Module
T5
Waste
Management
Healthcare
waste
(HCW)
• According
to
World
Health
Organiza8on,
"Healthcare
waste
(HCW)
is
defined
as
the
total
waste
stream
from
a
healthcare
facility
(HCF)
like-‐
• by-‐product
of
healthcare
that
includes
sharps,
non-‐sharps,
blood,
body
parts,
chemicals,
pharmaceu8cals,
medical
devices
and
radioac8ve
materials".
HCW
Management
• The
various
steps
involved
in
the
healthcare
waste
management
are:
– Genera8on
of
hazardous
or
infec8ous
waste
– Segrega8on
– Temporary
Storage
– Transport
– Treatment
– Reuse/Recycling
– Recovery
– Final
Disposal
HCW
Management
• Effec8ve
and
efficient
healthcare
waste
management
is
required
to
reduce
the
amount
of
hazardous
and
infec8ous
wastes
produced
in
the
health
care
facili8es.
• Effec8ve
healthcare
waste
management
not
only
helps
the
community
and
people,
but
also
helps
the
health
care
facili8es
and
can
bring
in
financial
benefits
along
with
health
and
environmental
benefits.
HCW
Management
• Some
of
the
benefits
are
men8oned
below:
– By
separa8ng
municipal
and
genuinely
infec8ous
waste,
we
can
minimize
the
amount
of
waste
that
requires
the
most
expensive
forms
of
treatment.
– Effec@ve
segrega@on
keeps
ordinary
glass,
plas8c
and
paper
away
from
infec8ous
materials,
allowing
them
to
be
recycled.
– Most
of
the
infec8ous
waste
is
incinerated
and
this
pollutes
the
environment.
Hence
the
segrega8on
of
wastes
reduces
the
hospital's
environmental
footprint.
HCW
Management
• Improper
management
of
HCW
results
in
infec8ons,
injuries
or
health
hazards
for
-‐
• healthcare
workers,
• waste
handlers,
and
• the
community.
• In
United
States
of
America
alone,
the
hospitals
generate
approximately
6,600
tons
of
waste
in
a
day.
Environmental
Concerns
• Hospitals
are
massive
resource
users
from
the
environment
and
massive
distracters
of
environment.
• It
has
been
es8mated
that
the
health
care
facility
ac8vi8es
have
been
es8mated
to
represent
3–8%
of
the
climate
change
footprint
in
developed-‐
country
se^ngs.
• This
shows
that
the
hospitals
and
health
care
facili8es
share
huge
responsibili8es
in
protec8ng
the
environment
and
contribu8ng
to
its
development.
Environmental
Concerns
• Input
and
output
of
the
hospitals
in
terms
of
resources
from
environment
Extrac8on
of
resources
Contribu8on
of
emissions,
from
the
Environment
wastes,
and
discharges
to
the
environment
Human
Resource
Energy
+
Healthcare
Material
Facility
Liquid
waste
Biohazardous
waste
Non-‐biohazardous
waste
Air
Management
of
Health
Care
Waste
Basic
principles
ØThe
managers/heads
of
health-‐care
establishments
are
responsible
for
health
protec8on
and
safety
at
the
workplace
and
bear
legal
responsibility
for
the
safe
disposal
of
health-‐care
waste
generated
in
their
establishments.
Basic
principles
Ø Managers/heads
should
therefore
take
all
reasonable
measures
to:
– prevent
health-‐care
waste
from
causing
environmental
pollu@on
or
adverse
effects
on
human
health;
– ensure
that
health-‐care
waste
is
adequately
segregated
and
safely
packed,
especially
in
the
case
of
sharps
which
should
be
packed
in
puncture-‐proof
containers;
Basic
principles
Ø Managers/heads
should
therefore
take
all
reasonable
measures
to:
– ensure
that
bags
or
containers
of
health-‐care
waste
are
handled
only
those
of
officially
licensed
to
transport
and/or
dispose
of
such
waste;
– ensure
that
a
transfer
note
describing
the
waste
is
handed
to
the
recipient
when
waste
is
transferred;
– check
that
the
driver
of
the
collec8on
vehicle
is
aware
of
the
rules
governing
transport
of
hazardous
goods.
