Normative comparative countries

of America South on the classification

Waste from
establishments Health (RES) and
identifying their Dangerous residues
(Chemical)

Mg. Sergio López Seijas

Summary

How Health Facilities Waste (RES) are classified and identified hazardous waste
(chemicals) -RESPEL- in neighboring countries? Is there in these specific regulations
for management ?. The paper describes and analyzes the current legislation on RES in
nine countries in South America, emphasizing the specific identification of RESPEL
(chemicals) generated therein.

Introduction

In this paper we are analyzed and comparatively assess current regulations regarding
the management of wastes from health (RES) in the countries of South America
(except Suriname, French Guiana and Guyana): Bolivia, Brazil, Chile , Colombia,
Ecuador, Paraguay, Peru, Uruguay and Venezuela.

Excels in each of these countries, the general classification thereof; and in more detail
specifically described, subclassification criteria residues (chemical) dangerous.

I. Bolivia

The Ministry of Health and Sports, issued in March 2002 by Ministerial Resolution No.
0131, the "Regulations for the Management of Solid Waste Generated in Health". In
Article 5, the following classification of waste (Ministry of Health of Bolivia 2003) is
performed:

• Class A: infectious waste

• Class B: special waste
• Class C: Household and similar waste

Special wastes: Waste from health facilities, presenting dangerous chemical physical
characteristics to health and the environment are: corrosivity, explosivity, flammability,
pathogenicity,
radioactivity, reactivity, toxicity, with
following subcategories:

B.1. Radioactive waste.

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B.2. Drug residues: expired drugs, rejected, returned from health facilities and / or
removed.

B.3. Chemical residues: Materials containing or contaminated by toxic, corrosive,

flammable materials, explosives, reagents and mutagenic genotoxic as batteries,
mercury thermometers, X-rays, etc.

II. Brazil

In Brazil, according to the resolutions ANVISA- National Health Surveillance Agency

No. 306/04 and CONAMA-National Environment Council No. 358/05 (Brazil, 2004 and
2005 respectively), the "Waste Health Services" ( RSS), are classified into 5 groups
(CONAMA Resolution No. 358, 2005):

• Group A: Infective waste

• Group B: Chemically residues
• Group C: radioactive waste
• Group D: common waste
• Group E: perforating or cutting waste

Group B: residues of chemical origin: residues containing chemicals that may

present a risk to public health or the environment, depending on their features:
flammability, corrosivity, reactivity, and toxicity. In this group are distinguished:

a) hormonal products and antimicrobials, cytostatic, anticancer product,

immunosuppressants, digitalis,
immunomodulators, anti-retrovirals, discarded by the
health services, pharmacies, drugstores and drug distributors.

b) Residues cleaners, disinfectants; waste containing heavy metals; laboratory

reagents, including packaging contaminated by them.

c) Effluent image processors (developer and fixer).

d) Effluent automated equipment used in clinical analysis; Y

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e) Other products deemed dangerous, according the
classification included in the NBR-10004, and ABNT (toxic, corrosive, flammable
and reactive).

III. Chile

On the basis nationally, Supreme Decree No. 148 /

2003, the Ministry of Health, Hazardous Waste, which came into force from its
regulations on June 16, 2005, under the name of "Health Regulations on Hazardous
Waste Management", as provided in Title III, It is formulated in November 2005, the
"Guide for the Preparation of Plans Hazardous Waste Management. (Chilean Ministry
of Health 2003).

Subsequently, the Ministry of Health, adopted on 23 February

2009, by No. 6/2009 Decree, "Regulations on Waste Management Health Care
Establishments (REAS)" (Undersecretariat of Health of Chile 2010).

In that year, the Ministry of Health, in collaboration with the Pan American Health
Organization, PAHO / WHO publishes the "Waste Management Manual for Health
Care Facilities".

