Proper management

1. MEDICAL WASTE
MANAGEMENT
IMELDA ASETRE-LUNA, M.D., DPPS, DPIDSP
Pediatrician – Infectious Disease Specialist
St. Luke’s Medical Center

2. OBJECTIVES
1. To provide an overview of the waste
management policies and practices
relevant to our setting with emphasis on
waste segregation
2. To inform the public on the risks
associated with handling of health care
wastes

3. Objectives…
3. To develop awareness on the health,
safety and environmental issues relating
to health care wastes

4. Health care waste (HCW)
Includes all waste generated by health care
establishments, research facilities, &
laboratories

5. Categories of health care waste
1. General waste
2. Infectious waste
3. Pathological waste
4. Sharps
5. Pharmaceutical waste
6. Genotoxic waste
7. Waste with high content of heavy metal
8. Pressurized container
9. Radioactive waste

6. Categories of health care waste
GENERAL WASTE
• Comparable to domestic waste
• Does not pose special handling
problems or hazards to human health or
to the environment
• Mostly from administrative &
housekeeping functions of health care
establishments, e.g., office paper, food
waste

7. Categories…
General waste…
• 75-90% of HCW
• Non-infectious wastes
• Should be dealt with by the municipal
waste disposal system

8. Categories…
INFECTIOUS WASTE
• Contains pathogens (bacteria, viruses,
parasites or fungi) in sufficient
concentration to cause disease in
susceptible hosts
• 10-15% of hospital waste
– Cultures & stocks of infectious agent
from laboratory work

9. Categories…
Infectious waste…
– Waste from surgery & autopsies on
patients with infectious diseases
– Waste from infected patients in
isolation wards
– Waste that has been in contact with
infected patients undergoing
hemodialysis

10. Categories…
Infectious waste…
– Infected animals from laboratories
– Any other instruments or materials that
have been contaminated by infected
persons or animals
– Pathological waste, sharps

11. Categories…
PATHOLOGICAL WASTE
• Human tissues or fluids (e.g., body parts,
blood or other body fluids, fetuses)

12. Categories…
SHARPS
• Needles, syringes, scalpels, saws,
blades, broken glass, infusion sets,
knives, nails, & other items that can
cause a cut or punctured wounds
• Considered as highly hazardous HCW

13. Categories…
PHARMACEUTICAL WASTE
• Expired, unused, spilt & contaminated
pharmaceutical products, drugs,
vaccines & sera that are no longer
required & need to be disposed of
appropriately

14. Categories…
GENOTOXIC WASTE
• Cytostatic drugs, vomitus, urine or feces
from patients treated with cytostatic
drugs, chemicals & radioactive materials
• Highly hazardous & may have
mutagenic, teratogenic or carcinogenic
properties

15. Categories…
CHEMICAL WASTE
• Discarded solid, liquid & gaseous
chemicals from diagnostic &
experimental work & from cleaning,
housekeeping & disinfecting procedures

16. Categories…
WASTE WITH HIGH CONTENT
OF HEAVY METAL
• Batteries, broken thermometers, blood
pressure gauges
• Subcategory of hazardous chemical
waste

17. Categories…
PRESSURIZED CONTAINERS
• Gas cylinders, gas cartridges, aerosol
cans

18. Categories…
RADIOACTIVE WASTE
• Waste containing radioactive substances
(e.g., unused liquids from radiotherapy or
lab research, contaminated glassware,
packages or absorbent paper, urine &
excreta from patients treated with
unsealed radionucleotides)

19. Persons at risk
1. Health care personnel
2. Laboratory workers
3. Waste workers
4. Substance abuser
5. General public

20. Impacts of health care waste

21. Diseases that can be transmitted through
needlestick injury
Infections from:
• Human immunodeficiency virus (HIV)
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)

22. Needlestick injuries
Risk of infection from patients with:
• HBV – 1:3 risk of transmission
• HCV – 1:30
• HIV – 1:300

23. Hazards
Chemical & pharmaceutical waste:
intoxication, burns
Genotoxic waste:
harmful effect on skin or eyes, dizziness,
nausea or headache
Radioactive waste:
reddening of skin, cancer induction,
genetic consequences

24. Waste handling, collection, storage
and transport

25. DOH Dept. Circular No. 156-C, 1993
All government hospitals, clinics,
laboratories and research offices shall
incorporate satisfactory segregation,
treatment, collection and disposal system.
All infectious and hazardous hospital wastes
shall be treated before storage, collection
and disposal.

26. DOH Dept. Circular No. 156-C…
All hospitals and other related institutions
shall inform their staff and personnel about
the proper waste segregation (color-
coding) and storage, collection and
disposal of hospital waste.