Basic
principles
Ø Safe
collec8on
and
disposal
of
health-‐care
waste
from
the
facili8es
usually
not
treat
their
own
waste
include
the
following:
– the
local
authority
or
an
authorized
private
contractor
collects
the
waste
for
treatment
at
a
local
hospital
incinerator
or
other
facility;
– an
authorized
private
contractor
collects
and
treats
the
waste
at
the
contractor’s
treatment
facility;
– the
local
authority
or
an
authorized
private
contractor
collects
the
waste
for
treatment
at
a
municipal
waste
incinerator
or
for
treatment
by
another
disinfec8on
or
confinement
process.
Basic
Rules
Ø Arrangements
should
be
made
for
waste
segrega8on,
collec8on,
specific
containers
for
sharps,
and
infec8ous
waste.
Ø When
an
injec8on
is
carried
out
at
a
pa8ent’s
home,
the
prac88oner
is
responsible
for
disposing
of
syringes,
needles,
and
all
other
items
used.
Ø Prac88oners’
employees
should
be
informed
of
policy
and
procedures
of
health-‐care
waste
disposal,
including
any
special
arrangements
with
hospitals,
clinics,
or
local
authori8es,
and
should
be
appropriately
trained.
Basic
Rules
Ø Highly
infec8ous
waste
should
be
autoclaved
or
incinerated
on
site
whenever
possible
and
should
be
handled
only
by
trained
and
authorized
staff.
Ø If
on-‐site
treatment
is
impossible
or
uneconomical,
cooled
storage
facili8es
should
be
provided
and
there
should
be
a
regular
collec8on
by
a
contractor
who
has
suitable
incinera8on
facili8es.
Ø Carcasses
that
cannot
be
destroyed
immediately
acer
experimenta8on
should
be
stored
at
a
temperature
below
-‐20oC.
Basic
Rules
Ø Waste
from
clinics
or
nursing
homes
will
consist
mainly
of
swabs,
soiled
dressings,
sharps,
stoma
bags,
and
incon8nence
pads.
Suitable
containers
will
be
required
for
infec8ous
waste
and
sharps.
The
Head
of
each
establishment
is
responsible
for
the
training
of
all
personnel
and
for
implemen8ng
segrega8on
prac8ces.
Parameters
to
be
monitored
• Waste
generated
each
month,
by
waste
category:
– in
each
department;
– treatment
and
disposal
methods.
• Financial
aspects
of
health-‐care
waste
management:
– direct
costs
of
supplies
and
materials
used
for
collec8on,
transport,
storage,
– treatment,
disposal,
decontamina8on,
and
cleaning;
– training
costs
(labour
and
material);
– costs
of
opera8on
and
maintenance
of
on-‐site
treatment
facili8es;
– costs
for
contractor
services.
Parameters
to
be
monitored
• Public
health
aspects:
– Incidents
resul8ng
in
injury,
“near
misses”,
or
failures
in
the
handling,
separa8on,
storage,
transport,
or
disposal
system,
which
should
also
be
reported
to
Biosafety
Office;
this
will
be
the
basis
for
preven8ve
measures
to
prevent
recurrences.
Topics
Covered
Ø Decontamina8on
and
different
ways
of
decontamina8on
Ø Waste
management
plan
Ø Guideline
for
biological
waste
management
Decontamina8on
Decontamina8on
To
remove,
inac8vate,
or
destroy
hazardous
materials,
by
the
use
of
physical
or
chemical
means
on
a
surface
or
items
to
the
point
where
they
are
no
longer
capable
of
transmi^ng
infec8ous
par8cles
and
the
surface
or
item
is
rendered
safe
for
handling,
use,
or
disposal.
Different
ways
of
Decontamina8on
Decontamina8on
is
the
reduc8on
of
contaminants
to
an
acceptable
level.
