HEALTH CARE
WASTE
MANAGEMENT
HEALTH CARE WASTE
DEFINITION
According to WHO Health Care Waste Health care
waste (HCW) is defined as the total waste stream
from a healthcare facility (HCF) that includes both
potential risk waste and non risk material.
According to Bio-Medical Waste (Management and
Handling) Rules, 1998 of India Bio-medical
waste, any solid, fluid or liquid waste, including
its container and any intermediate product, which
is generated during the diagnosis, treatment or
immunization of human beings or animals,
inresearch pertaining there to, or in the production
or testing of biological and the animal waste from
slaughter houses or any other like establishments.
CLASSIFICATION OF HEALTH CARE WASTE
S.N
Waste category
Description and examples
Infectious waste
Waste suspected to contain pathogen e.g.
laboratory culture , waste from isolation
ward , tissues (swabs) , Materials and
equipments that have been contact with
infected patient etc.
Pathological waste
Human tissue or fluids e.g. body parts,
blood and other body fluid , fetuses
Sharps waste
Sharpe waste e.g. Needle, infusion sets,
Scalpels, knives , blade , broken glass,
Pharmaceutical waste
Waste containing Pharmaceuticals e.g
Pharmaceuticals that are expired or no
longer needed ; items contaminated by or
containing pharmaceuticals ( Bottle , Boxes)
Geonotoxic Waste
Waste containing Substances with genotoxic
properties e.g waste containing cytostatic,
genotoxic chemical.
CLASSIFICATION OF HEALTH
CARE WASTE
S.N
Waste category
Description and examples
Chemical Waste
Waste containing chemical substances
e.g. Laboratory reagent , film developer,
Disinfectants , that are expired or no
longer needed , solvents
Waste with high
content of heavy
metals
Batteries, broken Thermometer, Blood
Pressure gauges, etc.
Pressurized container
Gas cylinder, gas cartridges
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 radio nuclides,
sealed sources.
HEALTHCARE WASTE CHARACTERIZATION
Non risk waste (75 -90)Percent
Risk waste (10 -25) Percent
SOURCES OF HEALTH CARE
WASTE
Hospitals
Health clinics
Dental clinics
Dispensaries
Blood bank & blood collection service
Dialysis centers
Medical & bio medical laboratories
Medical Research centers
Military medical services
Animal research & testing
CLASSIFICATION OF HEALTH CARE
WASTE IN THE CONTEXT OF NEPAL
Based on characteristics of waste
Health
Non-hazardous
Care Waste waste
Hazardous
waste
GENERATION OF HOSPITAL WASTE
IN SOUTH ASIAN COUNTRIES
Country
Waste generation
(Kg/bed/day)
Annual waste
generation
Bangladesh
0.8-1.67
93,0755 tons (255
ton/day)
(only in Dhaka)
Bhutan
0.27
73 tons
India
1.0-2.0
0.33 million ton
Maldives
NA
146 tons
Nepal
0.5
2,018 tons
Pakistan
1.63-3.69
0.25 million tons
Sri Lanka
0.36
6,600 tons (only from
Colombo)
COMPOSITION OF HEALTH CARE
WASTE
80 % general health care waste
15 % pathological & infectious waste
1 % sharp waste
3 % chemical or pharmaceutical waste
Less than 1% special waste (radio active ,
cytotoxic, pressurized containers or broken
thermometer & used batteries)
IMPLICATIONS OF HEALTHCARE
WASTE
To the health care provider and patient
. Needle stick injuries (accidental or
intentional as in re-cap, reuse or wrong
technique )
.
Cuts from other sharps not properly
disposed
. Blast injury
. Exposure to radioactive materials
. Abnormalities of the fetuses in pregnant
women
1.
2 Infections:
Transmission of infections e.g. hepatitis A, B, C,
HIV/AIDS
Enteric infections transmitted by flies feeding on
wastes e.g. cholera, dysentery
Skin and blood infections resulting from direct
contact with waste and infected wounds
Eye and Respiratory infections resulting from
exposure to infected dust, especially during
landfill operations
Zoo noses
resulting from bites by wild or stray
animals feeding on wastes
3 .Chronic Diseases
Incineration operations are especially at risk
of
chronic respiratory diseases, including cancers
resulting from exposure to dust and hazardous
compound
4. Accidents:
Musculoskeletal disorders resulting from the
handling of heavy containers
Wounds most often infected resulting from
contact with sharp items
Poisoning and chemical burns resulting from
contact with small amounts of hazardous chemical
waste mixed with general wastes
Burns and other injuries resulting from
occupational
accidents at waste disposal sites, or from methane
HEALTH HAZARDS OF HEALTH
CARE WASTE
Exposure to hazardous health care waste
result in
Disease or injury.
