Public health care

Question 5: Enumerate the concept of Bio-medical

Waste:

An average of 1-2 kg of waste is generated per bed per day in a hospital in

India while the hospital in the western countries produces 3-5 kg
respectively. It is estimated that annually about 0.33 million tones of bio-
medical waste is generated in the country. The improper management of bio-
medical waste causes serious environment problems in terms of air, water
and land pollution. Environment problems can arise due to the mere
generation of bio-medical waste and from the process of handling, treatment
and disposal. A study conducted by the WHO in 1996, reveals that more
than 50,000 people die everyday from infectious disease. One of the causes
for the increase in infectious disease is improper waste management.

Definition:

According to Bio-medical Waste (Management and Handling) Rules, 1998

of India, ”Bio-medical waste” means any waste, which is generated during
the diagnosis, treatment or immunization of human beings or animals or in
research activities pertaining thereto or in the production or testing of
biological, and including categories as mentioned in schedule I .

Between 75-90% of the waste produced by the health care providers is non
risk or general health-care waste, comparable to domestic waste. It comes
mostly from administrative and house keeping functions of the health-care
establishment, and may also include waste generated during maintenance of
health-care premises. The remaining 10-25% health-care waste is regarded
as hazardous and many create a variety of health risk.

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Classification of health-care waste

Waste category Description and examples

Infectious waste Waste suspected to contain pathogens e.g. laboratory
cultures; waste from isolation wards; tissues(swabs),
materials, or equipments that have been in contact
with infected patients; excreta
Pathological waste Human tissues or fluids e.g. body parts; blood and
other body fluids; fetuses
Sharps Sharp waste e.g. needles; infusion sets; scalpels;
knives; blades; broken glass
Pharmaceutical Waste containing pharmaceuticals e.g.
waste pharmaceuticals that are expired or no longer needed;
items contaminated by or containing
pharmaceuticals(bottles, boxes)
Genotoxic waste Waste containing substances with genotoxic
properties e.g. waste containing cytotoxic drugs
(often used in cancer therapy); genotoxic chemicals
Chemical waste Waste containing chemical substances e.g. laboratory
reagents; film developer; disinfectants that are
expired or no longer needed; solvents
Wastes with high Batteries; broken thermometers; blood-pressure
content of heavy gauges; etc
metals
Pressurized Gas cylinders; gas cartridges; aerosol cans
containers
Radioactive waste Waste containing radioactive substances e.g. unused
liquids from radiotherapy or laboratory research;
contaminated glassware, packages, or absorbent
paper; urine and excreta from patients treated or
tested with unsealed radionuclides; sealed sources

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Sources of health-care waste:

The institutions involved in generation of bio-medical waste are:
- Government hospitals
- Private hospitals
- Nursing homes
- Physician’s office/clinics
- Dentist’s office/clinics
- Dispensaries
- Primary health centres
- Medical research and training establishments
- Mortuaries
- Blood banks and collection centres
- Animal houses
- Slaughter houses
- Laboratories
- Research organizations
- Vaccinating centres
- Bio-technology institutions/ production units

All these health-care establishments generate waste and are therefore

covered under Bio-medical Waste (BMW) Rules (1).

Health hazards of health-care waste:

Exposure to hazardous health-care waste can result in disease or injury due
to one or more of the following characteristics:
(a) it contains infectious agents;
(b) it contains toxic or hazardous chemicals or pharmaceuticals;
(c) it contains sharps;
(d) it is genotoxic; and
(e) it is a radio-active

All individuals exposed to such hazardous health-care waste are potentially

at risk, including those who generate the waste or those who either handle
such waste or are exposed to it as a consequence of careless management.
The main groups at risk are:
- medical doctors, nurses, health-care auxiliaries, and hospital
maintenance personnel;

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- patients in health-care establishments;

- visitors to health-care establishments;
- workers in support service allied to health-care establishments
such as laundries, waste handling and transportations; and
- Workers in waste disposal facilities such as land fills or
incinerators including scavengers.

1. Hazards from infectious waste and sharps

Pathogens in infectious waste may enter the human body through a

puncture, abrasion or cut in the skin, through mucous membranes by
inhalation or by ingestion. There is particular concern about infection
with HIV and hepatitis virus B and C, for which there is a strong
evidence of transmission via health-care waste. Bacteria’s resistant to
antibiotics and chemical disinfectants may also contribute to the
hazards created by poorly managed waste.

