Biomedical waste or hospital waste is any kind of waste containing infectious (or
potentially infectious) materials generated during the treatment of humans or animals
as well as during research involving biologics. [1] It may also include waste associated
with the generation of biomedical waste that visually appears to be of medical or
laboratory origin (e.g. packaging, unused bandages, infusion kits etc.), as well
research laboratory waste containing biomolecules or organisms that are mainly
restricted from environmental release. As detailed below, discarded sharps are
considered biomedical waste whether they are contaminated or not, due to the
possibility of being contaminated with blood and their propensity to cause injury when
not properly contained and disposed. Biomedical waste is a type of biowaste.
Biomedical waste may be solid or liquid. Examples of infectious waste include
discarded blood, sharps, unwanted microbiological cultures and stocks, identifiable
body parts (including those as a result of amputation), other human or animal tissue,
used bandages and dressings, discarded gloves, other medical supplies that may have
been in contact with blood and body fluids, and laboratory waste that exhibits the
characteristics described above. Waste sharps include potentially contaminated used
(and unused discarded) needles, scalpels, lancets and other devices capable of
penetrating skin.
Biomedical waste is generated from biological and medical sources and activities,
such as the diagnosis, prevention, or treatment of diseases. Common generators (or
producers) of biomedical waste include hospitals, health clinics, nursing
homes, emergency medical services, medical research laboratories, o ices
of physicians, dentists, veterinarians, home health care and morgues or funeral
homes. In healthcare facilities (i.e. hospitals, clinics, doctor's o ices, veterinary
hospitals and clinical laboratories), waste with these characteristics may alternatively
be called medical or clinical waste.
Biomedical waste is distinct from normal trash or general waste, and di ers from
other types of hazardous waste, such as chemical, radioactive, universal or industrial
waste. Medical facilities generate waste
hazardous chemicals and radioactive materials. While such wastes are normally not
infectious, they require proper disposal. Some wastes are
considered multihazardous, such as tissue samples preserved in formalin.
E ects on humans
[edit]
Sharpsmart Reusable Sharps Container
Disposal of this waste is an environmental concern, as many medical wastes are
classified as infectious or biohazardous and could potentially lead to the spread
of infectious disease. The most common danger for humans is the infection which
also a ects other living organisms in the region. Daily exposure to the wastes
(landfills) leads to accumulation of harmful substances or microbes in the person's
body.
A 1990 report by the United States Agency for Toxic Substances and Disease
Registry concluded that the general public is not likely to be adversely a ected by
biomedical waste generated in the traditional healthcare setting. They found,
however, that biomedical waste from those settings may pose an injury and exposure
risks via occupational contact with medical waste for doctors, nurses, and janitorial,
laundry and refuse workers. Further, there are opportunities for the general public to
come into contact with medical waste, such as needles used illicitly outside
healthcare settings, or biomedical waste generated via home health care. [2]
Management
[edit]
Biomedical waste must be properly managed and disposed of to protect the
environment, general public and workers, especially healthcare and sanitation
workers who are at risk of exposure to biomedical waste as an occupational hazard.
Steps in the management of biomedical waste include generation, accumulation,
handling, storage, treatment, transport and disposal. [3]
The development and implementation of a national waste management policy can
improve biomedical waste management in health facilities in a country. [4]
On-site versus o -site
[edit]
These healthcare workers are being trained to safely
handle contaminated wastes before being assigned to an outbreak of Ebola
hemorrhagic fever.
Disposal occurs o -site, at a location that is di erent from the site of generation.
Treatment may occur on-site or o -site. On-site treatment of large quantities of
biomedical waste usually requires the use of relatively expensive equipment, and is
generally only cost e ective for very large hospitals and major universities who have
the space, labour and budget to operate such equipment. O -site treatment and
disposal involves hiring of a biomedical waste disposal service whose employees are
trained to collect and haul away biomedical waste in special containers for treatment
at a facility designed to handle biomedical waste.
