Introduction, Definition and

Characterization of Health Care Waste

 PREFACE
• The world is generating more and more waste
and hospitals and health centers are no
exception.
• Medical waste can be infectious, contain toxic
chemicals and pose contamination risks to both
people and the environment.
• If patients are to receive health care and
recover in safe surroundings, waste must be
disposed of safely.
• Choosing the correct course of action for the
different types of waste and setting priorities
are not always straightforward, particularly
when there is a limited budget.
• The management of the waste from health
services is complex and to be successful it must
be understood and addressed by everyone
working in health services from those washing
the floors to the senior administrators.
• This course provides guidance on what is
essential and what actions are required to
ensure the good management of waste.
 INTRODUCTION
• Health-care activities are a means of protecting
health, curing patients and saving lives.
• But they also generate waste, 20 percent of which
entail risks either of infection, of trauma or of
chemical or radiation exposure.
• Hospitals are responsible for the waste they produce.
• They must ensure that the handling, treatment and
disposal of that waste will not have harmful
consequences for public health or the environment.
• Poor waste management can jeopardize care
staff, employees who handle medical waste,
patients and their families, and the
neighboring population.
• In addition, the inappropriate treatment or
disposal of that waste can lead to
environmental contamination or pollution.
 DEFINITION AND DESCRIPTION OF
“HEALTHCARE/MEDICAL WASTE”
• The term “medical waste” covers all wastes
produced in health-care or diagnostic
activities.
• Hospital Wastes are the wastes produced in
the course of healthcare activities during
Treating, Diagnosing and Immunizing human
or animals or while doing study/research
activities.
• 75-90 % Non-Hazardous Wastes
• Similar to household refuse or municipal
waste and do not entail any particular hazard
• Refuse similar to household waste can be put
through the same collection, recycling and
processing procedure as the community’s
municipal waste
• 10-15% Hazardous Wastes
• Hazardous medical waste or special waste.
• This type of waste entails health risks.
 CLASSIFICATION
• It can be divided into following categories according to
the risks involved. (WHO)
– Infectious waste
– Pathological waste
– Sharps waste
– Chemical waste
– Pharmaceutical waste
– Cytotoxic waste
– Radioactive waste
– Pressurized Containers
– Non-hazardous or general waste
 Infectious Waste
• Infectious waste is material suspected to contain
pathogens (bacteria, viruses, parasites or fungi) in
sufficient concentration or quantity to cause disease
in susceptible hosts.
• This category includes:
• waste contaminated with blood or other body fluids
• cultures and stocks of infectious agents from laboratory
work
• waste from infected patients in isolation wards.
 Pathological Waste
• Pathological waste could be considered a subcategory of infectious
waste, but is often classified separately – especially when special
methods of handling, treatment and disposal are used.
• Pathological waste consists of tissues, organs, body parts, blood,
body fluids and other waste from surgery and autopsies on patients
with infectious diseases.
• It also includes human fetuses and infected animal carcasses.
• Recognizable human or animal body parts are sometimes called
anatomical waste.
• Pathological waste may include healthy body parts that have been
removed during a medical procedure or produced during medical
research.
 Sharps Wastes
• Sharps are items that could cause cuts or puncture
wounds
• Whether or not they are infected, such items are
usually considered highly hazardous health-care
waste and should be treated as if they were
potentially infected.
• Including needles, hypodermic needles, scalpels and
other blades, knives, infusion sets, saws, broken glass
and pipettes, etc.
 Chemical Waste
• Chemical waste consists of discarded solid, liquid and
gaseous chemicals; for example, from diagnostic and
experimental work and from cleaning and disinfecting
procedures.
• Chemical waste from health care is considered to be
hazardous if it has at least one of the following properties.
– toxic (harmful)
– corrosive (e.g. acids of pH 12)
– Flammable
– reactive (explosive, water reactive, shock sensitive)
– oxidizing
• Solvents and reagents used for laboratory
preparations
• Disinfectants, Sterilants and heavy metals contained
in medical devices and batteries
• Mercury waste (broken thermometers or
manometers, fluorescent or compact fluorescent
light tubes).