Hazards from chemical and pharmaceutical waste

Many of the chemicals and pharmaceuticals used in health-care

establishments are toxic, genotoxic, corrosive, flammable, reactive,
explosive or shock-sensitive. Although present in small quantity they
may cause intoxication, either by acute or chronic exposure, and
injuries, including burns. Disinfectants are particularly important
members of this group. They are used in large quantities and are often
corrosive, reactive chemicals may form highly toxic secondary
compounds.

Hazards from genotoxic waste

The severity of the hazards for health-care worker responsible for

handling or disposal of genotoxic waste is governed by a combination
of the substance toxicity itself and the extent and duration of
exposure. Exposure may also occur during the preparation of or
treatment with particular drug or chemical. The main pathway of
exposure is inhalation of dust or aerosols, absorption through the skin,
ingestion of food accidentally contaminated with cytotoxic drugs,
chemicals or wastes etc.

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Hazards from radioactive waste

The type of disease by radioactive waste is determined by the type and

extent of exposure. It can range from headache, dizziness and
vomiting to much more serious problem. Because it is genotoxic, it
may also affect genetic material.

Public sensitivity

Apart from health hazards, the general public is very sensitive to

visual impact of health-care waste particularly anatomical waste.

Steps of Hospital Waste Management:

Broadly speaking the steps of Hospital Waste Management can be

considered as follows:
1. Assign responsibilities
2. Develop a waste management plan and
3. Implement a waste management plan.

The head of the hospital should form a waste management team (WMT) to
develop a waste management plan. The staff involves are typically:

1. Head of Hospital ( as chairperson)

2. Head of Hospital Departments
3. Infection Control Officer
4. Chief Pharmacist
5. Radiation Officer
6. Matron (or Senior Nursing Officer)
7. Hospital Manager
8. Hospital Engineer
9. Financial Controller

A Waste Management Officer (WMO) with overall responsibilities for the

development of the hospital waste management plan and for the subsequent
day to day operation and monitoring of the waste disposal system should be
appointed.

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Basic Principles of Hospital Waste Disposal System:

Waste Minimization
Waste Segregation
Waste Transportation
Waste Treatment
Waste Disposal

The management principles are based on the following aspects:

• Reduction of waste by controlling inventory, waste of consumable

item, reagents, breakage, etc/
• Segregation of different types of waste into different categories
according to their treatment/disposal options given in schedule I of the
rules mentioned below.
• Segregated collection and transportation to onsite/offsite and then
final treatment/ disposal facility so that they do not get mixed.
• Proper treatment and final disposal as indicated in rules.
• Safety of handling, full care/ protection against operational hazard for
personnel at each level.
• Proper organization and management.
• Recycle of waste (with caution) wherever possible such as recycling
of glass after cleaning and disinfection, paper, corrugated cardboard,
aluminium, X-ray film, reclaimed silver from X-ray film.

Biomedical waste shall be treated or disposed of as follows:

• Pathological waste shall be incinerated or interred.

• Discarded blood, blood products and body fluids shall be: Incinerated;
Discharged through a sewer to a publicly owned treatment works
(POTW) provided that it is discharged in accordance with the local
ordinances
• All other biomedical waste shall be incinerated.
• All incineration of biomedical waste shall be in a licensed biomedical
waste incinerator.

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Packaging

• Biomedical waste shall be properly packaged to assure effective

containment throughout the handling, storage, transport, treatment,
and disposal processes.
• Biomedical wastes, other than sharps and bulk liquids, shall be
packaged in bags that are impervious to moisture and have a strength
sufficient to resist ripping, tearing or bursting under normal conditions
of usage and handling.
• All bags containing biomedical waste shall be red in color and
imprinted with the international biohazard symbol and the words
"biomedical waste" or "infectious waste." Waste in red bags shall be
considered biomedical waste and shall be managed as biomedical
waste.
• Bags shall be sealed by forming a secure closure that results in a leak-
resistant seal.
• Discarded sharps shall be segregated from other biomedical waste at
the point of generation. Discarded sharps shall be placed directly into
leak-resistant, rigid, puncture-resistant containers without clipping or
breaking. These containers shall be taped closed or tightly lidded to
preclude loss or leakage of contents. After proper packaging, sharps
containers may be placed in biomedical waste bags.
• Discarded bulk blood and other liquids which is to be transported off-
site shall be packaged in tightly stoppered, unbreakable flasks or
bottles.
• All biomedical waste bagged, sharps containerized, and bulk liquids
containerized in accordance with the regulations, that are to be
transported off-site shall also be packaged for storage or handling by
placement in disposable corrugated fiberboard boxes or equivalent
rigid containers such as reusable pails, cartons, drums, or portable
bins. The box or container shall be leak-resistant or lined with a bag
which is impervious to moisture and has a 200-pound burst strength as
measured by the industry's Mullen test.
• Reusable containers used for the handling of biomedical waste shall
be thoroughly washed and disinfected each time they are emptied
unless the surfaces of the containers have been effectively protected
from contamination by disposable liners, bags or other devices that
are removed and disposed of with the waste. *A red bag may not be
enclosed in a bag of another color.