27. Waste segregation
• Process of separating different types of
wastes at the point of generation &
keeping them isolated from each other

28. Waste segregation…
• To promote recycling, reuse of resources
and to reduce the volume of waste for
collection and disposal
• Responsibility of the waste producer
• Should take place as close as possible to
where the waste is generated

29. Color coding scheme for containers
Black
Green
Yellow
Yellow with
black band
Orange
Red
- non-infectious dry waste
- non-infectious wet waste
- infectious & pathological waste
- chemical/heavy metal wastes
- radioactive waste
- sharps/pressurized containers

30. Waste disposal practices
Residuals of General HCW should join the
stream of domestic refuse or municipal
solid waste for proper waste management.

31. Waste disposal practices
Sharps should be collected at source of use
in puncture-proof containers (metal or
high-density plastic) with fitted
covers.
Containers should be rigid,
impermeable, & puncture-proof.
Container made of dense cardboard may be
a substitute.

33. Waste disposal…
Bags & containers for infectious waste
should be marked with the international
infectious substance symbol.

35. Waste disposal…
Cytotoxic waste mostly produced in major
hospitals or research facilities should be
collected in strong, leak-proof containers
labeled “cytotoxic waste.”
Microbiological laboratory waste should be
sterilized by autoclaving.

36. Waste disposal…
Large quantities of obsolete or expired
pharmaceuticals stored in hospital wards
should be returned to the pharmacy for
disposal.
Small amounts of chemical or pharma-
ceutical waste may be collected together
with infectious waste.

37. Waste disposal…
Waste with high content of heavy metals
(e.g., cadmium or mercury) should be
collected separately.
Large quantities of chemical waste should
be packed in chemical-resistant container
and sent to specialized treatment facilities.

38. Waste disposal…
Aerosol containers may be collected with
general HCW once they are completely
empty.
Aerosol containers should not be burnt or
incinerated.

39. Waste disposal…
Appropriate containers or bag holder should
be placed in all locations where particular
categories of waste may be generated.

40. Waste disposal…
Staff should never attempt to correct errors
of segregation by removing items from a
bag after disposal or by placing one bag
inside another bag of different color.
If general & hazardous wastes are
accidentally mixed, it should be classified
as hazardous HCW.

41. Segregation of HCW according to
types of waste and sources

42. RED
(Sharps & Pressurized containers)
• needles & syringes
• scalpel blades
• glass vials – tuberculin
/ insulin
• stylet
• capillary tubes
• ampules
• test tubes
• blood evacuation
tubes
• pipette slides / cover
slips
• aluminum cover
• blood lancets
• empty aerosol cans
• rusty pins, nails, clips
& screws
• broken glasses

43. • gauze, cotton
bandage, cotton
applicators soaked with
blood/body fluids from
dressing of infected
wounds and post
operative cases,
procedures such as
Pap’s smear,
immunization
• foreign bodies
removed from any body
parts
• placenta, umbilical
cord
• used gloves
• used foley catheters
• used tubing – IV,
nebulizer
YELLOW
(Infectious & Pathological wastes)

44. YELLOW
(Infectious & Pathological wastes)
• used diapers, sanitary
napkin
• used suction tubes
• used NGT
• used test strips
• used urine bags
• used drains – penrose
• used cord clamp
• used plaster
• empty colostomy bag
• used swabs
• heplock & ET tubes
• used tongue guard
• used oxygen tubing
• used gladwrap
• used mask / face
mask
• used thoracic tube

45. • used hemovac
• used sensor /
electrodes
• used bandages
• used rubber sheet
• used rubber tubing
• used CVP tubes
• used t-tubes
• used central lines
• used oxygen catheter
• amputated limbs, toes,
fingers, organs,
extracted tooth
• tissues from minor /
major operation
• specimen containers
of blood & body fluids
• used culture media,
tissue culture plate
YELLOW
(Infectious & Pathological wastes)

46. • used test strips
• used beads / plates
• used kit from
laboratory analyzer
• used reaction pads,
foils
• used plastic wares /
disposables
• used Hemoline
Diphasique
• used T & B cell
separator
• used tissue typing / x-
matching trays for
discards
• used filter
• used blood products
bags & tubing
YELLOW
(Infectious & Pathological wastes)

47. YELLOW WITH BLACK BAND
(Chemical & Pharmaceutical wastes)
• empty bottles of acids
– HCl, H2SO4, HNO3, etc.
• empty bottles of
betadine, iodine, KMNO3
• empty bottles of
laboratory reagents
(Formaline, Toluene,
Xylene)
• empty bottles / cans of
Kerosene, Acetone,
Alcohol, Anesthetic,
Lacquer
• empty bottles of
disinfectants
• busted Fluorescent
bulb
• defective thermometer