Methods
applied
to
reach
this
goal
most
ocen
include:
vDisinfec8on
vSteriliza8on
Disinfec8on
Disinfec8on
is
used
when
the
acceptable
level
of
microorganisms
is
defined
as
being
below
the
level
necessary
to
cause
disease.
This
means
that
viable
microorganisms
may
s8ll
be
present.
Example:
decontamina8on
of
a
surface
(e.g.,
lab
bench)
is
accomplished
with
a
disinfectant
Disinfec@on
• Disinfec(on
is
the
process
of
reducing
a
contaminant
load
• Can
be
accomplished
in
the
laboratory
using
a
70%
solu8on
of
ethanol
(EtOH)
or
a
10%
solu8on
of
bleach
(sodium
hypochlorite)
• All
works
surfaces
and
materials
should
be
disinfected
before
and
acer
use
When
dissolved
in
water
it
will
• SOPs
for
rou8ne
decontamina8on
are
available
at
BSO
slowly
decompose,
releasing
chlorine,
oxygen
and
sodium
and
hydroxide
ions.
4
NaClO
+
2
H2O
→
4
Na+
+
4
OH-‐
+
2
Cl2
+
O2
Steriliza8on
Steriliza8on
is
defined
as
the
complete
killing
of
all
organisms
present.
Example:
decontamina8on
of
biomedical
waste
is
done
by
steriliza8on
in
an
autoclave.
Choosing
a
method
of
decontamina8on
When
choosing
a
method
of
decontamina8on,
it
is
important
to
consider
the
following
aspects:
• Type
of
biohazardous
agents,
concentra8on,
and
poten8al
for
exposure;
• Physical
and
chemical
hazards
to
products,
materials,
environment
and
personnel.
Ways
to
Decontaminate
Physical
and
chemical
means
of
decontamina8on
fall
into
four
main
categories:
• Heat
• Liquid
chemicals
• Vapors
and
gases,
and
• Radia8on
Increasing
Resistance
to
Chemical
Disinfectants
LEAST
Examples
RESISTANT
LIPID
OR
MEDIUM-‐SIZE
Cytomegalovirus,
Herpes
simplex
Virus
VIRUSES
Hepa88s
B
virus,
HIV
¦
¦
VEGETATIVE
BACTERIA
P.
aeruginosa
S.
aureus
¦
S.
choleraesuis
¦
FUNGI
Trichophuton
sp.
¦
¦
Cryptococcus
sp.
Candida
sp
¦
NONLIPID
OR
SMALL
Poliovirus
Coxsackievirus
¦
VIRUSES
Rhinovirus
\/
MYCOBACTERIA
Mycobacterium
tuberculosis;
M.
bovis
MOST
RESISTANT
BACTERIAL
SPORES
Bacillus
sub(lis
Clostridium
sporogenes
Characteris8cs
of
generally
used
“Chemical
Disinfectants
They
vary
greatly
in
their
efficiency,
depending
on
the
chemical
cons8tuents
and
the
agents
involved.
In
general,
these
can
be
categorized
as-‐
§Halogens
§Acids
or
alkalines
§Heavy
metal
salts
§Quaternary
ammonium
compounds
§Aldehydes
§Ketones
§Alcohols,
and
§Amines
Ac8vity
levels
of
selected
liquid
germicides
PROCEDURE/PRODUCT
AQUEOUS
CONCENTRATION
ACTIVITY
LEVEL
Glutaraldehyde
Variable
High
to
intermediate
Ortho-‐phthalaldehyde
0.5%
High
Hydrogen
peroxide
3-‐6%
High
to
intermediate
Formaldehyde
1-‐8%
High
to
low
Chlorine
dioxide
variable
High
Perace8c
acid
variable
High
Chlorine
compounds
500
to
5000
mg/L
free/ Intermediate
available
Cl
Alcohols(ethyl,isopropyl)
70%
Intermediate
Phenolic
compounds
0.5
to
3%
Intermediate
to
low
Iodophor
compounds
30-‐50
mg/L
free
or
up
to
Intermediate
to
low
10,000
mg/L
available
I
Quaternary
ammonium
0.1
-‐
0.2%
Low
compounds
Steriliza8on
Any
item,
device,
or
solu8on
is
considered
to
be
sterile
when
it
is
completely
free
of
all
living
microorganisms
and
viruses.