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• Reusable containers used for the handling of biomedical waste shall

not be used for containment of waste to be disposed of as non-
biomedical waste or for any other purpose except after being
disinfected.

Labeling

Biomedical waste to be transported off-site shall be labeled immediately

after packaging in accordance with the regulations. The label shall be
securely attached to the outer layer of packaging and be clearly legible.
Indelible ink shall be used to complete the information on the label, and the
label shall be at least three inches by five inches in size. The following
information shall be included on the label.

Handling

Packages of biomedical waste shall be handled in a manner that does not

impair the integrity of the packaging.

Storage

• Biomedical waste shall be segregated from other wastes.

• All on-site storage of containers of biomedical waste shall be in a
designated area away from general traffic flow patterns and, where
possible, in a room reserved for this purpose. The manner of storage
shall prevent access to or contact with such waste by unauthorized
persons.
• Biomedical waste shall be stored in a manner that preserves the
integrity of the container and is not conducive to rapid microbial
growth and/or putrefaction. Pathological waste, cultures, and
discarded animal carcasses and body parts stored for more than 24
hours after packaging shall be refrigerated at a temperature of 45 F
or below in a refrigerator or refrigerated space used only for
biomedical waste.
• All areas used for the storage of biomedical waste shall be capable of
being readily maintained in a sanitary condition.
• All biomedical waste containers must be stored in a manner that
allows access for inspection.

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• Biohazard signs shall be posted wherever biomedical waste is stored

or contained, including on storage rooms doors, refrigerators, bins and
other containers.

Transport

• Biomedical waste shall not be compacted or subjected to violent

mechanical stress during transport.
• Biomedical waste shall not be transported in the same vehicle with
other waste unless the biomedical waste is separately contained in
rigid reusable containers or kept separate by barriers from other waste,
or unless all of the waste is to be treated and disposed of as
biomedical waste in accordance with this rule.

Bio-medical rules, 1998 (Amended in 2000)

SCHEDULE-1
CATEGORIES OF BIO-MEDICAL WASTE:

Categ- Type of Waste Treatment and

ory Disposal Option
Cat. 1 Human Anatomical Wastes Incineration/
(Human tissues, organs, body parts) deep burial
Cat. 2 Animal Wastes Incineration/
(Animal tissues, organs, body parts, deep burial
carcases, bleeding part, fluid, blend and
experimental animals used in research,
waste generated by veterinary hospitals)
Cat. 3 Microbiology and Bio-technology waste Local/autoclaving/
(Waste from laboratory cultures, stocks or Micro-waving/
specimens of micro-organisms, live or Incineration
attenuated vaccines, human and animal
cell culture used in research and industrial
laboratories, waste from biological
production, toxins, dishes and devices
used to transfer cultures)

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Cat. 4 Waste sharps Disinfection(chemical)

