a description on Health Care Waste management

1. Health Care Waste
Definition, Classification
Hazards
Management
Presented by:
Ujwal Gautam (for)
Group C, (Roll no. 417-431)
BDS 2009, BPKIHS

2. Health Care Waste
Health care waste (HCW) is defined as the total
waste stream from a healthcare facility (HCF).
According to Bio-Medical Waste (Management and
Handling) Rules, 1998 of India “Bio-medical waste”,
“any solid, fluid or liquid waste, including its
container and any intermediate product, which is
generated during the diagnosis, treatment or
immunization of human beings or animals, in
research pertaining there to, or in the production or
testing of biological and the animal waste from
slaughter houses or any other like establishments”.

3. Types of waste
As per WHO, the biomedical wastes could be classified into eight categories
on the basis of the type of waste and the risk of transmission of infectious
material in them.
i. General waste (domestic)
ii. Pathological: recognizable body parts and contaminated animal
carcasses;
iii. Radioactive: such as glassware contaminated with radioactive
diagnostic material or radiotherapeutic materials;
iv. Chemical: for example mercury, solvents and disinfectants;
v. Infectious: waste contaminated with blood and its by-products,
cultures and stocks of infectious agents, waste from patients in
isolation wards, discarded diagnostic samples containing blood and
body fluids, infected animals from laboratories, and contaminated
materials (swabs, bandages) and equipment (such as disposable
medical devices);
vi. Pharmaceutical wastes: expired, unused, and contaminated drugs;
vaccines and sera;
vii. Sharps: syringes, needles, disposable scalpels and blades, etc.;
viii. Pressurised containers.

5. Types of hazards-
• The hazardous nature of health-care waste may
be due to one or more of the following
characteristics:
¥ it contains infectious agents;
¥ it is genotoxic;
¥ it contains toxic or hazardous chemicals or
pharmaceuticals;
¥ it is radioactive;
¥ it contains sharps

6. Risk group-
• medical doctors, nurses, health-care auxiliaries,
and hospital maintenance personnel;
• patients in health-care establishments or
receiving home care;
• visitors to health-care establishments;
• workers in support services allied to health-care
establishments, such as laundries, waste
handling, and transportation;
• workers in waste disposal facilities (such as
landfills or incinerators), including scavengers.

7. Methods of Health Care Waste disposal
The management of Health Care Waste involves:
 Health Care Facilities (HCFs) that generates
the waste;
 service providers who collect the waste
from the healthcare facilities and transport
it to the treatment facilities;
 treatment facilities that process the waste
to make it safe for final disposal.

8. Principles of Management:
1. Duty of care principle
2. Polluter pays principle
3. Precautionary principle
4. Proximity principle

9. Principles of Management:
1. Duty of care principle
This principle stipulates that any organisation
that generates waste has a duty to dispose of
the waste safely. Therefore it is the Health Care
Facilities that has ultimate responsibility for how
waste is containerized, handled on-site and off-
site and finally disposed of.

10. Principles of Management:
2. Polluter pays principle
According to this principle all waste producers are legally and
financially responsible for the safe handling and
environmentally sound disposal of the waste they produce. In
case of an accidental pollution, the organisation is liable for
the costs of cleaning it up. Therefore if pollution results from
poor management of health-care waste then the HCF is
responsible. However, if the pollution results because of poor
standards at the treatment facility then the HCF is likely to be
held jointly accountable for the pollution with the treatment
facility. Likewise this could happen with the service provider.
The fact that the polluters should pay for the costs they
impose on the environment, is seen as an efficient incentive
to produce less and segregate well.

11. Principles of Management:
3. Precautionary principle
Following this principle one must always assume
that waste is hazardous until shown to be safe.
This means that where it is unknown what the
hazard may be, it is important to take all the
necessary precautions.

12. Principles of Management:
4. Proximity principle
This principle recommends that treatment and
disposal of hazardous waste take place at the
closest possible location to its source in order to
minimize the risks involved in its transport.
According to a similar principle, any community
should recycle or dispose of the waste it
produces, inside its own territorial limits.

13. System dynamics model for hospital
waste management in a developing
country
System dynamics
was introduced by
Jay Forrester in
the 1960s at the
Massachusetts
Institute of
Technology as a
modeling and
simulation
methodology.

14. Causal loop diagram of hospital waste management model
The above mentioned casual loop is the application of System
dynamics in the Hospital Waste Management

15. Having defined the key elements, the core
elements contained in this model are mentioned
below;
o Population
o Health expenditure
o Health risks
o Waste generation
o Municipal solid Waste
o Infectious Waste treatment

16. Steps for a Health Care Waste
Management
i. Raise awareness
ii. Define a policy
iii. Set up a strategy
iv. Conduct an assessment of the current situation
v. Draft a HCWM plan
vi. Consolidate the legal & regulatory frameworks
vii. Standardise HCWM practices
viii. Strengthen the institutional capacities
ix. Set up waste management plans

17. Steps in Health Care Waste disposal:
1. Waste minimization
aims at reducing as much as possible the amount of
HCW that will be produced
2. HCW generation
The point at which waste is produced.