Steriliza8on
is
par8cularly
used
in
laboratories
for-‐
vSteriliza8on
of
laboratory
glassware
and
other
materials
for
use
and
recycling
vSteriliza8on
of
media
used
for
cell
growth
vSteriliza8on
of
biohazardous
waste
for
disposal
Decontamina8on:
Vapor
and
Gases
• A
variety
of
vapors
and
gases
possess
germicidal
proper8es.
– Formaldehyde
and
ethylene
oxide:
Applied
in
closed
systems
under
controlled
condi8ons
(e.g.,
humidity)
these
gases
achieve
sterility.
– Formaldehyde
gas
is
primarily
used
in
the
decontamina8on
of
spaces
or
biological
containment
equipment
like
biological
safety
cabinets.
Decontamina8on:
Vapor
and
Gases
• A
variety
of
vapors
and
gases
possess
germicidal
proper8es.
– Formaldehyde
is
a
toxic
substance
and
a
suspected
human
carcinogen.
– Considerable
cau8on
must
be
exercised
in
handling,
storing,
and
using
formaldehyde.
– Ethylene
oxide
is
used
in
gas
sterilizers
under
controlled
condi8ons.
– Ethylene
oxide
is
also
a
human
carcinogen
and
monitoring
is
necessary
during
its
use.
Decontamina8on:
Gamma
and
X-‐ray
• Gamma
and
X-‐ray
are
two
principal
types
of
ionizing
radia8on
used
in
steriliza8on.
– Their
applica8on
is
mainly
centered
on
the
steriliza8on
of
prepackaged
medical
devices.
Decontamina8on:
UV
radia8on
• Ultraviolet
(UV)
radia8on
is
a
prac8cal
method
for
inac8va8ng
viruses,
mycoplasma,
bacteria
and
fungi.
– UV
radia8on
is
successfully
used
in
the
destruc8on
of
airborne
microorganisms.
– The
sterilizing
capabili8es
of
UV
light,
such
as
that
found
in
biosafety
cabinets,
are
limited
on
surfaces
because
of
its
lack
of
penetra8ng
power.
Decontamina8on:
Incinera8on
• Incinera8on
is
useful
for
disposing
of
animal
carcasses
as
well
as
anatomical
and
other
laboratory
waste,
with
or
without
prior
decontamina8on.
Waste
management
plan
Total
waste
stream
Hospital
Office
Lab
Building
Power
Motor
waste
waste
waste
waste
generator
vehicle
waste
waste
ETP???
Food
Biohazardous
Chemical
waste
waste
waste
Nonbiohazardous
waste
MSDS!!!
Recyclable
Nonrecyclable
waste
waste
Biohazardous
waste
&
treatment
Research
Hospital
Clinical
BSL3
Labs
Labs
ARB
SRU
Lab
Biohazardous
and
mixed
waste
Chemical
Autoclave
Incinera8on
Nonbiohazardous
Guideline
for
Waste
management
Biohazardous/Medical
Waste
o Cultures
and
stocks
of
infec8ous
agents
and
associated
biologicals,
including
laboratory
waste,
biological
produc8on
waste,
discarded
live
and
aqenuated
vaccines,
culture
dishes,
and
related
devices.
o Liquid
human
and
animal
waste,
including
blood
and
blood
products
and
body
fluids,
but
not
including
urine
or
materials
stained
with
blood
or
body
fluids.
o Sharps:
Defined
as
needles,
syringes,
scalpels,
and
intravenous
tubing
with
needles
aqached
regardless
of
whether
they
are
contaminated
or
not.
o Contaminated
wastes
from
animals
that
have
been
exposed
to
agents
infec8ous
to
humans,
these
being
primarily
research
animals.
