Collection, Transportation,

Treatment & Disposal of

Laboratory waste

Presented By :
Yuresh Twayana
Medical Lab Technologist
 HCW (Health Care Waste) includes all the wastes generated by health-care
establishments, research facilities, and laboratories (WHO, 1999).
 HCW embraces all the wastes generated through all the medical activities as
• Diagnosis, preventive, curative and palliative treatments for human
beings
• Research pertaining to the above activities and
• Production or testing of biologicals
Health care waste divided as:
 Hospital waste: are waste generated from health care facilities including
cafeteria, office and construction waste.
 Medical waste (a subset of Hospital waste): waste generated as a result of
patient diagnosis, treatment and immunization of human beings or animals.
 Potentially infectious waste (a sub set of medical waste): that % of medical
waste potential to transmit infectious disease (10-25%).
 Bio-medical Waste

Waste generated during the diagnosis, treatment or immunization of human

beings or animals or in research activities pertaining there to or in the
production or testing of biological.
Includes
 Infectious: pathological waste, cotton, dressing, used needles, syringes,
scalpels, blades, glass etc.
 Non-infectious: general waste from the kitchen/canteen, packaging material
including radioactive wastes, mercury containing instruments, PVC plastics.
 SOURCE OF HEALTH CARE WASTE
 Governmental Hospital
 Private Hospital
 Nursing Homes
 Physician’s Office
 Dentist Office
 Dispensaries
 Blood Bank and collection center
 Mortuaries
 Animal Houses
 Laboratories
 Research Organizations
Classification of biomedical waste (WHO)
 Infectious waste

 Contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient

concentration or quantity to cause disease in susceptible hosts.
 Cultures and stocks of infectious agents from laboratory work
 Surgery and autopsies on patients with infectious diseases (e.g. tissues
and materials or equipment in contact with blood or other body
fluids.) (known as highly infectious waste)
 Waste from infected patients in isolation wards, patients undergoing
dialysis Infected animal carcasses from laboratories
 Any other instruments or materials including sharps that have been in
contact with infected persons or animals.
 Pathological waste
 Pathological waste consists of tissues, organs, body parts,
human fetuses, blood, and body fluids.
 (In some cases, recognizable human and animal body parts
are also called anatomical waste.)
 Sharps

 Sharps are items that could cause cuts or puncture wounds

 Including needles, hypodermic needles, scalpel and other
blades, knives, infusion sets, saws, broken glass, and nails
 such items are usually considered as highly hazardous waste
 Pharmaceutical waste

 Pharmaceutical waste includes expired, unused, spilt, and

contaminated pharmaceutical products, drugs, vaccines, and
sera that are no longer required and need to be disposed of
appropriately.

 discarded items used in the handling of pharmaceuticals, such

as bottles or boxes with residues, gloves, masks, connecting
tubing, and drug vials.
 Genotoxic waste

 Highly hazardous and may have mutagenic, teratogenic or

carcinogenic properties
 example of this type of waste is cytotoxic drugs that have the
ability to kill or stop the growth of living cells and are often
used in cancer chemotherapy.
 Chemical Waste
 consist of discarded solid, liquid, or gaseous chemicals used for
diagnostic or experimental purposes or for general cleaning,
housekeeping, and disinfecting procedures
 may be hazardous or non-hazardous
 Hazardous chemical waste may be toxic, corrosive, flammable, and
reactive. (formaldehyde, photographic chemicals, solvents, and other
chemicals)
 Wastes with High Content of Heavy Metals

 Highly toxic such as is the case with wastes with high

concentrations of mercury
 Cause neurological & behavioral disorder
 Pressurized Containers
 Many different types of gas are used in health care stored in
pressurized containers such as cylinders, cartridges, and
aerosol cans
 once empty or of no further use, must be disposed
 must be handled carefully since they may explode if
incinerated or accidentally punctured during handling
 Radioactive Waste

 Ionizing radiation is commonly used in medical treatment

 Eg - x-rays or the use of radionuclides in a laboratory setting
Radioactive waste can consist of
 solid, liquid, and gaseous materials produced from a number
of medical procedures
 such as the analysis of body tissue, organ imaging, and other
investigative or therapeutic practices
 Risk Groups
 Medical doctors, nurses, health care auxiliaries and hospital maintenance
personnel
 Patients & Visitors in health care establishments
 Workers such as laundries, waste handling and transportation, waste disposal
facilities such as land fills or incinerators
 Waste pickers (scavenger) & recyclers
 Drug addicts (who scavenge for used needles and disposed medicines); and
 The entire community.
Management of health care waste
 Waste Minimization

