1. World Health Organization
11 November, 2018
Module 5
Health care waste management
WASH FIT

2. Objectives Identify all types of healthcare waste
Describe the steps of waste management
Describe a waste management plan

3. Typical Healthcare Waste Compositions
Between 75% and 90% of the waste produced is similar to domestic waste and usually called ‘non- hazardous’ or ‘general health care waste’ 10-25% of health care waste is regarded as ‘hazardous’ and may pose a variety of environmental and health risks
Source: Safe management of waste from health-care activities, WHO, 2014

4. Non-hazardous / general waste
Waste that does not pose any particular biological, chemical, radioactive or physical hazard
Can be disposed of as household waste/garbage through the available landfills/waste disposal sites set by cities / municipalities or waste pits at the facility
Examples
Packaging materials (paper, cartons, sacks…)
Plastic bottles and cans
Food remains
Dry grasses and fallen leaves
Outdated equipment/furniture that does not contain hazardous elements (doors, office cabinets, sofa, etc.)

5. Hazardous waste Causes various health and environmental risks
Requires special care from the point of generation until final disposal
Requires treatment prior to final disposal
Categories
Infectious waste
Sharp waste
Pathological waste
Pharmaceutical and cytotoxic waste
Chemical waste
Radioactive waste

6. Hazardous waste Category Examples Sharps waste Infectious waste
Used or unused sharps (i.e. hypodermic, intravenous or other needles; auto-disable syringes; syringes with attached needles; infusion sets; scalpels; pipettes; knives; blades; broken glass
Infectious waste
Waste suspected to contain pathogens and pose a risk of disease transmission
(i.e. waste contaminated with blood and other body fluids; laboratory cultures and microbiological stocks
Pathological waste
Human tissues, organs or fluids; body parts; foetuses; unused blood products
Pharmaceutical waste, cytotoxic waste
Pharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceuticals
Cytotoxic waste containing substances with genotoxic properties, e.g. waste containing cytostatic drugs (often used in cancer therapy); genotoxic chemicals
Chemical waste
Waste containing chemical substances (i.e. laboratory reagents; film developer; disinfectants that are expired or no longer needed; solvents; waste with high content of heavy metals, e.g. batteries; broken thermometers and blood pressure gauges)
Radioactive waste
Waste containing radioactive substances (i.e. unused liquids from radiotherapy or laboratory research; contaminated glassware, packages, or absorbent paper; urine and excreta from patients treated or tested with unsealed radionuclides; sealed sources)

7. Waste management processes
Waste minimization
Segregation
Handling
Collection
Transport
Storage
Treatment
Final disposal

8. Waste minimization
This is the first and best way to reduce healthcare waste quantities and costs
Purchases of material and supplies should be made with waste reduction in mind
Issuing of supplies should follow first expire, first out (FEFO) and first in, first out (FIFO) rules
Encouraging the use of tablet medication as an alternative to injection to reduce sharps waste
Encourage recycling and reuse of non-infectious materials (e.g. glass, plastic and cardboard)
Example of purchases with waste reductions: quantity of syringe (box size; 1 box of 100 instead of 5 box of 20), most frequently use sizes of PPE items in larger quantity

9. Segregation
Different types of waste require different handling, treatment and disposal
Must start at the source
All waste must be segregated into these categories:
Basic (all patient care areas) = 3 bins
Bin for general waste (black bag in a bin)
Bin for infectious waste (yellow bag in a labeled pedal bin)
Sharp container or needle cutter
Special areas
Anatomical or pathological (operating theatre and labor rooms)
Chemical waste e.g. mercury containing waste or x-ray liquids
Pharmaceutical waste (pharmacy, wards)
Exceptional waste segregation
Cytotoxic Waste (oncology, pharmacy), Radioactive (oncology – cancer treatment unit)
Need to be review…

10. Three-bin System (Basic healthcare waste categories)
Black Lined container Yellow Lined Container

11. Handling – basic principles
Wear appropriate personal protective equipment (PPE)
Handle waste with care
Practice hand hygiene before and after handling waste
Do not re-sort waste
Never carry waste bags/containers against body
Avoid heavy loads (use transport tools)

12. Collection A schedule should be available for reference
Waste bags should be collected when 3/4 full or at least daily
Sharp waste should be collected when the container is 3/4 full
Tie bags securely
After removing the waste bag, replace with a new one

13. Transport Wear appropriate PPE
Transport waste with covered trolley, wheel barrow, wheeled bin, or a cart
Separated transport of hazardous and non-hazardous waste
Transport equipment should be dedicated for waste transportation only
The equipment must be cleaned and disinfected at the end of each working day
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14. Storage of Infectious and Sharp Waste
Inaccessible to unauthorized persons, animals, insects and birds
Sign with biohazard symbol
Floor and walls are sealed or tiled to allow easy disinfection
Keep well ventilated & protected from rain
Restrict access-lock at all times
Use for waste only
Large enough to cater for over-flow waste due to collection and treatment breakdowns.

