Over 75% of healthcare waste is non-hazardous, but there is no established system to segregate hazardous and non-hazardous waste. This mixing results in increased hazardous waste quantities. Healthcare waste is often dumped with municipal waste. Exposure to untreated healthcare waste poses infection, mechanical and chemical injury risks both inside and outside of healthcare facilities, and puts waste workers and the public at risk. Improper waste disposal can also release toxic pollutants into the environment.

1. 1

2. 2
• Over 75% of health care waste is non-hazardous.
• There is no established system of segregating hazardous from non-
hazardous waste in majority of the health care establishments.
• This mixing of various components results in increased quantity of
hazardous wastes.
• Very often, the health care wastes are dumped along with
municipal wastes.

3. In general, these may be listed as
below:
Risk of mechanical injuries
Risk of infections:
Inside the hospital
Outside the hospital
Eventually, to the general public;
Change in microbial ecology and spread of
antibiotic resistance further add to the above
risks.
Risk of chemical injury
3

4. PERSONS AT RISK
• All individuals exposed to hazardous health-care waste
are potentially at risk, including those within health-care
establishments that generate hazardous waste, and
those outside these sources who either handle such
waste or are exposed to it as a consequence of careless
management.
4

5. 5

6. 6

7. 7

8. 8

9. Types of hazards
• Exposure to hazardous health-care waste can result in
disease or injury.
• The hazardous nature of health-care waste may be due
to one or more of the following characteristics:
It contains infectious agents and sharps
It is genotoxic
It contains toxic or hazardous chemicals or
pharmaceuticals
It is radioactive
9

10. HAZARDS FROM INFECTIOUS WASTE AND
SHARPS
Pathogens in infectious waste may enter the human body
by a number of routes.
Through a puncture, abrasion or cut in the skin
Through the mucous membrane
By inhalation
By ingestion
10

11. Sharps
• Represent about 1% of the total waste but they are a major source of
disease transmission if not properly managed.
• Not only cause cuts & punctures but also infect these wounds if they are
contaminated with pathogens.
• Double risk of injury and disease transmission, sharps are considered as
a very hazardous waste class.
• 60-67% of hospital employees,
knowingly or unknowingly, sustain
injuries from sharps.
11

12. • Needles- Important sharps waste category particularly hazardous
because often contaminated with patient’s blood.
• Throughout the world an estimated 16 000 million injections are
administered every year. Not all needles and syringes are properly
disposed of, creating a risk of injury and infection and opportunities for
re-use.
• On job injuries among hospital staff in USA is reported to be 180 per
1000 per year. The figures are likely to be higher in India, though no
studies have been conducted so far.
12

13. • WHO estimates that, in 2000, injections with contaminated
syringes caused 21 million hepatitis B virus (HBV)
infections, two million hepatitis C virus infections and
260 000 HIV infections worldwide. Many of these infections
were avoidable if the syringes had been disposed of safely.
• Rag pickers commonly gather around hospital dumpster sites
and frequently injure themselves during rag picking, which
largely goes unnoticed.
13

14. 14
Type of infections Causative organism Transmission vehicles
Gastro enteric infections Enterobacteria Faces and/or vomit
Respiratory infections Myco. tuberculosis, Inhaled secretions, saliva
Ocular infection Herpes virus Eye secretions
Skin infection Streptococcus species Pus
Genital infections Neisseria gonorrhoeae
Herpes virus
Genital secretions
Anthrax Bacillus antracis Skin secretions
Meningitis Neisseria meningitidis Cerebrospinal fluid
AIDS HIV Blood
Hemorrhagic fevers Lassa, Ebola & Marburg
viruses
All bloody secretions
Septicemia Staphylococcus species Blood
Examples of infections that can be caused by exposure to health care waste are

15. 15
Type of infections Causative organism Transmission vehicles
Bacteremia
Coagulase –ve staph,
Staphylococcus aureus,
Enterobacteria,
Enterococcus, Klebsiella,
Streptococcus species
Blood
Candidaemia Candida albicans Blood
Viral Hepatitis A Hepatitis A virus Faeces
Viral Hepatitis B & C Hepatitis B & C viruses Blood and body fluids
Infection Risk of infection
HIV 0.3%
Hepatitis B 3%
Hepatitis C 3-5%
Risk of infection after needle puncture

16. • There is particular concern about infection with HIV and Hepatitis
viruses B & C, for which there is strong evidence of transmission via
health-care waste.
• The following is the documented evidence of HIV as occupational
infection recognized by CDC, Atlanta in 1994
32 from hypodermic injuries
1 from blade injury
1 from glass injury (broken glass from tube containing infected
blood)
1 from contact with non-sharp infectious items
4 from exposure of skin or mucous membrane to infected blood
16

17. • Pal D Chattopadhyay (1998) in their study at Calcutta
found that more than half of the disposable syringes
(56.3%) marketed in Calcutta are grossly contaminated
showing failure of the sterilization process. If such
unsterile articles are recycled and allowed in the market
without a proper check, it may lead to increased risk of
transmission of HIV and Hepatitis infection.
17

18. 18
• Quite often in hospitals, the placentae are thrown away in the
garbage without proper disinfection. Even placenta can be source
of HIV infection if the mother is HIV infected.
• It has been noticed that 8% of work slips belonging to patients
including investigational slips contains stains of blood, urine and
stool on them which are due to dispatch of samples along with
the investigation from ward to laboratory and back.
They can be a potential source of hospital acquired infection.

