Manage Hospital Waste

Introduction
This learning outcome addresses managing hospital waste including
segregation, methods of waste disposal, storage and transportation
Performance standard
1. Hospital waste is identified and segregated in accordance with the
WHO guidelines
2. Colour coded bins are identified according to the WHO guidelines
3. Handling and storage of hospital waste is done in accordance to the
hospital guidelines
4. Hospital waste is transported in line with the hospital policy and
guidelines
5. Methods of waste disposal is identified and used according to WHO
guidelines
Definition of Key Terms
Clinical Waste: Any waste arising from provision of healthcare or bio-
medical research.
Hazard: A substance, mixture or substances, process or situation that
have the potential to cause harm to human health or adverse effect to the
environment
Hazardous waste: A waste that is considered to be of special risk to
human health or environment and therefore needs special management
Infectious Waste: All kind of waste that may transmit viral, bacterial,
fungal or parasitic diseases to human beings and animals
Waste Segregation: Any activity that separates waste materials for
processing
Waste Management: The activities, administrative and operational, that
are used in handling, packaging, treatment, conditioning, reducing,
recycling, reusing, storage and disposal of waste.
Waste segregation
Waste segregation is separation of wastes according to types and
categories.
i. Segregation should;
a. Always be the responsibility of the waste producer,
b. Take place as close as possible to where the waste is generated, and
c. Be maintained in storage areas, during transportation, treatment and
disposal.
ii. The most appropriate way of identifying the categories of health-care
waste is by separating the waste into colour-coded plastic bags or
containers. The recommended colour-coding scheme is provided in
Annex 2.
iii. In addition to the colour coding of waste containers, the following
practices are recommended:
a. General (non-infectious) health-care waste can join the stream of
domestic refuse for disposal if none can be salvaged.
b. Sharps should all be collected together, regardless of whether or not
they are contaminated.
iv. Sharps containers should be;
a. Puncture-proof (usually made of cardboard or high-density plastic)
and fitted with covers.
b. Be rigid and impermeable so that they safely retain not only the
sharps but also any residual liquids from syringes.
c. To discourage abuse, containers should be tamper-proof (difficult to
open or break) and needles and syringes should be rendered unusable.
v. Liner bags used should be;
a. Highly resistant to puncturing and tearing with exceptional strength
and stretch properties.
b. They should be of a gauge not less than 150 microns.
c. Where bins are unavailable or too costly, containers made of dense
cardboard are recommended:
d. Bags and containers for infectious waste should be marked with the
international infectious substance symbol (Refer to annex 3a and 3b).
vi. Highly infectious waste should, whenever possible,
a. Be sterilized immediately by autoclaving.
b. It needs to be packaged in bags that are compatible with the proposed
treatment process. Red bags suitable for autoclaving are recommended.
vii. Waste collection bags for waste types needing incineration shall not
be made of chlorinated plastics.
viii. Cytotoxic waste, most of which is produced in major hospital or
research facilities, should be collected in strong, leak-proof containers
clearly labelled “Cytotoxic wastes”.
ix. Small amounts of chemical or pharmaceutical waste may be;
a. Collected together with infectious waste.
b. Large quantities of obsolete or expired pharmaceuticals stored in
hospital wards or departments should be returned to the pharmacy for
disposal.
c. Other pharmaceutical waste generated, such as spilled or
contaminated drugs or packaging containing drug residues should not be
returned because of the risk of contaminating the pharmacy; it should be
deposited in the correct container at the point
Waste Handling, Labelling and Transport
Waste Labelling
i. All waste liner bags and waste containers are to be colour coded
(Annex 2) and inscribed with hazard marks or stickers and
identified in accordance with international waste labelling
symbols
Health Care Waste Tracking
i. Tracking of HCW is necessary to enable both the regulatory
bodies and all other stakeholders to follow the movement of
waste from generation to safe final disposal. Tracking may be as
simple as a cardboard luggage label attached by string, sticky
labels or as sophisticated as a self-adhesive bar-code. Tracking
helps to rapidly identify the source of waste, facilitates
segregation, provides feedback, assists in providing data for
education purposes, decision making facilitates auditing and
may be used to allocate resources for HCWM.
ii. The use of tracking forms is therefore necessary and would
enable both the regulatory bodies and all concerned to follow
the movement of waste from generation to safe final disposal.
iii. All liner bags /containers of waste must be clearly marked to
identify the HCF unit and date of collection. iv. The illegal
 dumping of healthcare waste by unscrupulous waste
collectors/generators poses a great risk to public health.
Tracking the movement of waste from the points of generation
through transportation to the final disposal point would guard
against the malpractice of illegal dumping
Handling Waste Bags
i. Sharps must always be placed in injection safety boxes and
never be placed in waste bags.
ii. Waste must be contained in colour coded and well labelled
plastic bags.
iii. General waste should be contained in well labelled black bags.
iv. Waste bags must not be over filled (approx 2/3 of capacity).
v. The volume of a waste bag should not exceed 55 liters.
vi. Excess air should be excluded without compaction, prior to
closure using a bag tie at the point of waste generation.
vii. All bags should be held away from the body by the closed top of
the bag, and placed directly into a mobile garbage bin or trolley.
viii. Where waste bags are sealed and stored pending collection, they
should be in a secure place with restricted access.
ix. There should be a Waste collection schedule
Storage area recommendations
The following are recommendations for transfer station/storage area and
its equipment:
 There should be a water supply for cleaning purposes.
 The area should be clearly demarcated & warning trespassers
 The storage area should have an impermeable, hard-standing floor with
good drainage; it should be easy to clean and disinfect.
 The storage area should afford easy access for staff in charge of
handling the waste.
 It should be possible to lock the store to prevent access by
unauthorized persons.
 Easy access for waste-collection vehicles is essential.
 There should be protection from the sun.
 The storage area should be inaccessible to animals, insects, and birds.
 There should be good lighting and at least passive ventilation.
 The storage area should not be situated in the proximity of fresh food
stores or food preparation areas.
 A supply of cleaning equipment, protective clothing, and waste bags or
containers should be located conveniently close to the storage area.
 Clean up facilities, spills kits, appropriate drainage and banding should
be provided.
 Where wastes are stored in bins the bin must be locked.