18. 3. Segregation and containerization
• clear identification of the different categories of
waste is must and the separate disposal of the
waste in accordance with the categorization
chosen.
• Segregation must be done at the point of
generation of the waste.
• To encourage segregation at source, (reusable)
containers or baskets with colour coding is done.
• When they are 3/4 full, the liners are closed with
plastic cable ties or string and placed into larger
containers or liners at the intermediate storage
areas.
• Suitable latex gloves must always be used when
handling infectious waste.

19. Color Coding For Segregation Of
Biomedical Waste
Colour coding of polyethylene bag Type of waste material
Black Non-infectious and non-hazardous waste
Red Microbiological waste from pathological
laboratory, items contaminated with blood
and body fluids, and
waste generated from disposable items other
than sharps, etc
Yellow Human anatomical waste, microbiological
waste from pathological laboratory, items
contaminated with blood and body fluids,
and waste generated.
Blue Waste sharps, tubing etc.

20. 4. Intermediate storage (in the HCF)
• must be collected on a regular daily basis.
• should both be close to the wards and not
accessible to unauthorized people such as
patients and visitors.

21. 5. Internal transport (in the HCF)
• Transport to the central storage area is usually
performed using a wheelie bin or trolleyshould
be marked with the corresponding coding color.
• The transport of general waste must be carried
out separately from the collection of healthcare
risk waste (HCRW) to avoid potential cross
contamination or mixing of these two main
categories of waste.
• The collection should follow specific routes
through the HCF to reduce the passage of loaded
carts through wards and other clean areas.

22. 6. Centralized storage (in the HCF)
• should be sized according to the volume of waste
generated as well as the frequency of collection.
should not be situated near to food stores or
food preparation areas
• its access should always be limited to authorized
personnel.
• should also be easy to clean, have good lighting
and ventilation, and be designed to prevent
rodents, insects or birds from entering.
• should also be clearly separated to avoid cross-
contamination.
• Storage time should not exceed 24-48 hours
especially in countries that have a warm and
humid climate.

23. 7. External transport
• should be done using dedicated vehicles, shall be
free of sharp edges, easy to load and unload by
hand, easy to clean / disinfect, and fully enclosed
to prevent any spillage in the hospital premises or
on the road during transportation.
• transportation should always be properly
documented and all vehicles should carry a
consignment note from the point of collection to
the treatment facility.

24. 8. Treatment and final disposal
There are two different ways of final disposal at a
facility: Burn and Non-Burn techniques.
A. Non-burn techniques
B. Burn technique

25. A. Non-burn techniques:
 Burying solid medical waste: To use the burial method of
waste disposal there must be enough space available to dig a burial
pit and to enclose it in a fence or a wall. When burying solid medical
waste, adhere to the following guidelines:
• Burial should be at least 50 meters from the nearest water
source, located downhill from any wells, free of standing
water, and in an area that does not flood.
• Burial pit should be 1-2 meters wide and 2-5 meters deep.
The bottom of the pit should be at least 1.8 meters above
the water table.
• Erect a fence or a wall around the site to keep out animals.
• Every time solid medical waste is added to the pit, cover it
with 10-30 cm of dirt.
• When the level of waste reaches to within 30cm of ground
level, fill the pit with dirt, seal it with concrete, and dig a
new pit.

26.  Chemical disinfection Technology: It uses chemicals to destroy
pathogenic organisms from any inanimate object.
● Sharps contaminated with blood and body fluids.
● Instruments, equipment that are used to cut, pierce or enter the
natural orifices like needles, syringes and endoscopes
● Contaminated floors, surfaces, clothes, beds, beddings, enamel,
crockery and bed pans
● Wet mopping of intensive care units, operation theatres, wards
and patient waiting areas.

27. B. Burn technique: Incineration of solid medical
waste Incinerating is the best option for solid waste
disposal, since the high temperature (1300 °C)
destroys microorganisms and reduces the amount
of waste. Burning in an incinerator or oil drum is
recommended. Facilities that generate low levels of
solid medical waste can use a small drum
incinerator. A drum incinerator can be made from a
200 liter or 55 gallon oil drum.
• Burn only medical waste to minimize the amount of
waste to be burned.
• Use kerosene as an accelerant.
• To avoid an explosion add kerosene before ignition.
• Treat ash from incineration as general waste and
dispose of it properly.
• Liquid medical waste should be buried.

