Shiva Pandey

MPH Third Batch

National medical college , Birgunj

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”.

S.N Waste category Description and examples

1 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.

2 Pathological waste Human tissue or fluids e.g. body parts,

blood and other body fluid , fetuses

3 Sharps waste Sharpe waste e.g. Needle, infusion sets,

Scalpels, knives , blade , broken glass,

4 Pharmaceutical waste Waste containing Pharmaceuticals e.g

Pharmaceuticals that are expired or no

longer needed ; items contaminated by or

containing pharmaceuticals ( Bottle , Boxes)

5 Geonotoxic Waste Waste containing Substances with genotoxic

properties e.g waste containing cytostatic,

genotoxic chemical.

S.N Waste category Description and examples

6 Chemical Waste Waste containing chemical substances

e.g. Laboratory reagent , film developer,

Disinfectants , that are expired or no

longer needed , solvents

7 Waste with high

content of heavy

metals

Batteries, broken Thermometer, Blood

Pressure gauges, etc.

8 Pressurized container Gas cylinder, gas cartridges

9 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.

Non risk waste – (75 -90)Percent

Risk waste – (10 -25) Percent

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

Health Care Waste

Non-hazardous

wastesharps

Hazardous

waste

Based on characteristics of waste

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)

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)

1. 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

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

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

It contains infectious agent

It is genotoxic

It contains toxic or hazardous chemical

It contain sharp

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

1. Identification & segregation

2. Handling (collection, measurement, storage

& transport)

3. Treatment

4. Disposal

Colour

Coding

Type

of Containers

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

Color coding & types of container for disposal of Bio-

Medical 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.

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

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.

Measurement Health care waste is done to

Keep record about amounts of waste

generated.

Waste should be storage with respect to

temperature and climate.eg 72 hours in

winter & 48 hours in summer

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 black-

bagged 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.

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 .

I. Incineration

II. Chemical disinfection

III. Wet & dry thermal treatment

IV. Microwave irradiation

V. Land disposal

VI. Inertization

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 can’t be recycled.

Results in significant reduction of waste

volume & weight.

Wastes like high mercury, cadmium e.g.

broken thermometer, used batteries

Ampules containing heavy metals

Photographic/radiographic wastes

To kill or inactivate pathogens it contained.

Disinfection rather than sterilization

Most suitable for liquid waste eg urine,

blood, stool, hospital sewage,

microbiological cultures

1. Wet thermal treatment:

Similar to autoclave sterilization process.

Inappropriate for the treatment of

anatomical waste & animal carcasses.

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.

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.

If hazardous health-care waste cannot be

treated or disposed

Investigate more suitable treatment methods

disposal sites:

land open dumps

Sanitary landfills.

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.

Zero waste concept

Waste is managed and the waste disposed

into Kathmandu’s municipal waste stream is

negligible Based on three pillars that

support each other

1. waste management

2. Injection safety

3. Mercury elimination

1. Segregating waste at the source

2. Waste transportation

3. Waste treatment and storage centre

a) Steam based technology, that is,autoclaving

b) Chemical treatment

c) 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 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 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 vermi-

composting method

Mercury-containing thermometers, mercury-

containing sphygmomanometers (blood

pressure devices), and damaged mercury-

containing 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-containing thermometers, mercury-

containing sphygmomanometers (blood

pressure devices), and damaged mercury-

containing lightning tubes were collected

from each and every ward and unit.

These mercury-containing materials are

sealed and stored in the mercury collection

house.

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

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