Others
Breeding of flies and insects
Proliferation of rodents
Air pollution
Water pollution
Land pollution
Mechanical injury
Re-circulation of waste
Loss of aesthetics
Nuclear waste hazards & carcinogenic effects
Injury from improperly disposed sharps
Environmental pollution or degradation, e.g.
air, water
Exposure to radioactive waste
Injuries from blasts
Hazards of scavenging
Toxic waste effects
Fires
Public nuisance (offensive smells, unsightly
debris
WHY THE HEALTH CARE
WASTE ARE HAZARDOUS
It
contains infectious agent
It is genotoxic
It contains toxic or hazardous chemical
It contain sharp
RISK POPULATION
Medical doctors , nurses , health care
auxiliaries, hospital maintenance staff
personnel.
Patient in health care
Visitors in health care
Workers in waste handling , transportation, &
waste disposal facilities.
Rag pickers
WASTE MANAGEMENT
1.
2.
3.
4.
Identification & segregation
Handling (collection, measurement, storage
& transport)
Treatment
Disposal
Color coding & types of container for disposal of BioMedical Waste
Colour
Coding
Type
ofContainers
Waste
Category
Description
Yellow
Plastic bag
1,2,3,6
Infectious , pathological,
sharps , chemical
Red
Disinfected
Container/
Plastic bag
3,6,7
Sharps , chemical ,
waste with high contain
of heavy metals
Blue/ White
translucent
Plastic
bag/puncture
proof container
4,7
Pharmaceutical waste ,
waste with high contain
of heavy metals
Black
Plastic bag
5,9,10 (Solid) Genotoxic , radio
active , solid waste
a) COLLECTION OF WASTE
Waste are generally collected in Bin or Bags
Black
:-General or non hazardous waste
Yellow :- Hazardous waste & sharps
For sharp objects:
Must
be collected at the point of generation, in a
leak-proof and puncture-resistant container.
Containers should never be completely filled.
COLLECTION OF HAZARDOUS
WASTE CONT
Only one staff for collection for Hazardous
waste and incineration
Once a day
hazardous waste collected in incinerator
room & immediately burn.
No measurement system, approximately 50
kg per day
SANITARY STAFF AND SWEEPERS
SHALL ENSURE THAT:
a) Waste is collected at least daily, but more
often if necessary;
b) All bags should be labeled before
removal, indicating the point of production,
ward and hospital, and contents
c) Bags and containers which are removed
are immediately replaced with new ones
d) Where a waste bag is removed form a
container, the container is properly cleane
before a new bag is fitted there in.
B) MEASUREMENT
Measurement Health care waste is done to
Keep record about amounts of waste
generated.
C) STORAGE OF WASTE
Waste should be storage with respect to
temperature and climate.eg 72 hours in
winter & 48 hours in summer
D) TRANSPORTATION OF
WASTE
By means of wheeled trolleys, containers, or
carts that are not used for any other purpose
and meet the following specifications:
Easy
to load & unload
No sharp edges that could damage waste bags or
containers during loading & unloading
Easy to clean
Yellow-bagged hazardous waste and blackbagged general waste shall be collected
on separate trolleys.
All yellow-bagged waste is collected at least
once daily;
The collection route shall be the most direct
one from the final collection point to the
central storage facility designed in waste
management plan.
All concerned staff members should properly
trained in handling, loading and unloading,
transportation and disposal.
All vehicles should decontaminated, cleaned,
and disinfected after use.
STORAGE
For storage separate central storage facility
should be provided and located within the
health care institution and its Designated
should be
located within the health care institution .
easy to clean and disinfect.
Be large enough to contain all the hazardous.
Have adequate cleaning, equipment,
protective clothing and waste bags and
containers located nearby .
3. TREATMENT & DISPOSAL TECHNIQUE FOR HEALTH CARE WASTE
I.
II.
III.
IV.
V.
VI.
Incineration
Chemical disinfection
Wet & dry thermal treatment
Microwave irradiation
Land disposal
Inertization
I.
INCINERATION
It is a high temperature dry oxidation
process.