(Needles, syringes, scalpels, blades, glass /autoclaving/
etc. that are capable of causing puncture microwaving and
and cuts. This includes both used and multilation / shredding
unused sharps)
Cat. 5 Discarded medicines and Cytotoxic Drugs Incineration/
(waste comprising of outdated, Destruction
contaminated and discarded drugs and and disposal in land
medicines) fills
Cat. 6 Solid Wastes Incineration/
(Items contaminated with blood and body autoclaving/
fluids including cotton, dressings, soiled micro-waving
plaster, lines, bedding, other materials
contaminated with blood)
Cat. 7 Solid Wastes Disinfection by
(Waste generated from disposable items chemical treatment/
other than the waste sharps such as tubing, autoclaving/
catheters, IV sets etc.) microwaving and
multilation/ shredding
Cat. 8 Liquid Waste Disinfection by
( waste generated from laboratory and chemical and
washing, cleaning, house-keeping and discharge into drains
disinfecting activities)
Cat.9 Incineration ash Disposal in municipal
(ash from incineration of any bio-medical land fills
wastes)
Cat. 10 Chemical waste Chemical treatment
(Chemicals used in biological production, and discharge into
chemicals used in disinfection such as drains for liquid and
insecticides, etc.) secured land fills for
solids.
@@ Chemicals treatment using at least 1% hypochlorite solution or any
other equipment chemical reagent. It must be ensured that chemical
treatment ensures disinfection.
## Mutilations/shredding must be such so as to prevent unauthorized
reuse.
@ There will be no chemical pretreatment before incineration.
Chlorinated plastics shall not be incinerated.
• Deep burial shall be an option available only in towns with population
less than five lakh and in rural areas.

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• SCHEDULE-II

COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL

OF BIO-MEDICAL WASTES

Colour Type of Container-I Waste Treatment options as per

Coding Category Schedule I
Yellow Plastic bag Cat. 1, cat 2, and Cat Incineration/deep burial
3, Cat.6.
Red Disinfected container/plastic bag Autoclaving/ Microwaving/
Cat. 3, Cat 6, Cat 7. Chemical Treatment
Blue/Whit Plastic bag/puncture proof Cat. Autoclaving/Microwaving/
e 4, cat.7 Container Chemical Treatment and
translucent destruction/shredding
Black Plastic bag cat. 5 and cat. 9 and Disposal in secured landfill
cat. 10.(solid)

Cytotoxic Hazard
Bio-Hazard Symbol
Symbol

Technologies for treatment of Bio-medical waste:

Medical waste treatment systems are designed and operated to achieve the
basic requirements of disfigurement and decontamination. Most systems
achieve these requirements as a function of their internal processes, like
microwave, hydroclave, while others require add on components or
additional processing steps, like autoclave.

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There are five broad categories of medical waste treatment technologies as

follows:
1. Mechanical process
2. Thermal Process
a) Autoclaving
b) Hydro laving
c) Incineration
d) Paralysis
e) Plasma and plasma Paralysis systems

3. Chemical processes
4. Irradiation processes
5. Biological Processes.

1. Mechanical Processes:

Mechanical processes are used to change the physical form or

characteristics of the waste, either to facilitate waste handing or to
process the waste in conjunction with other treatment steps. The two
primary mechanical processes are compaction and shredding.
Compaction involves compressing the waste in to containers to reduce its
volume. Shredding, which also includes granulation, grinding, pulping
and the like, is used to break the waste in to smaller pieces.

2. Thermal Processes:

There are two categories of thermal processes, namely low heat systems
and high heat systems. Low heat systems use steam, hot water, or
electromagnetic radiation to heat and decontaminate the waste. High heat
systems employ combustion, pyrolysis and high temperature plasmas to
decontaminate and destroy the waste.
Incineration, autoclave, hydroclave are commonly used.

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i. Incinerators:

Incinerators can range from extremely sophisticated, high temperature

operating plants to very basic combustion units that operate at much
lower temperatures. All types of incinerator, if operated properly,
eliminate pathogens from waste and reduce the waste to ashes.
Segregation of waste is vital to the sustainable operation of an
incinerator. An incineration system is preferred and widely recommended
for certain categories of waste such anatomical and pathological waste,
discarded materials (swabs, bandages, cotton, and dressings)
contaminated with blood and body fluids, discarded medicines.

A. Operating Standards:
• Combustion efficiency at least 99.98%
• Primary Chamber temperature 800 ±50 C
• Secondary Chamber: Gas residence time at least ONE
second; temperature of 1050±C; minimum 3% oxygen in the
stack gas.

B. Emission Standards (at 12% CO2 Correction)

• Particulate matter ═ 100mg/Nm3
• Nitrogen oxides ═ 400 mg/Nm3
• HCL ═ 50 mg/nm3
• Minimum stack height ═ 30 meters
• Volatile organic compounds in ash shall be not more than
0.01%

Note:
• Chlorinated plastics shall not be incinerated.
• All waste to be incinerated shall not be chemically treated with any
chlorinated disinfectants.
• Only low sulphur fuel like LDO/LSHS/Diesel shall be used as fuel in
the incinerator.

