and body fluid in landfills and hospital wards, Sharps such as needles, surgical blades in hospital waste. PARASITES Wucheraria Bancrofti, Plasmodium Cutaneous leishmaniasis, Filariasis Kala Azar, Malaria Human excreta, blood and body fluids in poorly managed sewage system
  • 15. GENERATION,SEGREGATION,COLLECTION,STO RAGE,TRANSPORTATION AND TREATMENT OF WASTE SOPs for this system may differ from Hospital to Hospital/Nation wise.  1.Generation: Type Site of Generation Disposal By Non-Hazardous waste/General waste Office,Kitchen,Admini stration,Hostels,Store s,Rest rooms etc Muncipal/Public Authority Hazardous (Infectious & toxic waste) Wards,Treatment room, Dressing room, OT, ICU,Labour room, Labrotory, Dialysis room, CT scan, Radio-imaging etc Hospital itself
  • 16.  2.Segregation: Done at point of Generation of waste and put in separate coloured bags.Color coding varies from nation to nation.For eg. In AIIMS hospital,New delhi, Following color code bags are practised.
  • 20.
  • 21. 3.Collection of waste:  Centralized sanitation staffs or any other sanitation staffs should collect the waste during morning afternoon or evening under the supervision of nursing staff and sanitation supervisor; documentation should be done in register; Garbage bin should be cleaned and disinfected regularly. 
  • 22. 4. Storage of Waste:  Waste should not be stored in the generation area for more than a period of 4-6 hours.  It is responsibility of paramedic/sanitation staff to check for segregation  Waste collected in various areas should be trasported for disposal/Treatment. 
  • 23.  Transportation:  There should be separate corridor and lift in hospital to carry and transport waste. General waste are deposited at municipal dumps. Waste for autoclaving and incineration are dumped at separate site for external trasport (should have separate coloured plastic bag for these waste) Transportation should be done in sealed container/sanitation supervisor should ensure for leakage.   
  • 24.  Treatment & Disposal:  General waste should be dumped at municipal dumping site. Sanitation officer should be responsible for proper coordination between municipal and hospital.  Use of label/symbole is useful in identifying waste for treatment .eg: Risk of corrosion, Danger of Infection, Toxic hazards, Glass Hazards, Radioactive materials etc.
  • 25. LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS BIOHAZARD SYMBOL CYTOTOXIC HAZARD SYMBOL CYTOTOXIC BIOHAZARD HANDLE WITH CARE Note : Label shall be non-washable and prominently visible.
  • 26. TREATMENT & DISPOSAL TECHNOLOGIES 1.Incineration  2.Chemical Disinfection  3.Wet and dry thermal treatment  4.Microwave irradiation  5.Land disposal  6.Inertization 
  • 27. Inceneration:  High tempreture dry oxidation process that reduce organic and combustible waste into inorganic incombustible matter. Resulting in significant reduction in waste volume and weight.  --Process is selected to treat waste that cannot be recycled,reused or can be disposed in land.
  • 28.
  • 29.  Types if Incinerators: -Double chambered(for infectious waste)  Single chambered (if double chamber not affordable)  --Rotatory Kilns(for genotoxic waste) 
  • 30.  2.Chemical disinfection:  Commonly Used for treatment of liquid infectious waste eg.blood,urine,stool and hospital sewage  Chemicals are added to waste to kill or inactivate the pathogen it contains.
  • 31. 3.Wet and Dry thermal treatment:  Wet thermal treatment/steam disinfection is based on exposure if infecious waste to high tempreture and high pressure steam similar to process of autoclaving, inapropriate for treating anatomical waste, chemical and pharmaceutical waste.  Screw feed technology: Dry thermal treatment in which waste is shredded and heated in rotating auger.80% volume and 20-35 weight is reduced, suitable for infectius waste and sharps.
  • 32.  Microwave irradiation  Microwave of frequency 2450MHZ and wave length 12.24cm used to destroy the microorganism. water contained in the waste is rapidly heated by microwave and infectious components are destroyed by heat conduction.
  • 33.  Land Disposal: A.Open Dumps: risk for public health  B.Sanitary landfills: designed and constructed to prevent contamination of soil,surface,ground water and direct contact with public. 
  • 34.  5.Inertization  Process of mixing waste with cement and other substances before disposal in order to minimize the risk of toxic substance migrating into surface water or ground water and to prevent scavenging.  Proportion of 65% waste 15%lime 15% cement and 5% water is used.
  • 35. CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I WASTE CATEGORY Category No. 1 Category No. 2 Category No. 3 TYPE OF WASTE Human Anatomical Waste (Human tissues, organs, body parts) TREATMENT AND DISPOSAL OPTION Incineration@ / deep burial* Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts, fluid, blood and experimental animals used in Incineration@ / deep research, waste generated by burial* veterinary hospitals and colleges, discharge from hospitals, animal houses) Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, Local autoclaving/ human and animal cell cultures used in microwaving / research and infectious agents from incineration@ research and industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures) 35
  • 36. Category No. 4 Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Category No. 5 Discarded Medicine and Cytotoxic Incineration@ / drugs (Wastes comprising of outdated, destruction and drugs contaminated and discarded disposal in secured medicines) landfills Category No. 6 Soiled Waste (Items contaminated with body fluids including cotton, Incineration@ / dressings, soiled plaster casts, lines, autoclaving / bedding and other materials microwaving contaminated with blood.) Category No. 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting (chemical treatment@@ / autoclaving / microwaving Disinfecting by chemical treatment@@ / autoclaving / microwaving 36
  • 37. Category No. 8 Liquid Waste (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities) Disinfecting by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Chemical treatment Chemical Waste (Chemicals used in @@ and discharge into production of biologicals, chemicals Category No.10 drains for liquids and used in disinfecting, as insecticides, secured landfill for etc.) solids. 37