Reduces organic & combustible waste to
inorganic & incombustible waste.
For most hazardous waste .
It is used for waste that cant be recycled.
Results in significant reduction of waste
volume & weight.
NOT TO BE INCINERATED
Wastes like high mercury, cadmium e.g.
broken thermometer, used batteries
Ampules containing heavy metals
Photographic/radiographic wastes
II.CHEMICAL DISINFECTION
To kill or inactivate pathogens it contained.
Disinfection rather than sterilization
Most suitable for liquid waste eg urine,
blood, stool, hospital sewage,
microbiological cultures
III. WET & DRY THERMAL TREATMENT
Wet thermal treatment:
. Similar to autoclave sterilization process.
. Inappropriate for the treatment of
anatomical waste & animal carcasses.
1.
2.Screw feed/dry thermal technology:
Non burn , dry thermal disinfection process
in which waste is shredded & heated in a
rotating auger.
Suitable for infectious waste & sharps.
But not to be used for pathological ,cytotoxic
or radioactive waste.
IV. MICROWAVE IRRADIATION
Most organism destroyed by the of micro
wave of frequency of 2450 MHZ & a wave
length of 12.24 nm.
The efficiency of microwave disinfection
checked routinely through bacteriological
and virological test.
V.LAND DISPOSAL
If hazardous health-care waste cannot be
treated or disposed
Investigate more suitable treatment methods
disposal sites:
land open dumps
Sanitary landfills.
VI.INERTIZATION
Mixing waste with cement & other
substances before disposal
Inhibits the waste migrating into the surface
& ground water
Proportion of mixture is 65% pharmaceutical
waste,15%lime,15% cement & 5% water.
WASTE MANAGEMENT SYSTEM
IN BIR HOSPITAL
Zero waste concept
Waste is managed and the waste disposed
into Kathmandus municipal waste stream is
negligible Based on three pillars that
support each other
1.
2.
3.
waste management
Injection safety
Mercury elimination
PROCEDURE BASED ON
1.
2.
3.
Segregating waste at the source
Waste transportation
Waste treatment and storage centre
a)
b)
c)
Steam based technology, that is,autoclaving
Chemical treatment
Biological treatment
4. Mercury collection house
5. Handicrafts made from waste plastic
Segregation of waste
Wastes are segregated at the source in
different color coding bucket.
Trolley used by medical personnel for
segregation of risk and non-risk waste
Medical personnel trained for safe injection
practice.
WASTE TRANSPORTATION
Waste are transported waste once a day by
using two colored trolley a green trolley for
non-risk and red trolley for risk waste
Handled by Trained staff.
WASTE TREATMENT AND
STORAGE
Waste are storage and treated in treatment
centre. The waste treatment and storage
center is separated into two distinct areas
for risk and non-risk waste.
The collected waste from the non-risk
trolleys is weighed by category and data is
recorded.
Waste from the risk trolley is brought to its
own area in order to undergo packaging for
the safety of those working with the waste.
Infectious waste is packaged in red cartoon.
Similarly, syringes are packaged in drums.
Treated by 2 methods
Chemical Treatment -by using chemical
Biological Treatment - By using vermicomposting method
MERCURY COLLECTION HOUSE
Mercury-containing thermometers, mercurycontaining sphygmomanometers (blood
pressure devices), and damaged mercurycontaining lightning tubes were collected
from each and every ward and unit. These
mercury-containing materials are sealed and
stored in the mercury collection house.
MERCURY COLLECTION
HOUSE
Mercury-containing thermometers, mercurycontaining sphygmomanometers (blood
pressure devices), and damaged mercurycontaining lightning tubes were collected
from each and every ward and unit.
These mercury-containing materials are
sealed and stored in the mercury collection
house.
LEGISLATION, POLICY AND
GUIDELINE IN NEPAL
Environmental protection Act 1997
Solid Waste Management and Resource
Mobilization Act, 1987
The Labor Act, 1991
Industrial Enterprise Act, 1992
The Town Development Act, 1988
The Local Self- Governance Act, 1999
REFERENCES
Health care waste management ENGR (MRS.)
OA MOKUOLU FNSE SQHN 2009
http://www.who.int/water_sanitation_healt
h/medicalwaste/002to019.pdf
NHRC REPORT
K. Park 19th edition
Regional workshop on health care waste
management December 2011.
South Asain expert workshop 2006
Thank you