Waste types not to be incinerated:

• Pressurized gas containers.
• Large amounts of reactive chemical waste.
• Silver salts and photographic or radiographic wastes.
• Halogenated plastics such as polyvinyl chloride (PVC).

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• Waste with high mercury or cadmium content, such as broken

thermometers, used batteries, and lead-lined wooden panels.
• Sealed ampoules or ampoules containing heavy metals.

ii. Autoclave:

Autoclaving is a process of sterilization of medical waste using high

temperature and high-pressure steam. Effective sterilization results in the
destruction of bacteria, viruses, spores, fungi and other pathogenic
microorganisms. These are essentially cylindrical vessels with a provision
for loading and unloading waste. Steam at high temperature and pressure is
introduced into the vessel jacket. The steam transmits heat rapidly to the
waste, which in turn produces steam of its own. The process effectively
destroys pathogens and renders the waste dry. Typical operating conditions
for an autoclave are a temperature of at least 121 c at a pressure of 105 kPa
for a period of at least 60 minutes.

The Bio-Medical waste9Management and handling) Rules, 2000

recommend autoclaving for disposable, microbiological waste and sharps.
Simple maintenance procedures and a low cost of maintenance make it a
popular technology for waste treatment. Anatomical and pathological
wastes, low-level radioactive waste, organic solvents, laboratory chemicals
and chemotherapy waste should not be treated in an autoclave. Operational
malfunctioning may result in ineffective treatment. Steam treatment wets the
waste resulting in an increase in weight. And compared to incineration, the
reduction in volume is small. The capital and operating costs for an
autoclave are as compared to that for other treatment options.

Hydroclaves or Modified autoclaves:

The hydroclave is an innovative combination of waste sterilization (similar

to autoclaving), and waste fragmentation and dehydration. A hydroclave is a
double-walled cylindrical vessel, horizontally mounted, with one or more
top-loading doors, and a smaller unloading door at the bottom, the vessels is
fitted with a motor-driven shaft, to which are attached powerful
fragmenting/mixing arms that slowly rotate inside the vessel. When steam is
introduced in the vessel jacket, it transmits heat inside the vessel. When
steam is introduction in the vessel jacket, it transmits heat rapidly to the
fragmented waste, which in turn, produces steam of its own. The resultant

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dynamic interaction within the hydroclave will sterilize the waste by high
temperature and pressure steam, similar to an autoclave but with faster and
more even heat penetration. It reduces the waste substantially in volume by
80%.

Vapoclave (Modified Autoclave):

Is a state-of-art product for a better tomorrow in the field of environment. It

is a steam run unit to sterilize non-incinerable waste at low temperatures of
135 c as compared to an incinerator, which operates at high temperatures of
1000 c. the level of sterilization is very high at Log 6 or even more as
compared to the normal autoclaves where the level of sterilization is of Log
4. it takes less time compares to a normal autoclave. The entire waste is
dehydrated / demoisturized thereby, resulting into approximately 70%
reduction in the volume and quantity of waste

Standards for autoclaving:

A. Gravity type autoclave:

1. At 121 c, 15 psi pressure and residence time to be not less than 60
minutes.
2. at 135 C, 31 psi pressure for 45 minutes.
3. At 149 C, 52 psi pressure for 30 minutes.

B. Vacuum type autoclave:

1. At 121 C, 15 psi pressure and residence time to be not less than 45
minutes.
2. At 135 C, 31 psi pressure for 30 minutes.

C. Validation test:
. Spore test: Biological indicator for autoclave shall be bacillus
thermophilus spores using vials or spore strips, with at least 10 spores per
milliliter.
. Routine test: a chemical indicator strip/ tape that changes colour
when a temperature is reached can be used to verify that a specific
temperature has been achieved.

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Microwave:

A microwave system uses high frequency waves. These waves cause the
molecules within the waste material to vibrate. This generates heat from
within the matter itself. Microwave disinfection technology is relatively
advanced and the latest in the field of medical waste management. The
process uses microwave radiation to heat and destroy micro-organisms. The
waste is normally shredded and moistened with steam prior to exposure to
microwave to promote uniform heating and disinfection. Wastes loaded
from an automatic promote uniform heating and disinfection. Waste loaded
from an automatic hoisting bucket into a hopper is treated with high-
temperature steam treated and disinfected with microwave heat at 94 C for a
minimum exposure time of 25 minutes. The level of treatment achieved is
considered to fall between high-level disinfection and sterilization.