 Pharmaceutical Wastes
• Pharmaceutical waste includes expired, unused, spilt and
contaminated pharmaceutical products, prescribed and
proprietary drugs, vaccines that are no longer required,
and, due to their chemical or biological nature, need to be
disposed of carefully.
• The category also includes discarded items heavily
contaminated during the handling of pharmaceuticals,
such as bottles, vials and boxes containing pharmaceutical
residues, gloves, masks and connecting tubing.
• Expired, unused and contaminated drugs and vaccines
 Cytotoxic Wastes
• Cytotoxic (chemotherapeutic or antineoplastic) drugs, the principal
substances in this category, have the ability to kill or stop the growth
of certain living cells and are used in chemotherapy of cancer.
• They play an important role in the therapy of various neoplastic
conditions, but are also finding wider application as
immunosuppressive agents in organ transplantation and in treating
various diseases with an immunological basis.
• Cytotoxic drugs are most often used in specialized departments, such
as oncology and radiotherapy units, whose main role is cancer
treatment.
• Their use in other hospital departments and outside the hospital in
clinics and elsewhere is also increasing.
• Waste containing substances with genotoxic properties (i.e.
highly hazardous substances that are, mutagenic, teratogenic or
carcinogenic)
• Cytotoxic wastes are generated from several sources and can
include the following:
• contaminated materials from drug preparation and administration, such
as syringes, needles, gauzes, vials, packaging
• outdated drugs, excess (leftover) solutions, drugs returned from the
wards
• urine, faeces and vomit from patients, which may contain potentially
hazardous amounts of the administered cytostatic drugs or of their
metabolites, and which should be considered genotoxic for at least 48
hours and sometimes up to 1 week after drug administration.
 Radioactive Wastes
• Radioactive wastes are materials contaminated with
radionuclides.
• They are produced as a result of procedures such as
in vitro analysis of body tissue and fluid, in vivo organ
imaging and tumor localization, and various
investigative and therapeutic practices.
 Pressurized containers
• Gas cylinders, aerosol cans.
 Non-hazardous or General Wastes
• Waste that does not pose any particular biological,
chemical, radioactive or physical hazard.
SOURCES OF HEALTHCARE WASTES
• Different types of health-care facilities can be
viewed as major or minor sources of health-
care waste, according to the quantities
produced.
Major sources of health-care waste
• Hospitals
– University hospital
– General hospital
– District hospital
• Other health-care facilities
– Emergency medical care services
– Health-care centres and dispensaries
– Obstetric and maternity clinics
– Outpatient clinics
– Dialysis centres
– Long-term health-care establishments and hospices
– Transfusion centres
– Military medical services
– Prison hospitals or clinics
• Related laboratories and research centres
– Medical and biomedical laboratories
– Biotechnology laboratories and institutions
– Medical research centres
• Mortuary and autopsy centres
• Animal research and testing
• Blood banks and blood collection services
• Nursing homes for the elderly
Minor sources of health-care waste
• Small health-care establishments
– First-aid posts and sick bays
– Physicians’ offices
– Dental clinics
– Acupuncturists
– Chiropractors
• Specialized health-care establishments and institutions with low waste generation
– Convalescent nursing homes
– Psychiatric hospitals
– Disabled persons’ institutions
• Activities involving intravenous or subcutaneous interventions
– Cosmetic ear-piercing and tattoo parlours
– Illicit drug users and needle exchanges
• Funeral services
• Ambulance services
• Home treatment
 GENERATION OF MEDICAL WASTE
• Many factors affect the rate of waste generation, including:
– level of activity (often measured in terms of the number of
occupied beds, number of patients per day, and/or number of
staff);
– type of department (e.g. general ward, surgical theatre, office);
– type or level of facility (e.g. clinic, provincial hospital)
– location (rural or urban)
– regulations or policies on waste classification;
– segregation practices;
– temporal variations (e.g. weekday versus weekend, seasonal);
– level of infrastructure development of the country.
