The document provides an overview of infectious waste management. It begins by noting there is no agreed upon definition of "infectious waste" and discusses factors necessary for a waste to cause infection, including the presence of a pathogen, its virulence, sufficient dose, and a susceptible host. The document then outlines key components that should be included in an infectious waste management plan, such as designation, segregation, packaging, storage, transport, treatment, disposal, contingency planning, and staff training. It emphasizes the role of infection control professionals in developing a safe and effective plan based on scientific evidence.

1. Infectious Waste
Management
Dr. Faisal N. Kordy, MD, CIC
Consultant, Pediatric Infectious Diseases and Infection Control

2. Introduction
• Over the years, a considerable amount of concern and
confusion has existed regarding the risks associated with the
disposal of hospital wastes.
• Absence of a specific definition of ‘‘infectious waste,’’

3. Introduction
• What is the definition of “infectious waste”?
NO specific definition of ‘‘infectious waste’’

4. Introduction
• CDC published the following statement:
– There is no epidemiologic evidence to suggest that most hospital waste
is any more infectious than residential waste.
– There is no epidemiologic evidence that hospital waste disposal
practices have caused disease in the community;
– Identifying wastes for which special precautions are indicated is a
matter of judgment about relative risks of disease transmission.

5. Introduction
• Microbiological waste, blood/ body fluids, sharps,
pathological wastes, and certain wastes from patients who are
placed in isolation for specific diseases have always been
treated as occupational hazards within healthcare facilities.
This may help to explain the absence of transmission in the
community.

6. Introduction
• biomedical waste,
• medical waste,
• infectious waste

7. Definitions
‘‘Infectious wastes are all the types of wastes
produced by hospitals, clinics and other
medical and research facilities.”

8. Definitions
‘‘any solid waste which is generated in the diagnosis,
treatment or immunization of human beings or animals, in
research pertaining thereto, or in the production or testing of
biologicals.’’

9. Pathogenesis
• For a waste to be capable of causing infection, the following
specific factors are necessary:
– There must be the presence of a pathogen.

10. Pathogenesis
• For a waste to be capable of causing infection, the following
specific factors are necessary:
– The pathogen must be virulent.

11. Pathogenesis
• For a waste to be capable of causing infection, the following
specific factors are necessary:
– The pathogen must also be present in sufficient dose.

12. Pathogenesis
• For a waste to be capable of causing infection, the following
specific factors are necessary:
– The organisms must have a portal of entry.

13. Pathogenesis
• For a waste to be capable of causing infection, the following
specific factors are necessary:
– There must be a susceptible host. (unimmunized, careless,
unfamiliar…)

14. Where do we find germs in the hospital?

15. Where do we find germs in the hospital?
•
•
•
•
•
•
•
•
Bed linens,
soiled diapers,
unwashed hands,
Key boards,
Door knobs,
Bedrails,
Patients’ charts
……

16. What wastes are we interested in?
1. Contaminated sharps.
All discarded sharps (e.g., needles, scalpels) that have
come into contact with infectious materials should be
considered infectious waste.

17. What wastes are we interested in?
2. Microbiologic cultures.

18. What wastes are we interested in?
3. Animal wastes.

19. What wastes are we interested in?
4. Blood and blood products.

20. What wastes are we interested in?
5. ‘‘Selected’’ isolation wastes. (Ebola, Dengue, …)

21. What wastes are we interested in?
6. Pathology wastes. (They do not usually fit the
definition of infectious waste outlined above. There is
an absence of a portal of entry; most of these
materials have been soaked in alcohol or
formaldehyde and seldom contain pathogens).

22. What wastes are we interested in?
• Wastes from surgery and dialysis, with the exception
of contaminated sharps, bulk blood, and blood-tinged
suction fluids, need not be considered infectious
wastes. Once they are properly contained, they are no
more infectious than any residential waste.
• For the same reason isolation trash is not considered
infectious waste.

23. Remember
• Most persons with
infectious diseases are
not hospitalized.

24. Infectious Waste Management Plan
• Once a facility has a working definition of
what constitutes ‘‘infectious waste,’’ a prudent
next step to take is to develop a program or
plan for managing these materials.

25. Infectious Waste Management Plan
• Written plan for infectious waste management
include:
- Objectives:
- rendering infectious waste safe for disposal,
- insuring that there is minimal risk to patients, personnel,
visitors and the community from exposure to pathogenic
organisms associated with waste generated in the
hospital,
- educating the healthcare staff regarding the
management plan and the real versus the perceived risk
associated with ‘‘infectious waste.’’

26. Infectious Waste Management Plan
• Written plan for infectious waste management
include:
-
Designation,
Segregation,
Packaging,
Storage,
Transport,
Treatment or disposal,
Contingency planning,
Staff training.

27. Infectious Waste Management Plan
• Designation
– Designate waste as infectious or noninfectious.

28. Infectious Waste Management Plan
• Segregation
– segregate infectious waste at the point of origin.
– waste should then be placed into appropriate
designated containers.

29. Infectious Waste Management Plan
• Packaging
– Infectious waste must be packaged properly to
protect patients, staff, visitors and the public from
potential exposure to infectious materials and to
facilitate the proper handling, storage, treatment
and /or disposal of the waste.