Biohazardous/Regulated
waste
o Liquid
or
semi-‐liquid
blood
or
other
poten8ally
infec8ous
materials;
o Contaminated
items
that
would
release
blood
or
other
poten8ally
infec8ous
materials
in
a
liquid
or
semi-‐liquid
state
if
compressed;
o Items
that
are
caked
with
dried
blood
or
other
poten8ally
infec8ous
materials
and
are
capable
of
releasing
these
materials
during
handling;
o Contaminated
sharps
which
includes
any
contaminated
object
that
can
penetrate
the
skin;
o Pathological
and
microbiological
wastes
containing
blood
or
other
poten8ally
infec8ous
materials.
Biohazardous
waste
o Laboratory
waste
are
defined
in
the
Guidelines
For
Research
Involving
Recombinant
DNA
Molecules
(NIH)
and
the
CDC/NIH
Biosafety
in
Microbiological
and
Biomedical
Laboratories-‐
– The
CDC/NIH
Biosafety
Guidelines
cover
contaminated
waste
that
is
poten8ally
infec8ous
or
hazardous
for
humans
and
animals.
– The
same
is
true
for
the
NIH
Guidelines
on
recombinant
DNA
which
also
cover
contaminated
waste
poten8ally
infec8ous
or
hazardous
for
plants.
Waste
Segrega@on,
Packaging,
pickup
and
Sending
To
properly
segregate,
package,
label,
and
pickup
waste
generated
during
diagnos8c
or
research
purpose
at
different
biosafety
level
laboratories
at
icdd,b.
§ Solid
Biological
§ Liquid
Biological
§ Mixed
Wastes
§ Sharps
Waste
§ Non-‐biohazardous
waste
Waste
Segrega@on,
Packaging,
pickup
and
Sending
• Waste
pickup
from
laboratories
• Waste
pickup
from
hospital
facili@es
• Sending
of
waste
for
treatment
• Storage
of
biohazardous
waste
Waste
Treatment
Procedures
To
properly
render
all
the
biohazardous
generated
during
diagnos8cs
or
research
purposes
at
different
biosafety
level
laboratories
at
icddr,b
to
non-‐biohazrdous
waste
before
disposal.
• Autoclaving
• Inac@va@on
Chemical
Treatment
• Incinera@on
Recycling
of
Sterilize
materials
To
help
to
promote
a
green
and
clean
environment
by
helping
to
reduce
medical
waste
incinera8on,
reduce
landfill
volume,
and
to
reduce
carbon
emissions,
by
recycling
of
sterilized
plas8c
or
metal
waste
that
came
in
contact
with
infec8ous
materials.
• Segrega@on
• Steriliza@on
• Recycling
Disposal
of
laboratory
equipments
&
furniture
• To
properly
dispose
all
laboratory
equipments
and
furniture
used
for
diagnos8c
or
research
facili8es
considering
all
risks
during
disposal,
for
all
the
lab
personals,
suppor8ng
staffs,
and
for
the
environment
acer
disposal.
• Decontamina@on
• Disposal
Disposal
of
Vaccines
• Unused
vaccine
and
diluent
returnable
to
vaccine
supplier
• Disposal
of
a`enuated
live
or
low
virulence
vaccines
• Disposal
of
preserva@ve-‐free
whole
cell
killed
vaccine
• Disposal
of
protein
subunit
vaccines
• Disposal
of
manufacturer-‐supplied
prefilled
syringes
• Disposal
of
empty
vaccine
vials
• Disposal
of
used
needles,
used
syringes,
or
sharps
Specific
procedure
for
BSL2
• If
not
stated
otherwise,
most
biohazardous
waste
will
be
disposed
of
in
biohazard
bags
for
autoclaving.
Specific
procedure
for
BSL2
• Biohazardous
waste
that
will
not
be
autoclaved
before
disposal,
directly
incinerated
before
disposal
will
be
disposed
in
burn
box
lined
with
autoclave
bag.
Specific
procedure
for
BSL2
• Cultures,
Stocks
and
Related
Materials
Cultures
and
stocks
of
infec8ous
agents
and
associated
biologicals
(as
defined
above),
shall
be
placed
in
biohazard
bags
and
decontaminated
by
autoclaving.
