Healthcare Waste Management Concepts

1. Healthcare Waste Management
PULINA RANASINGHE
BSc (Mgt), Dip in PHI, Dip in Edu Sci.
Tutor Public Health Inspector
PHTC - Galle

3. Learning Outcomes
At the end of the session student should be able to,
 Define healthcare waste
 Describe categories of healthcare waste
 Explain management of health care waste
 Explain treatment of infectious waste
Describe regulations on health care waste management

4. Introduction
• Healthcare institutions are dispersed island-wide
(curative and preventive)
• Proper healthcare waste management is essential

5. Introduction cont.
• Healthcare waste can be divided into
– Non-hazardous general waste
– Hazardous waste
• Around 75-90% of the waste – Non-hazardous
• Around 10- 25% of the waste – Hazardous waste

6. Definitions..
Health-care waste
Health-care waste includes all the waste produced by a
medical institution (public or private), a medical research
facility or a laboratory. It can be divided into three
groups: non - risk health-care waste, hazardous health-
care waste and highly hazardous health-care waste.

7. Definitions..
Non-risk Health Care Waste
Non-risk HCW includes all the waste produced
by a medical institution that has not been
contaminated with potential infectious agents or
toxic products. It is similar to domestic waste
and can be managed with the municipal waste.

8. Definitions..
Hazardous Health Care Waste
Hazardous HCW includes all the waste produced by a
medical institution that has been contaminated with
a potential infectious agent or a toxic product. It
includes pathological, anatomical, pharmaceutical,
chemical waste, waste with high contents of heavy
metals and pressurized containers.

9. Definitions..
Highly Hazardous Health Care Waste
Highly hazardous HCW includes sharps, highly
infectious waste, genotoxic and radioactive
waste

10. Non-hazardous General Waste
• Food waste
• Garden waste
• Clean plastic/polythene
• Clean paper/cardboard
• Clean glass
• Mixed waste

11. Hazardous waste
1. Infectious waste
2. Sharps waste
3. Chemical waste
4. Pharmaceutical waste
5. Pathological waste

12. Hazardous waste
6. Genotoxic waste
7. Radioactive waste
8. Pressurized containers
9. Waste with high content of heavy metals
(cadmium, mercury, lead etc)
10.Electrical and electronic waste(E-waste)

13. Infectious waste
Infectious waste are a type of hazardous waste which
are suspected to contain pathogens in sufficient
concentration or quantity to cause disease in
susceptible hosts.

14. Infectious waste
 blood and blood products
 items contaminated with blood and
body fluids
(e.g. dressings, cotton swabs, drip sets)
 microbiological cultures and items
contaminated with microorganisms
 excreta and clinical specimens

15. Sharps waste
Sharps generated at healthcare institutions are
also infectious and a part of hazardous waste.
Ex;
Used or unused needles
Syringes
Cannulas
Scalpel blades/ razors
Contaminated broken glass

16. Chemical waste
Solid, liquid and gaseous chemicals, used for
diagnostic work and disinfection procedures
which are either toxic, corrosive, flammable,
reactive or genotoxic.

17. Pharmaceutical Waste
Expired, unused drugs, vaccines, bottles or
boxes with drug residues, used connecting
tubing and drug vials.

18. Pathological Waste
 Any substance which contains visible blood, semen,
vaginal secretions, cerebrospinal fluid
 Human tissues, organs, body parts, similar waste
from surgical biopsies and autopsies

19. Genotoxic Waste
Drugs, vomits, urine, or faeces from patients
treated with cytotoxic drugs.

20. Radioactive Waste
• Solid, liquid, and gaseous materials
contaminated with radionuclides
• Body fluids of patients undergoing radiation
therapy

21. Pressurized Containers
Pressurized cylinders, cartridges, and aerosol
cans.

22. Waste With High Content Of Heavy
Metals
Mercury in thermometers and
sphygmomanometers.

23. Electrical And Electronic Waste
Computers, microscopes, lab analyzers, and
more specialized medical equipment like
sphygmomanometers, electrocardiograms, and
spectrophotometers.