Generation and accumulation
[edit]
Biomedical waste should be collected in containers that are leak-proof and
su iciently strong to prevent breakage during handling. Containers of biomedical
waste are marked with a biohazard symbol. The container, marking, and labels are
often red.
Discarded sharps are usually collected in specialized boxes, often called needle
boxes.
Specialized equipment is required to meet OSHA 29 CFR 1910.1450[5] and EPA 40 CFR
264.173.[6] standards of safety. Minimal recommended equipment include a fume
hood and primary and secondary waste containers to capture potential overflow. Even
beneath the fume hood, containers containing chemical contaminants should remain
closed when not in use. An open funnel placed in the mouth of a waste container has
been shown to allow significant evaporation of chemicals into the surrounding
atmosphere, which is then inhaled by laboratory personnel, and contributes a primary
component to the threat of completing the fire triangle. To protect the health and
safety of laboratory sta as well as neighboring civilians and the environment, proper
waste management equipment, such as the Burkle funnel in Europe and the ECO
Funnel in the U.S., should be utilized in any department which deals with chemical
waste. It is to be dumped after treatment.
Storage and handling
[edit]
Waste bin for infectious medical waste in a hospital in Poland
Storage refers to keeping the waste until it is treated on-site or transported o -site for
treatment or disposal. There are many options and containers for storage. Regulatory
agencies may limit the time for which waste can remain in storage. Handling is the act
of moving biomedical waste between the point of generation, accumulation areas,
storage locations and on-site treatment facilities. Workers who handle biomedical
waste must observe standard precautions.[7]
Treatment
[edit]
The goals of biomedical waste treatment are to reduce or eliminate the waste's
hazards, and usually to make the waste unrecognizable. Treatment should render the
waste safe for subsequent handling and disposal. There are several treatment
methods that can accomplish these goals. It includes segregating the bio waste.
Biomedical waste is often incinerated. An e icient incinerator will destroy pathogens
and sharps. Source materials are not recognizable in the resulting ash. Alternative
thermal treatment can also include technologies such as gasification [8] and pyrolysis
including energy recovery with similar waste volume reductions and pathogen
destruction.
An autoclave may also be used to treat biomedical waste. An autoclave uses steam
and pressure to sterilize the waste or reduce its microbiological load to a level at
which it may be safely disposed of. Many healthcare facilities routinely use an
autoclave to sterilize medical supplies. If the same autoclave is used to sterilize
supplies and treat biomedical waste, administrative controls must be used to prevent
the waste operations from contaminating the supplies. E ective administrative
controls include operator training, strict procedures, and separate times and space
for processing biomedical waste.
Microwave disinfection can also be employed for treatment of Biomedical wastes.
Microwave irradiation is a type of non-contact heating technologies for disinfection.
Microwave chemistry is based on e icient heating of materials by microwave
dielectric heating e ects. When exposed to microwave frequencies, the dipoles of the
water molecules present in cells re-align with the applied electric field. As the field
oscillates, the dipoles attempts to realign itself with the alternating electric field and
in this process, energy is lost in the form of heat through molecular friction and
dielectric loss. Microwave disinfection is a recently developed technology which
provides advantage over old existing technologies of autoclaves as microwave based
disinfection has less cycle time, power consumption and it requires minimal usage of
water and consumables as compared to autoclaves.
For liquids and small quantities, a 1–10% solution of bleach can be used to disinfect
biomedical waste. Solutions of sodium hydroxide and other chemical disinfectants
may also be used, depending on the waste's characteristics. Other treatment methods
include heat, alkaline digesters and the use of microwaves.
For autoclaves and microwave systems, a shredder may be used as a final treatment
step to render the waste unrecognizable. Some autoclaves have built in shredders.
Country-wise regulation and management
[edit]
The international symbol for biological hazard.