Microwave disinfection is appropriate for the treatment of microbiology

laboratory waste, human blood, body fluid waste and waste sharps. The
Microwave treatment should not be used for cytotoxic, hazardous or
radioactive wastes, contaminated animal carcasses, body parts and large
metal items.

Plasma Systems:

Plasma is basically a material in which the temperatures are so high that

some of its electrons are separated from their atoms. A plasma torch or
burner is used to heat the waste to super high temperatures. These systems
are very similar to incineration except that conventional combustion does
not take place. The plasma-fired chambers operate in an oxygen-deficient
mode, and off gases need to be combusted separately. The residue produced
is a glass-like substance, rather than a particulate ash typical of an
incinerator.

3. Chemical disinfection:

Chemical disinfection, used routinely in health care to kill microorganism on

medical equipment and on floors and walls, is now being extended to the
treatment of health-care waste. Chemicals are added to waste to kill or
inactive the pathogens it contains; this treatment usually results in

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disinfection rather than sterilization. Chemical disinfection is most suitable

for treating liquid waste such as blood, urine, stools, or hospital sewage.

Human body parts and animal carcasses should not normally be disinfected
chemically. Mycobacteria are least resistant parasites, while Giardia and
Cryptosporidium spp. Are significantly resistant to disinfection. Chemical
disinfection is suitable option for, treating highly infectious physiological
fluids, such as patients’ stools in case of cholera outbreaks. Chemical
disinfection is usually carried out on hospital premises.
The types of chemicals used for disinfection of health-care waste are mostly
aldehydes, chlorine compounds, ammonium salts, and phenolic compounds;
the use of ethylene oxide is no longer recommended for waste treatment
because of the significant hazards related to its handling.

Chemical disinfection has a wide application in small health care facilities.

A good disinfectant is bleach. For chemically treating the waste, an optimum
concentration of bleach has to be prepared. The concentration prescribed by
WHO is 10 gm of bleach in 1 litre water. However, it must be noticed that
medical wastes that have been chemically disinfected should continue to be
complete. The bleach solution should be prepared at the beginning of the
shift. At the end of the shift or after the bin is three-fourth full and the waste
has been treated with suitable chemical disinfectant, it has to be disposed
off.

4. Irradiation:

Cobalt 60 and electron beam accelerator gun for irradiating and sterilizing
the medical waste have been developed. These systems require post-
shredding to render the waste unrecognizable.
Electron beam gun technology: Hospital waste is exposed to an ionized
electron beam including chemical and biological changes in the waste
material. Decontamination occurs when nucleic acids in living cells are
irradiated. The equipment emits sufficient radiation to destroy micro-
organisms and changes the molecular structure of materials. However, the
technology produces radioactive fields that require costly shielding.
Additionally, Ozone is produced, but this can be destroyed using a catalyst.
The volume of waste is reduced by about 20% and the disinfected remains

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are shredded and land filled. The high capital and operating cost are limiting
factors for commercial utilization of this technology.

5. Biological processes:

It is claimed that biological reactions will not only decontaminate the waste
but also cause the destruction of all the organic constituents so that only
plastics, glass, and other inerts will remain in the residues. Various systems
are being developed using biological enzymes for treating medical waste.

6. Land disposal:

Municipality land:
There are two distinct types of waste disposal to land open dumps and
sanitary landfills. Heath-care waste should not be deposited on or around
open dumps. Sanitary landfills are designed to have at least four advantages
over open dumps: geological isolation of wastes from the environment,
appropriate engineering preparations before the site is ready to accept
wastes, staff present on site to control operations, and organized deposit and
daily coverage of waste. The deep burial site should be relatively
impermeable and no shallow well should be close to the site. It must be
ensured that animals do not have any access to burial sites. Covers of
galvanized iron/ wire meshes may be used.

Inertization:
The process of inertization involves mixing waste with cement and other
substances before disposal, in order to minimize the risk of toxic substances
contained in the wastes migrating into the surface water or ground water. A
typical proportion of the mixture is: 65% pharmaceutical waste, 15% lime,
15% cement and 5% water. A homogeneous mass is formed and cubes or
pellets are produced on site and then transported to suitable storage sites.

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