28. Liquid medical waste can be poured down a sink, drain, and
flushable toilet. If none of these are available, in a pit. Points
to be considered while disposing of liquid medical waste:
o Always wear heavy utility gloves and shoes when handling or
transporting liquid medical waste.
o Afterwards, wash both gloves and shoes.
o Consider where the sink, drain or toilet empties.
o It is hazardous to have medical waste flowing through open
gutters or emptying onto the grounds of the facility.
o When carrying or disposing of liquid medical waste, avoid
splashing the waste on yourself, on others or on surfaces.
o After disposal rinse the sink, drain, or toilet to remove
residual waste, being careful to avoid splashing.
o Clean the fixture with a disinfectant solution at the end of
each day or more often if heavily soiled.
o Decontaminate the container that held the liquid medical
waste by filling it with a 0.5% chlorine solution and leaving it
for 10 minutes before washing.

29. ADA Best Management Practices for Amalgam Waste
DON’T
DOs  Don’t use bulk mercury
 Do use precapsulated alloys  Don’t put used disposable
and stock a variety of capsule amalgam capsules in biohazard
sizes containers, ninfectious waste
 Do recycle used disposable container (red bags) or regular
amalgam capsules garbage.
 Do salvage, store and recycle  Don’t put non-contact amalgam
non-contact amalgam waste in biohazard containers,
(scrap amalgam) infectious waste containers (red
 Do salvage (contact) amalgam bags) or regular garbage
pieces from  Don’t put contact amalgam waste in
restorations after removal biohazard containers,
and recycle the amalgam infectious waste containers (red
waste bags) or regular garbage
 Do use chair-side traps,  Don’t rinse devices containing
vacuum pump filters and amalgam over drains or sinks
amalgam separators to retain  Don’t dispose of extracted teeth
amalgam and recycle their
that contain amalgam
contents.
restorations in biohazard
 Do recycle teeth that contain containers, infectious waste
amalgam restorations.
containers (red bags), sharps
 Do manage amalgam waste containers or regular garbage
through recycling as much as  Don’t flush amalgam waste down
possible
the drain or toilet

30. WHO recommendations:
duty of care
all associated with financing and
supporting health-care activities should
provide for the costs of managing health-
care waste

31. Governments should:
• allocate a budget to cover the costs of
establishment and maintenance of sound
health-care waste management systems
• request donors, partners and other sources of
external financing to include an adequate
contribution towards the management of waste
associated with their interventions
• implement and monitor sound health-care waste
management systems, support capacity building,
and ensure worker and community health.

32. Donors and partners should:
• include a provision in their health program
assistance to cover the costs of sound healthcare
waste management systems.

33. Non-governmental organizations should:
• include the promotion of sound health-care
waste management in their advocacy
• undertake programs and activities that
contribute to sound health-care waste management.

34. The private sector should:
• take responsibility for the sound management
of health-care waste associated with the
products and services they provide, including
the design of products and packaging.

35. All concerned institutions and organizations
should:
• promote sound health care waste management
• develop innovative solutions to reduce the
volume and toxicity of the waste they produce
and associated with their products
• ensure that global health strategies and
programs take into account health-care waste
management.

36. ..International agreements
1. The Basel Convention
This convention is a global agreement, ratified by some 178
member countries to address the problems and challenges posed
by hazardous waste.
The key objectives of the Basel Convention are:
• to minimize the generation of hazardous wastes in terms
of quantity and hazardousness;
• to dispose of them as close to the source of generation as
possible;
• to reduce the movement of hazardous wastes.
A central goal of the Basel Convention is “environmentally sound
management” (ESM), the aim of which is to protect human
health and the environment by minimizing hazardous waste
production whenever possible.
2. The Stockholm Convention on Persistent Organic Pollutants
This Convention is a global treaty to protect human health and
the environment from persistent organic pollutants (POPs).

37. References
M. Tsakona, E. Anagnostopoulou, E. Gidarakos, Hospital waste management and
toxicity evaluation: A case study, Waste Management, Volume 27, Issue 7,
2007, Pages 912-920, ISSN 0956-053X, 10.1016/j.wasman.2006.04.019.
(http://www.sciencedirect.com/science/article/pii/S0956053X06001541)
Mochammad Chaerul, Masaru Tanaka, Ashok V. Shekdar, A system
dynamics approach for hospital waste management, Waste Management,
Volume 28, Issue 2, 2008, Pages 442-449, ISSN 0956-053X,
10.1016/j.wasman.2007.01.007.
(http://www.sciencedirect.com/science/article/pii/S0956053X07000360)
M Manzurul Hassan, Shafiul Azam Ahmed, K Anisur Rahman, and Tarit
Kanti Biswas, Pattern of medical waste management: existing scenario in
Dhaka City, Bangladesh, BMC Public Health. 2008; 8: 36.
Published online 2008 January 26. doi: 10.1186/1471-2458-8-36
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254398/?tool=pmcentr
ez)

38. ….References
K. Park, Park’s Textbook of Preventive and Social Medicine, 20th Ed., M/s
Banarsidas Bhanot Publishers- Jabalpur (India), 2009
World Health Organization, WHO core principles for achieving safe and
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