24. Management of Health Care Waste
1. Minimisation
2. Segregation
3. Collection
4. Labelling
5. Transportation
6. Storage
7. Treatment
8. Disposal

25. Waste Minimisation
Minimisation is an important step in the management
of HCW.
• Optimal stock management practices
• Modification of purchasing procedures
• Control of inventory
• Production of less toxic materials
• Safe reuse and recycling procedures

26. Waste Segregation
• Segregation at the point of waste generation is
important.
• National colour code for the segregation of Hospital
waste General Circular no 01-12/2006

27. Waste Segregation Colour Code

29. Waste Collection
• Collecting waste on a regular schedule from
each ward/unit
• Specially designed carts
• Waste bins:
Waste bins should be strong, durable and foot-
operated with well-fitting lids.
• Waste bags:
75 microns/300 gauged, leak-proof strong plastic
bag should be labeled to identify the source

30. Labelling
Must be labeled according to national guidelines

31. Storage
• Must have Sufficient storage space.
• Easily accessible to the sanitary staff.
• Instructions for segregation and handling should be
displayed.
• Radioactive waste should be stored in specifically as
stipulated.

32. Transportation
If any health institution is using a vehicle to transport
healthcare waste it should be specially designed as per
the guidelines stipulated by CEA for transportation of
hazardous waste with a valid hazardous waste
transportation license.

33. Treatment and Disposal
• Stream sterilization / Steam autoclave
• Deep burial
• Chemical disinfection
• Microwaving
• Incineration
• Disposal at a secure landfill

34. Treatment and Disposal
• Inertization
• Encapsulation
• Radioactive waste treatment
• Amputation
• Cytotoxic drugs
• Placenta

35. Stream sterilization / Steam autoclave
• Waste is added to a large
autoclave where a
combination of heat and
pressure sterilizes the
waste.
• Various commercial
models are available.
• In some countries locally
made autoclaves are
available.

36. Waste Burial
Pit sides covered with a low permeability material,
covered and fenced. The pit should be sealed with
cement once it is full or at least the last 50cm should be
filled with compacted soil and the area identified.

37. Chemical disinfection
Treatment of wastes
with chemical
disinfectants
e.g. bleach (sodium
hypochlorite 1%
solution)

38. Microwaving
Micro organisms are destroyed by the action of
microwaves that rapidly heat the water
contained within the wastes.

39. Incineration
• Low Temperature burning
(< 400°C)
• Medium Temperature burning
(800 – 1000°C)
• High Temperature burning
(> 1000C°)
• Rotary Kiln - High T° burning
(1200 – 1600 °C)

40. Low Temperature burning (< 400°C)
Open air burning of waste in pits, drums, open -
brick enclosures on the ground, single chamber
incinerator. Waste residues and ashes are
buried.

41. Medium Temperature burning
(800 – 1000°C)
• Relatively high-temperature burning (i.e. above
800°) reduces combustible waste to
incombustible matter and results in a very
significant reduction of waste volume and
weight. E
• Ensure full combustion and sterilization of used
needles. Incineration produces a small amount
of ash and waste material that must be buried.

42. High Temperature burning
• Incineration
– High Temperature burning (> 1000C°)

43. Rotary Kiln
A rotating oven with a post - combustion
chamber. High Temperature burning
(1200 – 1600 °C)

44. Disposal at a secure landfill
• Landfills are specifically designed to prevent wastes
from contaminating the environment.
• Public access to the landfill is restricted.
• Trained staff manages the wastes at the site.
• Landfill is a supervised facility as opposed to as open /
unregulated dumping of wastes.

45. Inertization
Mixing of waste with cement before disposal in
order to minimize the risk of leakage of toxic
substances contained in the waste

46. Encapsulation
• Store in High-density plastic containers or metal
drums - full safety boxes or disinfected needles
• When the containers are full, an immobilizing
material such as plastic foam, sand, cement or clay is
added.
• Once dry the containers are sealed and disposed of
in landfill sites or waste burial pits.

47. Radioactive waste treatment
• Foot operated waste collection bins with
disposable polythene lining – Solid
• polythene carboys for liquid waste
• Glassware should be avoided
• Incineration
– High Temperature burning (> 1000C°)
– Rotary Kiln - High T° burning (1200 – 1600 °C)
• Buried in exclusive burial sites approved by the
competent authority

48. Cytotoxic drugs
• Incineration
– High Temperature burning (> 1000C°)
– Rotary Kiln - High T° burning (1200 – 1600 °C)

49. Amputation / Placenta
• Incineration
– Med T° burning (800 – 1000°C)
– High T° burning (.> 1000C°)
– Rotary Kiln - High T° burning (1200 – 1600 °C)
• Waste Burial – Small quantities

50. Cemented sharp pit
• Pit well covered with a
narrow access for sharps.
• Should be filled with
cement once full.