19. HAZARDS FROM CHEMICALS AND
PHARMACETICAL WASTE
• Chemicals and pharmaceuticals account for about 3% of
waste from health-care activities
• They may be toxic, genotoxic, corrosive, flammable,
reactive or explosive.
• Many drugs are hazardous.
19

20. • Disinfectants are particularly important members of this
group: they are used in large quantities and are often
corrosive.
20

21. • Open burning of health care waste and incineration of
plastics and hazardous materials will generate at least 75
hazardous chemicals as byproducts like oxides of sulphur &
nitrogen, carbon dioxide, suspended particulate matter,
dioxins and furans.
• Dioxins and furans are carcinogenic in nature, and the
other substances when inhaled by persons can cause
respiratory diseases.
21

22. Vaccine waste
• In June 2000 six children were diagnosed with a mild
form of smallpox (vaccinia virus) after having played with
glass ampoules containing expired smallpox vaccine
at a garbage dump in Vladivostok (Russia). Although the
infections were not life-threatening, the vaccine
ampoules should have been
treated before being discarded.
22

23. HAZARDS FROM GENOTOXIC WASTE
• Highly hazardous, mutagenic, teratogenic or carcinogenic, such as
cytotoxic drugs used in cancer treatment and their metabolites.
• Exposure to genotoxic substances in health care may occur during the
preparation of or treatment with particular drugs or chemicals.
• The main pathways of exposure are inhalation of dust or aerosols,
absorption through the skin, ingestion of food accidentally contaminated
with cytotoxic drugs, chemicals, or waste, and ingestion as a result of
bad practice, such as mouth pipetting.
23

24. • Exposure may also occur through contact with the bodily
fluids and secretions of patients undergoing
chemotherapy.
• They may also cause dizziness, nausea, headache, or
dermatitis.
24

25. • Many cytotoxic drugs are extremely irritant and have
harmful local effects after direct contact with skin or
eyes.
Ex: Alkylating agents (mitomycin, cisplatin), Vinblastine,
Doxorubicin etc.
25

26. • A study undertaken in Finland found a significant
correlation between fetal loss and occupational exposure
to antineoplastic drugs during the first three months of
pregnancy, but similar studies in France and the USA
failed to confirm this result.
26

27. HAZARDS FROM RADIOACTIVE
WASTE
• Occasionally, the public is exposed to radioactive waste,
which originates from radiotherapy treatment, that has
not been disposed of properly.
• Type & extent of exposure.
• Headache, dizziness and vomiting to much more
serious problems.
• As certain radioactive waste-genotoxic, it may also affect
genetic material.
27

28. • In 21 March–August 1962, a radiation accident in Mexico
City occurred when a ten-year-old boy took home an
unprotected radiography source. Four people died from
overexposure to radiation from a Co-60 capsule. Five other
individuals also received significant overdoses of radiation.
• Serious accidents have been documented in Brazil in 1988
(where four people died and 28 had serious radiation burns),
Mexico and Morocco in 1983, Algeria in 1978 and Mexico in
1962.
28

29. PUBLIC SENSITIVITY
• The general public is very sensitive to visual impact of health care
waste, esp. anatomical waste.
• Foul odour is emitted at the collection point if quick removal of the
wastes is not done along with spreading of the waste in the area
adjacent to local collection point due to activity of rag pickers.
• Sometimes body parts are found in trucks carrying the municipal
wastes from hospitals that result in investigative dilemmas for local
police.
• This affects sensibilities and sensitivities of the public.
29

30. 30

31. Risks associated with waste disposal
• Although treatment and disposal of health-care waste reduces risks, indirect
health risks may occur through the release of toxic pollutants into the
environment through treatment or disposal.
• Landfills can contaminate drinking-water if they not properly constructed.
Occupational risks exist at disposal facilities that are not well designed, run, or
maintained.
• Inadequate incineration or the incineration of unsuitable materials results in the
release of pollutants into the air and of ash residue.
• Incinerated materials containing chlorine can generate dioxins and furans ,
which are carcinogens.
• Incineration of heavy metals or materials with high metal content (in particular
lead, mercury and cadmium) can lead to the spread of toxic metals in the
environment.
31

32. Reference:
• Park’s Textbook of Preventive and Social Medicine, 22nd
Edition.
• Acharya D.B, and Singh Meeta. The Book of Hospital
Waste Management
• Khan F.M. Hospital Waste Management: Principles and
Guidelnes
32

33. 33