30. Infectious Waste Management Plan
• Packaging
– Selection of the packaging must be appropriate for
the type of waste being contained to maintain the
integrity of the packaging during collection,
transport and storage.

31. Infectious Waste Management Plan
• Packaging
– Sharps be placed in
rigid puncture-proof
containers.

32. Infectious Waste Management Plan
• Packaging
– Infectious waste must be properly identified as a
biohazard.

33. Infectious Waste Management Plan
• Packaging
– Infectious waste containers should be labeled

34. Infectious Waste Management Plan
• Packaging
– Potentially infectious liquid wastes can be
carefully poured down the drain.

35. Infectious Waste Management Plan
• Storage
– Storage areas should have limited access and a
universal biohazard symbol should be posted so it
is readily visible to anyone with access to the area.

36. Infectious Waste Management Plan
• Storage
– A system for immediate spill containment and
clean up should be available in the storage area
(e.g., hose connected to steam line, etc.).

37. Infectious Waste Management Plan
• Transport
– The systems used for the transportation of
infectious waste internally and externally must
maintain the integrity of the packaging.

38. Infectious Waste Management Plan
• Transport
– Leak-proof carts which are readily cleanable or
which can be lined with plastic are generally used
for transportation of infectious waste.

39. Infectious Waste Management Plan
• Transport
– Some commercial companies have been licensed
to transport and treat infectious wastes.

40. Infectious Waste Management Plan
• Treatment.
– The treatment selected should be based upon the
type of waste generated and the suitability of
available options.

41. Infectious Waste Management Plan
• Disposal
– The direct disposal of infectious waste at a
properly sited landfill does not in fact present a
threat to public health and safety, according to
many experts, and is still acceptable in many areas.

42. Infectious Waste Management Plan
• Disposal
– However, perceived risk concerns and the
nationwide movement away from land disposal
have resulted in widespread landfill prohibitions
on the disposal of untreated infectious waste in
landfills.

43. Infectious Waste Management Plan
• Disposal
– After treatment, medical waste are usually
disposed of in a sanitary landfill.

44. Infectious Waste Management Plan
• Contingency planning
– Systems should be in place to address unforeseen
events, which may disrupt the normal treatment,
transportation and disposal of these materials.

45. Infectious Waste Management Plan
• Contingency planning
– Emergency spill procedures should also be in place
for both on-site and off-site emergencies.

46. Infectious Waste Management Plan
• Training
– Training of all personnel involved in:
•
•
•
•
generation,
handling,
transporting,
treatment or disposal of infectious waste.

47. Infectious Waste Management Plan
• Training of staff
–
–
–
–
Needles
Sharps
Broken glass
Wires

48. Infectious Waste Management Plan
• Training of staff
– Materials
contaminated
with blood or
body fluids.

49. Infectious Waste Management Plan
• Training of staff

50. Infectious Waste Management Plan
• Training of staff

51. Infectious Waste Management Plan
• Training of staff

52. Infectious Waste Management Plan
• Training of staff

53. Infectious Waste Management Plan
• Training of staff

54. Infectious Waste Management Plan
• Training of staff
– Materials
contaminated
with blood or
body fluids.

55. Infectious Waste Management Plan
• Training of staff

56. Infection Control Implications
In most healthcare facilities, the infection
control professional is responsible for
developing and overseeing the infectious
waste management plan.

57. Infection Control Implications
The role of the infection control professional is
to develop a safe and effective infectious
waste management plan and to assure that it is
based on sound scientific information and is
consistent with MOH regulations.

58. Infection Control Implications
• Rutala et al. have recently published several
important facts that should be kept in mind
during the development of infectious waste
policies or rules and regulations.
Rutala WA, Odette RI, Samsa GP.Management of infectious waste by United States hospitals. JAMA 1989;262:1635–1640
Rutala WA. Disinfection, sterilization and waste disposal—medical waste. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections.
2nd ed. Baltimore, MD: Williams and Wilkins;1993:483–487

59. Infection Control Implications
• Several of these facts include:
– Hospitalized patients generate approximately 6.8
kilograms of hospital waste per day.

60. Infection Control Implications
• Several of these facts include:
– About 15% of the total hospital waste by weight is
considered ‘‘infectious waste’’.

61. Infection Control Implications
• Several of these facts include:
– The cost of disposing infectious waste is 5–20
times that of other hospital wastes.

62. Infection Control Implications
• Several of these facts include:
– With the exception of ‘‘sharps’’ such as needles,
which have caused disease only in an occupational
setting, there is no scientific evidence that medical
waste has caused disease in the hospital or in the
community.

63. Infection Control Implications
• Several of these facts include:
– Household waste contains on average 100 times as
many human pathogens than medical waste.

64. Infection Control Implications
• Several of these facts include:
– The beach wash-ups of syringe related materials
which created nationwide concern about medical
waste were found to come from illegal drug use
and home healthcare.

65. Infection Control Implications
• When regulations are not based on sound
science, ICPs are encouraged to become
involved in assisting regulators by providing
scientific input as well as basic ‘‘common
sense.’’

66. Thanks