United Kingdom
[edit]
In the UK, clinical waste and the way it is to be handled is closely
regulated.[9] Applicable legislation[10] includes the Environmental Protection Act
1990 (Part II), Waste Management Licensing Regulations 1994, and the Hazardous
Waste Regulations (England & Wales) 2005, as well as the Special Waste Regulations
in Scotland. A scandal erupted in October 2018 when it emerged that Healthcare
Environment Services, which had contracts for managing clinical waste produced by
the NHS in Scotland and England, was in breach of the environmental permits at four
of its six sites by having more waste on site than their permit allows and storing waste
inappropriately. Seventeen NHS trusts in Yorkshire terminated their contracts
immediately. The company sued for compensation.[11] Amputated limbs were said to
be among 350 tonnes of clinical waste stockpiled instead of incinerated
in Normanton.[12] The company maintains that the problem was caused by a reduction
in incineration capacity, and the re-classification of clinical waste as "o ensive",
which meant more needed incineration. The government's contingency plans included
installing temporary storage units at hospitals, but the company say that this is more
dangerous than allowing them to exceed their permitted allowances. The company
still has contracts with 30 other trusts in England, and a waste disposal contract with
NHS England for primary care and pharmacy.[13]
United States
[edit]
In the United States, biomedical waste is usually regulated as medical waste. In 1988
the U.S. federal government passed the Medical Waste Tracking Act which allowed
the EPA to establish rules for management of medical waste in some parts of the
country. After the Act expired in 1991, responsibility to regulate and pass laws
concerning the disposal of medical waste returned to the individual states. The states
vary in their regulations from none to very strict.
In addition to on-site treatment or pickup by a biomedical waste disposal firm for o -
site treatment, a mail-back disposal option allows generators of waste to return it to
the manufacturer. For instance, waste medicines and equipment can be returned. The
waste is shipped through the U.S. postal service. While available in all 50 U.S. states,
mail-back medical waste disposal is limited by very strict postal regulations (i.e.,
collection containers must comply with requirements set out by the Food and Drug
Administration, while shipping containers must be approved by the postal service for
use).[14]
India
[edit]
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The Bio-medical Waste (Management and Handling) Rules, 1998 and further
amendments were passed for the regulation of bio-medical waste management. On 28
March 2016 Biomedical Waste Management Rules (BMW 2016) [15] were also notified by
Central Govt. Each state's Pollution Control Board or Pollution control Committee will
be responsible for implementing the new legislation. New regulations [which?] a ect the
distribution of medical waste by medical professionals into their proper receptacles.
Due to the competition to improve quality and so as to get accreditation from agencies
like ISO, the NABH, JCI, and many private organizations have initiated proper
biomedical waste disposal but still the gap is huge.
Many studies[which?] took place in Gujarat, India regarding the knowledge of workers in
facilities such as hospitals, nursing homes, or home health. It was found that 26% of
doctors and 43% of paramedical sta were unaware of the risks related to biomedical
wastes.[citation needed] After extensively looking at the di erent facilities, many were
undeveloped in the area regarding biomedical waste. The rules and regulations in
India work with The Bio-medical Waste (Management and Handling) Rules from 1998,
yet a large number of health care facilities were found to be sorting the waste
incorrectly.[citation needed]
The National Green Tribunal (NGT) has been stringent on the application of the BMW
2016 over the past[which?] 12 months. There are now over 200 licensed Common Bio
Medical Waste Treatment and Disposal Facilities (CBWTDF) or Common Treatment
Facility (CTF) in the country.[citation needed] The training of Health Care Facility sta and the
awareness of the Hazards of Bio Medical waste is still a challenge in most of the
country. The compliance is being enforced through penalties and via awareness. The
CTF are operational in most Tier 1 cities and Tier 2 cities of India and compliance is
high today because of NGT.[citation needed] But lack of awareness lead to issues of improper
segregation. In Tier 2 and 3 cities the general waste is also mixed with biomedical
waste.[citation needed]
The latest guidelines for segregation of bio-medical waste recommend the following
color coding:[16]
Red Bag – Syringes (without needles), soiled gloves, catheters, IV tubes etc.
should be all disposed of in a red colored bag, which will later be incinerated.