In 2010, with plans to expand distribution to a larger number of hospitals and other
health facilities, launches its second edition. This regulation classifies waste health
facilities in the following categories:

• Category 1: Hazardous Waste

• Category 2: low-level radioactive waste
• Category 3: special waste
• Category 4: solid waste similar to household

Category 1: Hazardous waste: hazardous wastes are those with one or more of the
following hazardous characteristics defined in Supreme Decree No. 148 of 2003, the
Ministry of Health:

a) Acute toxic residues acute toxic substances which mentions the Supreme Decree
148/2003 include drugs such as epinephrine, phentermine and warfarin, and other
substances that may be used in support units

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diagnosis such as Clinical Laboratory and Pathology (potassium cyanide and osmium
tetroxide for example).

b) chronic toxic residues include drugs such as drugs used in chemotherapy

(chlorambucil and melphalan for example), and other substances that can be used in
diagnostic support units, such as ethyl acetate, methanol, acetone, xylene,
formaldehyde, etc., used in Clinical Laboratory and Pathology. It is also considered
mercury used in vaccines

(Thimerosal), antiseptics (Merbromin),

thermometers, sphygmomanometers, gastrointestinal probes
(Cantor probes, Miller Abbott, esophageal dilators), thermostats, manometers,
barometers, fluorescent tubes, batteries, etc.

c) extrinsic toxic residues include mercury, some compounds used in pharmaceuticals

(silver nitrate and m-cresol, for example) and others that can be used in diagnostic
support units, such as radiology and pathology (e.g. sulfate barium and chloroform).
The solutions used in developer and fixer generated in Radiology, aprons and other
Leaded radiological protection components to be discarded. electronic waste, used
nickel- cadmium or lead acid batteries, paint residues (containing lead, chromium and
cadmium).

d) flammable residues contaminated pharmaceutical products as alcohol, elastic

collodion, amyl nitrite or silver nitrate waste. Substances used in diagnostic support
units, such as xylene, toluene, methanol or potassium permanganate (in Pathology);
silver nitrate, acetone, ethanol or hydrogen peroxide (Clinical Laboratory).
Contaminated waste based paints, solvents, certain adhesives, white benzine,
turpentine or flammable propellants aerosols (propane, butane).

e) Waste reagents: lithium batteries used, waste and contaminated with picric acid (in
Histology) elements, or sodium azide (preservative used as laboratory reagents in
diagnostic in vitro).

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f) corrosive residues waste and / or contaminated with sulfuric, hydrochloric, nitric and
chromic acid, alkaline solutions of sodium hydroxide or ammonia elements.

Moreover, hazardous waste occurring more frequently in health care facilities are
(Article 4 of Decree 6/2009):

1- consistent waste or contaminated with cytotoxic drugs,

such as chlorambucil, cyclosporine, cyclophosphamide, melphalan, semustine,
tamoxifen, thiotepa and treosulfan.

2- consistent wastes or contaminated by organic solvents

halogenated hydrocarbons such as trichlorethylene methylene chloride, chloroform;

3- consistent waste or contaminated by organic solvents

nonhalogenated such as xylene, methanol, acetone,
isopropanol, toluene, ethyl acetate, and ethyl nitrile.

4- consistent waste or contaminated by organic substances

dangerous, such as: formaldehyde, perchlorethylene, Y
disinfectants and cleaning solutions based on phenol.

5- consistent waste containing or contaminated by

heavy metals such as mercury-containing equipment and batteries containing
cadmium or lead.

6- consistent wastes or contaminated with chemicals

inorganic hazardous, such as sulfuric, hydrochloric, nitric and chromic; alkaline
solutions of sodium hydroxide and ammonia; oxidizing substances such as
potassium permanganate and potassium dichromate and also reducing agents
such as sodium bisulfate.

IV. Colombia

On December 22, 2000, the comprehensive management of hospital and similar waste
is regulated by Decree 2676 / 2000. Articles 4to. and 21, defined the "Manual of
Procedures for Hospital Waste Management and Allied Workers (MPGIRH)" (Ministry
of Health of Colombia 2000).

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This is considered as the document issued by the Ministries of Environment and
Health, in a coordinated manner by which are established procedures, processes,
activities to be taken for internal and external management of waste from the
generator.

On September 6, 2002, the Procedures Manual is adopted in all health establishments

(Decree No. 01164/2002) (Ministry of Health of Colombia 2002).

This regulation classifies waste health facilities in the following categories:

• Non-hazardous waste: biodegradable, recyclable, and common inert.

• Dangerous residues: one. infectious: biosanitarios,

cytotoxic, sharps and animals; 2. radioactive; 3.
chemical: drugs, pathology, metals, reagents, containers and used oils.

The Chemical wastes They are defined as chemical residues and packaging, or any
other waste contaminated with these, which, depending on its concentration and
exposure time, have the potential to cause death, serious injury or adverse health
effects and environment. They can be classified in turn:

• drugs partially consumed, up and / or degraded: those due, damaged and / or

surplus of substances that have been used in any type of procedures drugs within
which the waste produced in pharmaceutical laboratories and medical devices that
do not meet include the quality standards, including their packaging.