15. Storage
Storage times for infectious waste (e.g. the time gap between generation and treatment) should not exceed the following periods:
Temperate climate:
72 hours in winter
48 hours in summer
Warm climate:
48 hours during the cool season
24 hours during the hot season
Source: Safe management of waste from health-care activities, WHO, 2014

16. General waste storage areas
Sized according to the quantities of waste generated and the frequency of collection
Fenced and paved
Easy access for municipal waste collection trucks
In case of recycling activities separate areas for recyclables should be available

17. Treatment - Incineration
An incinerator is the ideal method for burning infectious and sharp waste
The incinerator should have two burning chambers
The location of the incinerator should be away from the medical wards and public housing
Wear heat-resistant gloves when handling flammable material
It is essential to make sure that total incineration has taken place
Basic waste treatment technology. WASH 28

18. Alternative treatment technologies
Autoclaves (steam treatment technology)
Gravity displacement autoclaves (with and without integrated shredder systems
Pre-vacuum or high vacuum autoclaves
Pressure pulse autoclaves
Microwave treatment technologies
Frictionated heat treatment technologies

19. Final disposal methods
Ash pit: Disposal of incineration ash
Landfill or waste burying pit: Disposal of general waste including the autoclaved waste
Burning pit: Disposal of waste only during emergency in the absence of incinerators/autoclaves. It causes higher smoke pollution and other health risks
Encapsulation: Disposal of expired vaccines, medications by adding immobilizing materials i.e. cement and seal the container
Placenta pit: Disposal of placenta and body parts

20. Example drawings: Pits
Source: Technical Specifications, Healthcare Without Harm / MSF

21. Final disposal methods - Landfill
Lined to prevent leachate from contaminating the environment
For liquid waste where do we dispose??
Cross-section of an active Landfill

22. What is wrong in this picture?
Waste is:
Not segregated
Exposed
Not treated
Not properly
disposed

23. Risk assessment
Think about your workplace, what can harm you, patients and their families?
Which part of your body can be exposed to the harm?
Which PPE items can protect you?
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24. Healthcare Waste Officer
A responsible person for the management of healthcare waste should be appointed (Healthcare Waste Officer – HWO)
Roles and duties:
Introduction of supervision
of safe handling methods
Data recording
Regular training of
medical and logistic staff
Development and revision
of a waste management plan
Observing the
legal regulations
Supervision of safe waste treatment and disposal

25. Content of a Waste Management Plan
Aims and Objectives
Legal background and Responsibilities
Generated waste and waste amounts
Waste handling procedures
Segregation, Collection, Transport, Storage, Treatment, Disposal
Occupational Safety
Education and Awareness
Documentation and Recording
Action Plan and budget

26. WASH FIT Indicators (1)
ESSENTIAL 2.11 A trained person is responsible for the management of health care waste in the health care facility. 2.12* Functional waste collection containers for 1) non-infectious (general) waste, 2) infectious waste and 3) sharps waste in close proximity to all waste generation points Waste correctly segregated at all waste generation points Functional burial pit/fenced waste dump or municipal pick-up available for disposal of non-infectious (non-hazardous/general waste).

27. WASH FIT Indicators (2)
ESSENTIAL 2.15* Incinerator or alternative treatment technology for the treatment of infectious and sharp waste is functional and of a sufficient capacity Sufficient energy available for incineration or alternative treatment technologies (mark if not applicable) ADVANCED 2.17 Hazardous and non-hazardous waste are stored separately before being treated/disposed of or moved off site. 2.18* All infectious waste is stored in a protected area before treatment, for no longer than the default and safe time.

28. WASH FIT Indicators (3)
ADVANCED 2.19* Anatomical-pathological waste is put in a dedicated pathological waste/placenta pit, burnt in a crematory or buried in a cemetery (if applicable). 2.20* Dedicated ash pits available for disposal of incineration ash (if applicable) Protocol or SOP (Standard Operating Procedure) for safe management of health care waste clearly visible and legible. 2.22* Appropriate protective equipment for all staff in charge of waste treatment and disposal.

29. WASH FIT Indicators
3.10 Dedicated ash pits available for disposal of incineration ash (mark if not applicable) 3.11 Protocol or SOP (Standard Operating Procedure) for safe management of health care waste clearly visible and legible Appropriate protective equipment for all staff in charge of waste treatment and disposal.

30. Questions?