Yellow Bag – All dressings, bandages and cotton swabs with body fluids, blood
bags, human anatomical waste, body parts are to be discarded in yellow bags.
Cardboard box with blue marking – Glass vials, ampules, other glassware is to
be discarded in a cardboard box with a blue marking/sticker.
White Puncture Proof Container (PPC) – Needles, sharps, blades are disposed
of in a white translucent puncture proof container.
Black Bags – These are to be used for non-bio-medical waste. In a hospital
setup, this includes stationery, vegetable and fruit peels, leftovers, packaging
including that from medicines, disposable caps, disposable masks, disposable
shoe-covers, disposable tea cups, cartons, sweeping dust, kitchen waste etc.
Environmental impacts
[edit]
The syringe tide environmental disaster
[edit]
The syringe tide environmental disaster of 1987–1988 raised awareness about medical
waste as medical syringes washed ashore in Connecticut, New Jersey, and New York.
The syringes endangered marine species and posed a threat to humans who visited
the beach. The crises spurred scientists and lawmakers to create mechanisms,
policies, and laws so that health care providers would process their bio-waste in an
environmentally friendly way.[17]
E ects of medical waste on the environment
[edit]
Accumulation of biomedical waste in a hospital
basement.
Improper management of health care waste can have both direct and indirect health
consequences for health personnel, community members and on the environment.
Indirect consequences in the form of toxic emissions from inadequate burning of
medical waste, or the production of millions of used syringes in a period of three to
four weeks from an insu iciently well planned mass immunization campaign.
Biomedical waste is not limited to medical instruments; it includes medicine, waste
stored in red biohazard bags, and materials used for patient care, such as cotton and
bandaids. The most serious e ect that biomedical waste has on our seas is the
discharge of poisons into the waters that could then be consumed by ocean life
creatures. Toxins would interject into the food chain and eventually reach humans
who consume sea creatures. Human exposure to such toxins can stunt human growth
development and cause birth defects.[18]
The high volume of plastic use in the medical field also poses a dangerous threat to
the environment. According to North and Halden, 85% of disposable plastic materials
make up all medical equipment.[19] Our current reliance on plastic materials is rooted
in their unique capabilities to be lightweight, cost-e ective, and durable while
preserving the sterility of medical equipment. In addition to the serious health
implications of releasing harmful toxins in the environment from medical waste
deposits, introducing this volume of single-use plastics can catalyze the
compounding health detriments caused by macro and microplastics.
Incineration of biomedical waste
[edit]
See also: Incineration
Methods of biomedical waste incineration
[edit]
The three type of medical waste incinerators are controlled air, excess air, and rotary
kiln. Controlled air is also known as starved-air incineration, two-stage incineration, or
modular combustion. This is the process of which waste is fed to a combustion
chamber and combustion air begins to dry and facilitates volatilization of the waste.
As a result, carbon dioxide and other excess gases are released into the atmosphere.
The second type of incineration is the excess air process. This is similar to the
controlled air process, such as the waste being dried, ignited, and combusted by heat
provided by the primary chamber burner. However, the main di erence is that
moisture and volatile components in the waste are vaporized.