• cytotoxic waste: They are excess drug from cancer treatments, and elements used
in application, such as syringes, gloves, bottles, gowns, absorbent paper bags, and
other material used in the drug application.

• Heavy metals: are objects, elements or remains unused, contaminated or contain

heavy metals such as lead,

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 chromium, cadmium, antimony, barium, nickel, tin, vanadium, zinc, mercury. The
latter, from the Service of Dentistry, removal processes or preparation of
amalgams, thermometers by breakings and other accidents in which mercury is
present.

• reagents: are those which by themselves under normal conditions, when mixed or
when in contact with other elements, compounds, substances or waste generated
gases, vapors, toxic fumes, explosion or thermally react, placing a risk to human
health or the environment. They include liquid developer and fixer, laboratories,
contrast media, diagnostic reagents in vitro, and blood banks.

• Pressurized containers: They are pressurized packaging anesthetic gases, drugs,

ethylene oxide, and others with this presentation, full or empty.

• Oils: are those oils with mineral or synthetic base that have become or become
inadequate to the assigned or intended use initially, such as engine lubricants and
transformers used in vehicles, fats, oils equipment and waste grease trap.

V. Ecuador

In December 2010, Ecuador, through the Official Gazette No. 338 approving the
Regulation on "Solid Waste Management in health establishments of the Republic of
Ecuador"; which replaces the previous regulation, published in the Journal No. 106, in
1997 (Ministry of Health of Ecuador 2010). In its Art.10, classification of wastes
produced in the ES provides:

• general or common waste

• infectious waste
• special wastes

Special wastes: They are generated in the auxiliary diagnostic and treatment services,
which by its physical and chemical characteristics, represent a risk or potential danger
to

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humans, animals or the environment. In turn they are divided into:

C 1. Hazardous chemical waste substances or chemical hazards with toxic, corrosive,

flammable and / or explosive properties.

C 2. Radioactive waste: those containing one or more nuclides that emit particles or
electromagnetic radiation spontaneously, or that fuse spontaneously. Are from
chemical analysis laboratories, nuclear medicine and radiology.

C 3. Pharmaceutical waste: expired drugs, waste, cytostatic drugs (mutagenic,

teratogenic), etc.

SAW. Paraguay

Management of waste from health facilities is based on three instruments: the Law No.
3361/2007 ( "Of the waste generated in health establishments and Allied"), Decree No.
6538/2011 Regulatory ( "Instrument for Comprehensive Management of Medical
Waste "); and the
"Manual of
Procedures for Comprehensive Management of Waste Generated in Health Facilities
and Allied Workers "prepared by the Ministry of Public Health and Social Welfare in
2011, with technical support from PAHO-WHO.

In this context, the waste generated in health establishments are classified into (Article
19 of Law 3361 and Article 26 of Regulatory Decree No. 6538/11..) (Ministry of Health
of Paraguay 2011):

• Type I: common waste

• Type II: anatomical waste
• Type III: Sharps
• Type IV: nonanatomic
• Type V: chemical residues

Chemical wastes: drugs and other hazardous waste. They are chemical compounds
as laboratory reagents and production of biological agents and drugs not radiological or
chemical radioactive source, expired drugs, expired reagents, containers that
contained substances and

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chemical products, plates radiographic, liquid fixative,
broken thermometers and amalgams.

VII. Peru

In Peru, it was approved by Ministry of Health No. 217/2004, mandatory compliance in

all health establishments,
Technical Standard No. 008 / MOH / PHD / V.01:
"Procedures for Solid Waste Management Hospital" (updated by Resolution No.
554-2012 / MOH). (Ministry of
Peru Health 2012). In this context, the waste is classified as:

• Class A: biocontaminated residue

• Class B: special waste
• Class C: common residue

special waste: are those hazardous wastes generated in hospitals, with physical and
chemical characteristics, so potentially hazardous corrosive, flammable, toxic,
explosive and reactive, for the exposed person. In turn, they are divided into three
types:

• B1: Hazardous chemical waste

• Type B2: waste pharmaceuticals: compounds by

expired medicines, contaminated, outdated, unused, from research trials, etc.