 Careful management prevents the accumulation of large quantity of

waste.
 Health care service providers and institutions administrator play
important role in reduction of waste volume.
 Is directly proportional with waste management cost and related
risk.
 Institution can adopt many policies and practices that might reduce
the waste volume.
 Some policies of waste minimization are;
1. Source reduction- Purchasing and supplies materials which are less
wasteful and or generate less medical waste.
2. Stock management- Frequent auditing; use oldest stock first and
checking the expired date of products during receiving and supplies
of goods.
3. Encourage use of Recyclable products- Use materials that can be
recycled both off-site or on-site.
4. Control at institution level- Centralized purchase and monitoring the
receipt and supply procedure of medical goods.
 Waste Segregation
 The whole waste management depends upon effective waste
segregation, because incorrect segregation creates lot of hassles in
the down stream of waste management.
 Proper segregation - small amount are needed for disposal instead of
large quantity of waste, ultimately related manpower, related cost,
related risk lowered.
 Improper segregation - small quantity of hazardous waste has a
chance to mix with large volume of non-hazardous waste making
the whole volume into hazardous waste.
 Segregation of medical waste is responsibility of waste producer
and waste should be segregated at the point just after its generation.
Avoid Mixing of various types of waste!!
 Waste Identification
 By sorting the waste into different COLOR CODE.
 Color code is easy for identification and thereby easy for safe
handling, transportation and waste treatment.
 The color code varies from country to country, due to
socioeconomic status, literacy rate, availability of local resources,
countries classification of waste etc.
Color-coding for collection of biomedical waste
Pathological waste Infectious waste Sharp waste
 Waste Handling
 Waste handling means the links between packing, storage and transportation
of medical waste from every area of the institution by designated individual.
 Waste Collection
 Waste should not accumulate at the point of birthplace.
Guidelines for waste collection :
 wear protective materials.
 waste in colored bag or colored covered bins.
 Waste should not be collected more the ¾ of containers capacity.
 If bag is used for waste collection, tie the neck tightly.
 Avoid throwing, dragging over floor or holding the bottom of the containers.
 No container should be used if damaged or licked.
 All bins should be covered with lid during
collection and transportation of waste.
 No container should be transported without
labeling.
 During collection each containers should be
replaced with a new one.
 Collection of Sharp medical waste under
maximum precaution.
 If there is spillage of waste from the
container (gently collect the waste into a bin,
soak the area with 2% Lysol solution, wait
for 30 minutes, then wash and wipe.
 Labelling
 Container labeled with some basic information’s: about its waste
category, weight of the waste materials, date of collection, and site of
waste production.
 Could be written on preprinted labels with irremovable or water
resistance ink.
 Labeled and marked with international symbol especially during
transportation.
 Safety measures
 Adopt universal precautions and appropriate safety measures while
doing therapeutic and diagnostic activities and also while handling
the biomedical waste.
 It should be ensured that:
- Person involved on collecting and carrying waste are aware of the
nature and risk of the waste.
- Written instructions, provided regarding the procedures to be
adopted in the event of spillage and/or accidents.
- Vaccination against infectious diseases (Hepatitis B, tetanus) is
given.
 Personal hygiene and hand hygiene
 In-house transportation
 Transportation of waste from the site of origin or collection to
temporary storage area within the institution.
 Transported by designated trolley, through the designated route
according to time schedule given by the institutional authority.
 A consignment note should accompany the waste during
transportation.
 The trolley or handcart should be easy to clean, loading and
unloading, leak proof body, should not be used in any other case
other then waste transportation.
 Normally waste should not be stored more then 24 hours.
 Transportation for out house management

 Transport of waste to the final disposal site.

 Collection of waste from different institute should be in a covered Van.
 The driver area should be totally separated from waste carrying area.
 Record keeping
 For effective medical waste management.
 Give some important information’s, which are needed for:
• Assess the recurrent expenditure
• Assess the quality and quantity of generated waste
• Assess the cost related with waste treatment and disposal method
• Assess the risk involved with generated waste, amount and
nature of accident, amount of damage, measure taken against
accident etc.
• Assess the failures, problem and obstacle in waste management
for better compliance of the program.
 Treatment of hospital waste
 Treatment of waste is required to disinfect the waste so that it is no
longer the source of infection, reduce the volume of the waste, make
waste unrecognizable for aesthetic reasons and make recycled items
unusable.
a. General waste (85% of hospital waste)
Safe disposal of this waste is necessary which the responsibility of the
local authority
b. Biomedical waste (15% of hospital waste)
 Incineration
 Description: A high temperature dry oxidation process that reduces organic and
combustible waste to inorganic matter.
 Types if Incinerators:
• Double chambered
(for infectious waste)
• Single chambered
(if double chamber not affordable)
• Rotatory Kilns
(for genotoxic waste)
Advantages:
• Requires no pre-treatment.
• Good disinfection efficiency.
Disadvantages:
• If not operated effectively may pollute atmosphere
(Generation of POPs e.g Dioxin and Furans)
• High capital and operational costs.
• Using a drum or brick incinerator –
large emission problems and are not
as effective in the destruction of hazards.
Suitable condition:
• >60% combustible
• Moisture content < 30%.
• Not suitable for pressurized gas canisters, reactive chemical waste, PVC, wastes with high
heavy metal content, photographic or radiography wastes.
 Chemical disinfection
Description:
 Chemicals added to the waste to kill/inactivate the pathogens.
 Commonly Used for treatment of liquid infectious waste eg. blood,
urine, stool and hospital sewage
 Aldehydes, chlorine compounds, phenolic compounds are added to
HCW to kill or inactivate pathogens.
 reaction with 5% sodium hypochlorite; acid hydrolysis followed by
alkaline hydrolysis; reduction using zinc powder, degradation using
30% hydrogen peroxide; and destruction using heated alkali
 Advantages:
• Efficient disinfection when operated well.
• Some chemical disinfectants are low cost.
• Shredding reduces volume of waste.