In a rotary kiln, the process is similar to the two mention above, however, it is more
versatile in terms of being able to mix wet and dry waste components and viewed by
many waste engineers as being the most environmentally friendly.[20]
Impact on the environment
[edit]
Post incineration process, toxic ash residue is produced and is often disposed
at landfills. These landfills are not protected by any barrier and the residue has the
potential of reaching underground water that is often exposed to human use. The
combustion of plastic material releases toxic gases that escapes and joins breathable
air. Human and animal exposure to such gases can cause long term breathing and
health issues.[21] The rotation of toxic air does not only impact human well-being, but
also of animals and plants. Air pollution caused by the incinerators depletes the ozone
layer, causes crop and forest damage, and increases the e ects of climate
change.[22] Constant exposure to such toxins and chemicals in the air could be deemed
detrimental to trees and plants and could eventually lead to extinction of certain
plants in specific areas. Pollution and chemical leaks also a ect the fruits of trees
and would cause them to be poisonous and therefore inedible.[23]
Environmental waste in California
[edit]
Medical waste management program
[edit]
California created the Medical Waste Management Program, which regulates the
generation, handling, storage, treatment, and disposal of medical waste by providing
oversight for the implementation of the Medical Waste Management Act. Precautions
have been taken in California which permits and inspects all medical waste o site
treatment facilities and medical waste transfer stations. In order to dispose waste, the
department recommends the following process to make controlled substance waste
non-retrievable. Pills containing a controlled substance are crushed before placing
the residue into a pharmaceutical waste container. Controlled substance that is
remaining in a syringe is wasted into a pharmaceutical waste container before
disposing of the syringe in a sharps container. Expired medications should be returned
through a reverse distributor.[24]
Environmentally friendly alternatives
[edit]
Reusable RMW or sharps containers reduce the amount of plastic sent to landfills and
CO2 emissions.[25]
Non-incineration treatment includes four basic processes: thermal, chemical,
irradiative, and biological. The main purpose of the treatment technology is
to decontaminate waste by destroying pathogens. Modern technology invented
mechanics that would allow medical professionals and hospitals to dispose medical
waste in an environmentally friendly way; such as: autoclaving, plasma
pyrolysis, gasification, chemical methods, and microwave irradiation. These
alternatives are also highly versatile and can be used for all di erent types of waste.
An autoclave, similar to a pressure cooker, uses high-temperature steam to penetrate
waste material and kill micro-organisms. Autoclave treatment has been
recommended for microbiology and biotechnology waste, waste sharps, soiled and
solid wastes. Microwave irradiation is based on the principle of generation of high
frequency waves. These waves cause the particles within the waste material to
vibrate, generating heat and killing the pathogens from within. A simple yet e ective
method is chemical disinfection: 1% hypochlorite can kill thriving bacteria. Plasma
pyrolysis is an environment-friendly mechanism, which converts organic waste into
commercially useful byproducts. The intense heat generated by the plasma enables it
to dispose all types of waste including municipal solid waste, biomedical waste
and hazardous waste in a safe and reliable manner.[citation needed] Gasification can
o er carbon sequestration and energy generation, reducing the carbon footprint of
biomedical waste treatment.[26]
Other possible solutions
[edit]
Significant strides may be made relatively quickly if the focus shifts towards surgical
subspecialties and their involvement in generated medical waste. Surgical specialties
in particular have focused on infection control and thus have implemented single-use
operative tools in their practices. One example of this can be seen within the practice
of gastroenterology, where each endoscopy alone in the U.S. generates approximately
2.1 kg of disposable waste, of which 64% of the waste ended up in
landfills.[27] Thankfully, it appears that surgeons across the U.S. have agreed that their
practice generates a high amount of waste and that a change needs to be
implemented. A multi-center survey of 219 U.S. surgeons showed that 90% of them
agreed strongly that waste of sterile surgical items is an issue and moreover, 95% of
them agreed to a willingness to change their operating room workflow to reduce
waste.[28] Another focus that proves to be e ective is reform around the policies that
surround "red bag waste." Separation of medical waste is typically done via these bags
and a narrative review out of U.S. operating rooms found that 90% of red bag waste, or
the items found in the red waste bags, did not actually meet the criteria for pathologic
or infectious waste.[29]
Initiative from corporations and hospitals is essential to creating a healthier
environment, however, there are various methods in which involves action from the
general population and would contribute to a clean air environment. By creating
surveillance groups within hospitals, everyone would be held accountable for
misconduct and improper disposal of waste. Consequences could be implemented
where individuals would be required to pay a fine, or face unpaid suspension from
work. Companies and governmental organization should also initiate non-routine
checkups and searches, this would place pressure on hospitals to ensure that waste
is properly disposed all year round. Voluntary clean-ups would involve hospital sta in
assuring that medical waste is not littered around the hospital or thrown into regular
garbage bins.[30]