• Knowing the types and quantities of waste produced in a
health-care facility is an important first step in safe disposal.
• Waste-generation data are used in estimating the required
capacities for containers, storage areas, transportation and
treatment technologies.
• Waste-generation data can be used to establish baseline
data on rates of production in different medical areas and for
procurement specifications, planning, budgeting, calculating
revenues from recycling, optimization of waste-management
systems, and environmental impact assessments.
Daily data collection form
• Average waste generation rates are calculated in kilograms (kg) per
day or kg per year.
• Kilograms per occupied bed per day, and kg per patient per day, are
used especially when comparing different health-care facilities with
different levels of activities.
• If inpatient occupancy rates and the daily number of outpatients are
not available, the total number of beds is often used to estimate kg
per bed per day.
• For analyzing departments within a health system, Tudor (2007)
suggests using kg per person per month (where “person” refers to
both patients and staff) as a more accurate and stable measure of
activity, and as a tool to identify departments that could benefit from
waste reduction, reuse and recycling.
• The quantity of waste produced in a hospital
depends on the level of national income and the
type of facility concerned.
• A university hospital in a high-income country can
produce up to 10 kg of waste per bed per day, all
categories combined.
• An ICRC hospital with 100 beds will produce an
average of 1.5 to 3 kg of waste per patient per day
depending on the context (all categories combined
and including household refuse).
• High-income countries generate on average up
to 0.5 kg of hazardous waste per hospital bed
per day; while low-income countries generate
on average 0.2 kg.
• However, health-care waste is often not
separated into hazardous or non-hazardous
wastes in low-income countries making the
real quantity of hazardous waste much higher.
 CONTEXT OF NEPAL
• NHRC and WHO published National Guidelines
for Healthcare Waste Management in 2002 on
behalf of MOH
• Kathmandu Metropolitan City have initiated
an action plan in association with USAID for
management of healthcare waste.
• Kathmandu Metropolitan City and ENPHO
have organized a study on biomedical waste in
hospital located in Kathmandu.
• Results: 1.72 Kg waste/day/patient
• Out of which 26% of waste was infectious and
hazardous waste.
Average Composition of Hospital Waste in
Hospitals in Kathmandu
 Magnitude of Problem
• GLOBALLY: Developed countries generate 1 to
5 kg/bed/day
• Developing countries: meager data, but
figures are lower. 1-2 kg/pt./day
• WHO Report: 85% non hazardous waste
• 10% infective waste
• 5% non infectious but hazardous. (Chemical,
Pharmaceutical and radioactive)
 Minimum approach to overall management
of health-care waste
• All personnel dealing with health-care waste should be familiar
with the main categories of health-care waste as set out in
either national or local regulations on waste classification.
• As a minimum, managers responsible for healthcare waste
should conduct a walk-through of the facility to identify the
medical areas that produce waste, to obtain an initial estimate
of the types and quantities of waste generated, and to
understand how the waste is handled and disposed of.
• A rapid assessment, combining observations with interviews
and survey questionnaires, should provide sufficient data to
identify problems and begin the process of addressing them.
 Desirable improvements to the minimum
approach
• Beyond the minimal requirements, health-care
facilities should adopt an organized approach
to waste characterization to obtain accurate
data.
• This approach is necessary to develop or
improve the waste management system in use.
• Undertaking a formal waste assessment entails
planning and preparation.
• From a systematic assessment, one could:
– identify locations in the health-care facility where good
waste segregation is undertaken and where segregation
practices need to be improved
– determine the potential for recycling and other waste-
minimization measures
– estimate the quantities of hazardous health-care waste
that require special handling
– obtain data to specify and size waste collection and
transport equipment, storage areas, treatment
technology and disposal arrangements to be used.