• Type B3: radioactive waste

Hazardous chemical waste: It includes containers or

contaminated by chemical substances or materials, with characteristics
toxic, corrosive, flammable, explosive,
reactive, genotoxic or mutagenic; such how
Chemotherapeutic unused chemicals, pesticides out of specification, solvents, chromic
acid (used in cleaning laboratory glass), mercury thermometers, x-rays development
solutions, used lubricating oils, among others.

VIII. Uruguay

Management "Solid Waste Hospital" is regulated by Decree 135/99 (18 March 1999)
together between the

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Ministry of Public Health and the Ministry of Housing, Spatial Planning and the
Environment. (Ministry of Public Health of Uruguay 1999). They are classified as:

• infectious
• Sharp or cutting
• special
• Common solid waste

Special wastes: are those generated in ancillary activities centers health care that, if
they are not well come into contact with infectious agents pose a risk to health or the
environment, for its properties of corrosivity, reactivity, toxicity, explosiveness,
flammability, irritability and / or radioactivity, and that they are included in some of the
following groups: chemicals and pharmaceuticals, such as substances or chemicals
with one of the aforementioned characteristics, or that are genotoxic or mutagenic
expired medicines, contaminated, damaged or outdated, even when discarded without
being used, oncological and radioactive medication.

Chapter II: Integrated Management of Solid Waste Hospitalarios (Integrated

Management Plan); Decree 135/99 of, clarifies that:

hub of health care, generator hospital solid waste, must have a plan for
waste management, which includes intra-institutional management,
transportation, treatment, and disposal, as appropriate for the health and
environment, and in accordance with provided in this Decree.

IX. Venezuela

Decree No. 2218 signed in 1992, establishes the "Rules for the Classification and
Waste Management in Health", which should make mandatory all establishments. In its
Article 5, the following classification (Official Gazette of the Republic of Venezuela,
Decree No. 2218 1992) described:

• Type A: common waste

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 • Type B: potentially hazardous waste one
• Type C: Infectious Waste
• D Type: organic and / or biological waste
• Type E: special waste

Type E: special waste: These are products and pharmaceutical or chemical waste,
radioactive materials and flammable liquids. As well as any listed as dangerous not
between the above groups. The management of these wastes separately and it will be
governed by the provisions of the Rules for the Control of Generation and Management
of Hazardous Wastes. (Official Gazette of the Republic of Venezuela, Decree No. 2211

1992).

conclusions

In this review of the rules of South America, on the classification of RES and
identification of chemical RESPEL generated in the ES, it was verified that except
Suriname, Guyana and French Guiana, which countries could not find any
information, in all other countries,

the ES have specific legislation for classification (and management)

thereof. In these classifications, it is agreed to identify five characteristics chemical
residues
Hazard: corrosivity, reactivity,
explosiveness, toxicity and flammability (CRETI). However, although Latin American
classifications are not defined by the list attached as Annexes I and III to the Basel
Convention are set out in full accordance with the guidelines of the WHO (Pruess et al.
1999, 2nd. Edition 2014, English version), published in the Manual " Suitable Waste
Management Health Facilities (RES) ".

In most countries, packaging and / or materials

contaminated with chemical moieties are considered as hazardous waste. Brazil
includes as hazardous waste spills Autoanalyzers. While Chile, includes medicines that
use mercury ( "thimerosal"). Paraguay and Colombia, laboratory reagents.

one hazardous wastes all materials, without being its dangerous nature, location, contact or any other circumstances may be considered
contaminated, those from areas of hospitalization in patients and outpatient included.

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Bolivia and Peru, classifies them Lessons ( A, B and C), calling "special waste" those
with characteristics of chemical hazard, both.

Paraguay and Venezuela classifies them Types. For the first type they are: I, II, III, IV
and V, V being the chemical residue; while for Venezuela, the types are determined
with letters A, B, C, D and E, E being defined as the "special waste" (with
characteristics of chemical hazard).

In Brazil, they are classified groups ( A, B, C, D and E), the B, the chemical origin.

In Chile, they are classified Categories ( 1, 2, 3 and 4), the one the of hazardous
chemical waste.

In Uruguay, they are divided into infectious, sharp or cutting, common and special
solid waste; It is determined by the characteristics of chemical hazard, the last.

Colombia, classifies hazardous and non-hazardous, defined within the hazardous

chemical.

Finally, Ecuador classifies them as "waste": common,

infectious and special; the latter being also defined by the characteristics of chemical
hazard.

Bibliography

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