 Disadvantages:
• Disinfectants may themselves be hazardous to operators & pose risks in the
case of leakage and subsequent disposal.
• Needs highly trained operators.
• Shredder liable to mechanical failure ( surface of intact solid waste )

 Suitable condition:
• Best for liquid or sewage
• Inadequate for pharmaceutical, chemical and some types of infectious waste.
 Render inert
Description:
 Mixing the waste with cement in order to prevent migration of toxic substances
from waste into ground water etc.
 composition of 65% waste, 15% lime,
15% cement and 5% water

Advantages:
• Relatively low cost.
• Low-technology

Disadvantages:
• Bulky and heavy final waste product to
be disposed of.
• Especially suitable for pharmaceuticals.
 Wet thermal treatment (including autoclaving)
 Description: Exposure of shredded waste to high temperature, high-pressure
steam. If temperature and contact time is sufficient, most micro-organisms are
inactivated. Waste can subsequently be disposed of as municipal waste.
 Advantages:
• Relatively low capital and operating costs.
• Low environmental impact.

 Disadvantages:
• Shredder liable to mechanical failure.
• Efficiency of disinfection very sensitive to operational conditions.

 Suitable condition
• Not suitable for anatomical, pharmaceutical or chemical wastes.
 There are a number of medical waste components that should not be
incinerated including:
1. Pressurized gas containers.
2. Large amounts of reactive chemical waste.
3. Photographic or radiographic wastes.
4. Halogenated plastics such as polyvinyl chloride (PVC).
5. Waste with high mercury or cadmium content such as broken
thermometers and used batteries.
6. Sealed ampoules or ampoules containing heavy metals.
 Microwave irradiation
 Description:
Waste shredded, humidified and then irradiated by microwaves. The heat
generated (frequency 2450MHZ and wavelength 12.24cm )destroys micro-
organisms.
 Advantages:
• Very efficient disinfection when operated well. Environmentally sound.
Reduction in volume of waste.
 Disadvantages:
• Relatively high capital and operating costs.
• Potential operation and maintenance problems.
 Suitable condition
• Not suitable for pharmaceutical or chemical wastes
• Not suitable for large metal objects.
 Landfill
 It isolates waste from the environment; it requires appropriate engineering preparation,
staff to control operations, organized deposition and covering of waste. Waste may be
pre-treated . Ideally, healthcare waste is separated from municipal waste.

 Advantages:
• Simple, low cost & safe

 Disadvantages:
• scavengers may access the waste and
may cause pollution of environment etc.

 Suitable condition
• Generally suitable
 Encapsulate
 Description: Pre-treatment involving filling containers with waste, adding an immobilizing
material and sealing the container e.g. bituminous sand, cement mortar.

 Advantages:
• Preventing access to HCW by
scavengers.
• Relatively simple, low cost & safe

 Disadvantages:
• Not recommended as sole method for
non- sharp infectious waste.
• Bulky and heavy final waste product to
be disposed of.

 Suitable condition
• Appropriate for establishments using
minimal programs for disposal of sharps,
chemical or pharmaceutical residue.
Methods of treatment of HCWs
Health Care Waste Management at Clinic/Pathology lab clinic
 Reference
 Health Care Waste Management Guideline 2014
 CSH, 2013: Health Care Waste Management Policy at Civil Service
Hospital, Minbhawan, Kathmandu
 WHO, 1999: Safe management of wastes from health-care
activities, World Health Organization, Geneva
 WHO, 2011: Regional Workshop on Health Care Waste
Management, Kathmandu Nepal, 7-9 December,World Health
Organization, Regional Office for South-East Asia
 Remember…
Safety First!

LET THE WASTE OF THE “SICK” NOT CONTAMINATE THE

LIVES OF“THE HEALTHY”.
K.Park

Thank you