¨ Health care waste is a term used for all wastes arising from health care establishment.
¨ Studies shows that in Pakistan in large hospitals 0.5-2 kg of waste is generated per bed per day. Out of this 0.1-0.5 kg can be categorized as biomedical risk waste.
¨ Biomedical wastes need clear management if not it may lead to injury by contaminated sharps and infection with hep-B, C and HIV
Types of wastes
¨ Hospital wastes can be classified into two main groups.
¨ Risky and non-risky waste
¨ The wastes contaminated by any type of bacterium, virus, parasite or fungi and include,
¨ Culture from lab work
¨ Wastes from surgery and autopsies
¨ Wastes from infected patients
¨ Infected animals from lab
¨ Any materials having been in contact with infected patients
q Body parts
q Blood and body fluids
¨ Sharps includes the following whether infected or not.
¨ Infusion sets
¨ Saws and knives
¨ Broken glass
¨ Any other items that cut or puncture
¨ This includes
¨ Expired unused pharmaceuticals product
¨ Spilled or contaminated products
¨ Surplus drugs, vaccines or sera
¨ Discarded items used in handling pharmaceuticals, e.g. bottles, boxes. Gloves, masks, tubes or vials.
¨ It includes,
¨ Cytotoxic drugs and outdated materials
¨ Vomitus, faeces or urine from patients treated with cytotoxic drugs or chemicals
¨ Contaminated materials from preparation or administration of drugs such as syringes or vials.
¨ It includes,
¨ Chemicals from diagnostic and experimental work
¨ Cleaning processes
¨ Housekeeping and disinfecting procedures
¨ Mercury wastes such as from broken clinical equipment spillage.
¨ Cadmium wastes, mainly from discarded batteries
¨ It includes,
¨ Liquid, solid and gaseous wastes contaminated with radionuclide’s generated from in vitro analysis of the body tissues/ fluids in vivo body organs imaging and tumours localization and investigation and therapeutic procedures.
¨ Papers and Cardboard Packaging
¨ Food wastes
Formation of Waste Management Team
¨ Each health care must have its own health management team.
¨ The head of the Department is responsible for this
¨ The Team includes the MS, Infection control officer, Chief Pharmacist, Senior Matron, Hospital supervisor, and Hospital engineer.
¨ Designation may vary from Hospital to Hospital.
¨ The Team is responsible for preparing a waste management plan.
Waste management plan(WMP)
¨ The Hospital waste management plan should include,
¨ A plan of hospital showing the disposal point for every ward and department. each point should show whether the point is for risk or non-risk.
¨ A plan of hospital showing the site of the central storage having a site for both the risks
¨ Details of the types of containers and the trolleys required.
¨ A timetable for the frequency of collection of waste
¨ Details of the sharps containers and their number
¨ Definitions of the responsibilities and duties for each category of staff who will generate wastes and involved in its segregation and its disposals.
¨ An estimate of the number of staff required for waste collection
¨ The procedure for the storage, and segregation of wastes and its flow to the incinerator
¨ Training course and programs
¨ Emergency procedures
¨ It is essential that risk and non-risk wastes are separated at the source. Non-risk wastes are often more than risk wastes. Approximately 80% are non-risks
¨ These are of no greater risk but have the same effect as ordinary domestic garbage.
¨ It can take the same disposal rout. Nothing special and costly arrangements are needed.
¨ Segregation must take place at source i.e. at the ward, in bedside, theatre, laboratory, delivery room, etc. by the person working there, in order to secure the dangerous waste.
¨ Segregation must start from the point of a source where they are produced to the point where they are finally discarded
¨ All categories of risk wastes other than sharps, large quantities of pharmaceuticals, chemicals, broken thermometers, or radioactive wastes should be placed in a suitable container lined with a strong yellow plastic bags
¨ Sanitary staff sweepers should ensure that the waste bags are removed and sealed
¨ The preferred method of sealing is the plastic sealing tag of the self-locking type.
¨ Each bag should be labelled with the point of production
¨ The bag should immediately be replaced with a new bag of the same type
¨ It should be placed in a container which is resistant to penetration and leakage.
¨ Made up of high-density plastic or metal and designed so that items can be dropped in using one hand in a way that no items can be removed.
¨ These bags are marked yellow, and marked DANGER CONTAMINATED SHARPS FOR INCINERATION.
Containers and Color Coding:
|Container lined with plastic bags||Container lined with plastic bags|
|Purpose designed, penetration and leakage resistant||Strong and tear resistant|
|Incineration or secure landfill||Incineration or secure landfill|
¨ A route for the collection of waste should be established in the waste management plan.
¨ The staff must wear protective clothing at all times when handling wastes, like face masks, industrial aprons, leg protectors, industrial boots, and disposable gloves.
¨ The staff should ensure that waste is collected at least daily.
- The sealed plastic bags should be carefully loaded into a wheeled trolley, which should never be used for purposes other than transportation of wastes.
- Trolley should be easy to load and unload, free of sharp edges, and easy to clean daily with disinfectant.
- Risk waste and non-risk wastes must be collected in separate bags, and not to mix with each other.
- All these bags should be transported to an incinerator. If not available should be handed over to municipal authority staff on daily basis.
¨ Risk waste must be segregated continuously from non-risk at the storage area. The storage area should have the following characteristics.
- Must be located within the hospital ground
- Located close to the incinerator
- Large enough to contain all the risk wastes
- Easy to clean/disinfect and equipped with water supply
- Must be secure from unauthorized access
- Easily accessible to authorized staff and vehicle.
- Must not be close to food preparation area or storage.
- No waste should be stored for longer than 24hours
¨ Mainly two methods of waste disposals are.
- incineration.- Wastes are burnt in the incinerator and the ashes which still contain pieces of sharps and other materials are handed over to municipal authority for further burial.
- Landfill.-should be sited away from any possible pollution of groundwater and rivers. only biomedical wastes should be buried in the landfill to maximize the life of the site.
Waste Minimization and Reuse:
¨ Purchasing and stock control.-careful management of the ordering process to avoid overstocking. Stock release control is also important. The oldest product should always be used first before the expiry.
- Unused chemicals are returned to the supplier for reprocessing
- The pressurized gas cylinder can be returned to the supplier for refilling and reuse.
- Radioactive wastes in Pakistan is governed by federal law. Such wastes should be stored and transported under the controlled condition to the original supplier