Double
or
triple
bagging
may
be
required
to
avoid
rupture
or
puncture
of
the
bags.
Specific
procedure
for
BSL2
Bulk
Liquid
Waste,
Blood
and
Blood
Products
All
liquid
waste
from
humans
or
animals
that
may
contain
blood,
blood
products
and
certain
body
fluids,
that
may
contain
infec8ous
agents,
can
be
disposed
of
directly
by
flushing
down
a
sanitary
sewer
acer
approved
chemical
treatment.
However,
due
to
coagula8on,
flushing
of
large
quan88es
of
blood
is
imprac8cal
and
chemical
treatment
may
not
be
enough
to
kill
infec8ous
material
in
blood.
USE
of
BI
Specific
procedure
for
BSL2
• Sharps
All
sharps
must
be
placed
in
a
rigid,
puncture
resistant,
closable
and
leakproof
container,
which
is
labeled
with
the
word
"Sharps"
and
the
biohazard
symbol.
• When
a
sharps
container
is
first
put
into
use
it
must
be
labeled
with
a
completed
sharps
label.
• All
sharps
must
be
handled
with
extreme
cau8on.
The
clipping,
breaking,
and
recapping
of
needles
is
not
recommended.
Specific
procedure
for
BSL2
• Contaminated
Solid
Waste
Contaminated
solid
waste
includes
cloth,
plas8c
and
paper
items
that
have
been
exposed
to
agents
infec8ous
or
hazardous
to
humans,
animals,
or
plants.
These
contaminated
items
shall
be
placed
in
biohazard
bags
and
decontaminated
by
autoclaving.
Specific
procedure
for
BSL3
• All
biohazardous
waste
including
RG-‐2
and
3
agents
that
are
handled
at
BSL3
is
to
be
autoclaved
at
the
point
of
origin
(laboratory,
or
facility).
Transporta8on
of
non-‐autoclaved
BSL3
waste
outside
of
the
building
is
generally
not
permiqed.
All
autoclaved
waste
is
further
incinerated
before
final
disposal.
Clinical
Laboratories’
waste
• All
waste
solid/liquid
are
treated
following
above
men8oned
guideline.
• All
waste
from
the
sample
recep8on
unit
is
disposed
in
burn
box
and
sent
to
incinerator
directly
by
covered
rickshaw
van.
Animal
waste
• All
animal
waste
is
incinerated
by
incinera8on
facility
following
ins8tu8onal
guideline.
Emergency
Response
Plan
(ERP)
• The
Emergency
Response
Plan
to
mi8gate
incidents
involving
Biohazardous
and
other
hazardous
materials
Ø Spill
response
Ø Exposure
control
and
post
exposure
prophylaxis
Waste
Minimiza8on
Plan
• Each
waste
generator
will
develop
a
wriqen
Waste
Minimiza8on
Plan
with
detailed
methods
to
reduce
the
volume
of
waste
generated.
This
plan
will
be
updated
annually.
Training
• Waste
management
training
is
required
for-‐
ü For
all
staff
and
students
who
may
generate
waste.
ü Refresher
training
is
also
required
annually.
ü Addi8onal
training
is
required
for
the
staff
involved
in
the
packaging
and
disposal
of
wastes
What’s
Wrong
with
these
Pictures?
Left: Sharps sticking out of Sharps Waste container.
Right: Sharps Waste container past full line. No generator label.
What’s
Wrong
With
Incinera8on?
The
air
emissions
affect
the
local
environment
and
may
affect
communi@es
hundreds
or
thousands
of
miles
away
Toxic air emissions
Incinera8on Toxic ash residue
The
ash
residue
is
sent
to
landfills
for
disposal,
where
the
pollutants
have
the
poten@al
to
leach
into
groundwater.
Other
methods
Waste
treated
by
other
methods
and
then
landfilled
will
also
produce
leachate.
Futuris8c
Approach
• hqp://www.ecodas.com/en/savoir_faire/
technique.php?menu=3&ssmenu=2&lang=en
ECODAS_EN.wmv
Thank
you