48. YELLOW WITH BLACK BAND
(Chemical & Pharmaceutical wastes)
• empty cans of glue,
epoxy & floor wax
• expired & adulterated
drugs & medicines
• used batteries

49. BLACK
(Non-infectious dry wastes)
• paper & paper
products
– used papers
– newspapers
– tetra packs, paper
cups
– boxes / cartons
• bottles
– glass & plastic
• packaging materials
– styropore
– aluminum
– plastic candy / food
wrapper

50. GREEN
(Non-infectious wet wastes)
• kitchen leftover food
• used cooking oil
• fish entrails, scale &
fins
• fruits & vegetable
peelings
• rotten fruits &
vegetables
• non-infectious leftover
foods

51. ORANGE
(Radioactive / Nuclear wastes)
• Iodine 125 (I-125)
• Iodine 131 (I-131)
• H3 – Thymidine
• Cesium 137
• Chromium 51
• Technetium 99m
• Iridium
• used x-ray films,
developers & fixers
• contaminated things
– gloves
– tissue papers
– cotton swabs
– aluminum foil
– gauze
– test tubes
– pipette tips
– repetitive syringes

52. Collection and transport of
health care waste

54. Collection & transport of HCW
• Waste should be collected daily (or as
frequently as required) & transported to
the designated central storage site.
• No bags should be removed unless they
are labeled with their point of production &
contents.
• Bags or containers should be replaced
immediately with new ones of the same
type.

55. Collection & transport…
• A supply of fresh collection bags or
containers should be readily available at
all locations where waste is produced.
• Collection practice for active solid
radioactive waste shall consist of
distributing orange color-coded suitable
containers with the radiation symbol.

56. Health care waste treatment
technology
(Non-incinerator treatment technology)

57. Purpose
To change the biological & chemical
characteristic of the waste to minimize its
potential to cause harm

58. Clean Air Act of 1999
• Prohibits the incineration of medical
wastes
• It promotes the use of state of the art,
environmentally sound & safe non-burn
technologies for handling, treatment,
thermal destruction, utilization & disposal
of sorted unrecycled biomedical &
hazardous waste.

59. Waste treatment technologies
A. Thermal process
B. Chemical disinfection
C. Biologic process
D. Radiation technology

60. A. Thermal process
1. Pyrolysis – thermal decomposition of
substance & materials in the absence of
supplied molecular O2 in the destruction
chamber in which the said material is
converted into gaseous, liquid or solid
form

62. A. Thermal process…
• Pyrolysis is suitable for bulk
chemotherapy waste, many hazardous
substances, spent solvents & chemicals,
expired pharmaceuticals, low-level
radioactive waste.

63. A. Thermal process…
2. Wet & dry thermal treatment – based on
exposure of shredded infectious waste to
high temperature, high pressure steam,
and similar to the autoclave sterilization
process
a. Autoclave
b. Microwave

64. AUTOCLAVE
• Uses steam sterilization to render waste
harmless & is an efficient wet thermal
disinfection process
• Cultures & stocks, sharps, materials
contaminated with blood, isolation &
surgery waste, laboratory waste, soft
waste (gauze, bandages, drapes, gowns,
beddings)

66. Autoclave…
• Volatile & semi-volatile organic
compounds, chemotherapeutic waste,
mercury, other hazardous chemical waste
& radiological waste SHOULD NOT be
treated in an autoclave.

67. Shredding
• Mechanical process done after
autoclaving
• To increase the contact of reducing agent
with the waste,
to decrease the volume of the treated
waste, and
to render the waste unrecognizable

68. B. Chemical disinfection
• Chemicals like aldehydes, chlorine,
phenolic compounds are added to waste
to kill or inactivate pathogens present in
HCW.
• Most suitable in treating blood, urine,
stool, & sewage

69. Waste disposal system
1. Sanitary landfill – an engineered method
to keep the waste isolated from the
environment
2. Safe burial on hospital premises
3. Septic or concrete vault – especially
suitable for the disposal of used sharps
& syringes

71. Basic steps in health care waste
handling

77. Advantages of good
health care waste management
1. Help control nosocomial disease,
complementing the protection effect of
proper handwashing
2. Reduce community exposure to multi-
drug resistant bacteria
3. Dramatically reduce HIV/AIDS sepsis
and hepatitis transmission from dirty
needles & other improperly cleaned/
disposed medical items

78. Advantages of good HCW management…
4. Control zoonoses (disease passed to
humans through insects, birds, rats &
other animals)
5. Cut cycles of infection
6. Easily and cost-effectively address
health care worker safety issues,
including reducing the risk of needlestick
injuries

79. Advantages of good HCW management…
7. Prevent illegal repackaging & resale of
contaminated needles
8. Avoid negative long-term health effects,
e.g., cancer from the environmental
release of toxic substances such as
dioxin, mercury & others

81. Thank you.