HOSPITAL WASTE

MANAGEMENT

Dr. Sanjeev Rajbhandari

Assoc. Professor
Department of Community Medicine

1
• “Health-care waste includes all the waste generated
by health-care establishments, research facilities, and
laboratories. In addition, it includes the waste
originating from “minor” or “scattered” sources--such
as that produced in the course of health care
undertaken in the home.”

2
• Health-care waste contains potentially harmful
microorganisms which can infect hospital patients, health-
care workers and the general public.

• Poor management of HCW causes high risk of infection

and environmental pollution.

3
•Of the total amount of waste generated by
health-care activities, about 80% is general
waste.
•The remaining 20% is considered hazardous
material that may be infectious, toxic or
radioactive.

4
• Non-risk Health Care Wastes are those wastes generated
from the Health Care Facilities which have not been
infected. This type of waste are comparable to the
domestic waste. It is usually generated from the
administrative and house-keeping services of HCFs.

• Examples of suchwastes includes: general office

waste, garden waste, packaging or left over food. These
wastes can be composted to make manure or can be
recycled or can be managed by the municipal waste
services.

5
•Sources of health-care waste.
•Government hospitals
•Private hospitals
•Nursing homes
•Physician’s office/clinics
•Dentist’s office/clinics
•Dispensaries
•Primary health centers
•Medical research and training establishments
•Mortuaries
6
•Blood Bank and Collection Centers
•Animal houses
•Slaughter houses
•Laboratories
•Research organizations
•Vaccinating centers
•Bio-Technology institutions/Production Units

7
•Average distribution of Health care wastes in
developing countries
• 80% general health-care waste, which may be dealt with
by the normal urban and domestic waste management
system
• 15 % pathological and infectious
• 1 % sharp waste
• 3 % chemical and pharmacological waste
• Less than 1 % special waste, such as radio-active or
cytotoxic waste, pressurized containers, or broken
thermometer and used batteries

8
• Kathmandu Metropolitan City & ENPHO have organized
a study on biomedical waste in hospitals located in
Kathmandu.

• Results:1.72kg waste/day/patient. Out of which 26% of

waste was infectious and hazardous waste.

GLOBALLY- Developed countries generate 1 to 5

kg/bed/day

9
AVERAGE COMPOSITION OF HOSPITAL WASTE IN HOSPITALS IN
KATHMANDU

Types of Waste Percentage

Medical General waste 62%

Infectious Hazardous waste 23%

Non-degradable medical waste 12%

(saline Bottle)
Bio-Medical sharp 3%

Source:KMC & ENPHO 2001

10
•Categories of health care waste
• Sharps: This kind of biomedical waste covers anything that
might pierce the skin. These wastes pose a potential risk of
injury and infection. It includes needles, broken glass,
scalpels, wires, ampules, blades and knives.

• Infectious: Infectious waste is material suspected to

contain pathogens (bacteria, viruses, parasites or fungi). It
includes: waste contaminated with blood or other body
fluids, cultures of infectious agents from laboratory work;
dressings, bandages etc.
11
• Pathological: Human tissues, organs or fluids; body
parts; unused blood products.
• Pharmaceutical : This type of non-biomedical waste
covers unused drugs and vaccines, including expired
pills, injectable and antibiotics.
• Genotoxic waste: waste containing cytostatic drugs
(often used in cancer therapy); genotoxic chemicals.
• Chemical: Waste containing chemical substances (e.g.
laboratory reagents; film developer; disinfectants that
are expired or no longer needed).

12
• Radioactive: Waste containing radioactive substances
(e.g. unused liquids from radiotherapy or laboratory
research; contaminated glassware, packages etc.)
• Waste with high content of heavy metals: batteries,
broken thermometers, blood pressure gauges

• Pressurized containers: aerosols, gas cylinder etc

13
• Risk groups are:
• Medical doctors, nurses, health care and hospital
maintenance personnel
• Patient in health care establishments
• Visitors to health care establishments
• Workers in support service allied to health care
establishments such as laundries, waste handling and
transportation
• Workers in waste disposal facilities such as land fills or
incinerators including scavengers

14
 Health hazards of health care wastes
1.Hazards from infectious waste and sharps:
- Infectious waste may contain pathogenic
microorganisms.
Pathogens in infectious waste may enter the human body:

• through a puncture, abrasion, or cut in the skin;

• through the mucous membranes;
• by inhalation;
• by ingestion.

15
 PROBLEM ASSOCIATED WITH BIOMEDICAL WASTE
ORGANISM DISEASES CAUSED RELATED WASTE ITEM

VIRUSES AIDS, Infectious Hepatitis, Infected needles, body

HIV, Hepatitis B, Hepatitis Infectious Hepatitis, Dengue, Fluids, Human excreta,
A,C, Arboviruses, Japanese encephalitis, Blood, body fluids. Eye
Enteroviruses, Herpes Virus Ocular infection, Genital secretions, genital
Infection Secretions

BACTERIA Typhoid, Cholera, Tetanus Human excreta and body

Salmonella typhi, Vibrio Wound infections, fluid in landfills and hospital
cholerae, Clostridium Tetani, septicemia, rheumatic fever, wards. Sharps such as
Pseudomonas, endocarditis, skin and soft needles, surgical blades in
Streptococcus tissue infections hospital waste.

PARASITES Cutaneous leishmaniasis, Human excreta, blood and

Wuchereria Bancrofti, Filariasis, Kala Azar, Malaria body fluids in poorly
Plasmodium managed sewage system

16
2.Hazards from chemical and pharmaceutical waste:
- may cause intoxication and injuries including burns.
3. Hazards from genotoxic waste:
- From inhalation of dust or aerosols, absorption
through the skin, ingestion of food accidentally
contaminated with cytotoxic drugs, chemicals or wastes
etc.
4.Hazards from radioactive waste:
- dizziness, vomiting and may affect genetic material.
5. Public sensitivity: Public is very sensitive to visual
impact particularly to anatomical waste

17
•Steps for the proper waste management:
1. Waste minimization
2. Waste segregation
3. Waste collection and storage
4. Waste transportation
5. Waste treatment and disposal

1.Waste Minimization
- Waste minimization is defined as the prevention of
waste production and/or its reduction.
Waste minimization can be achieved by purchasing
less goods and giving preference to reusable and
recyclable items.

18
2. Waste Segregation
- Waste segregation refers to the process of
separation of waste at the point of generation and
keeping them apart during handling, collection, interim
storage and transportation.
- Segregation must take place at the bed site, at the
operation theater, at ward, at laboratory, wherever it is
generated. Non-risk waste (e.g. paper, glass, plastic, iron)
can be recycled. Non-risk biodegradable organic wastes
(i.e. food waste, garden waste) can be composted.
- Segregating risk wastes from non-risk waste greatly
reduces the risks of infecting workers handling HCWs.

19
Colour coding & type of container for disposal of bio-medical wastes
Colour coding Type of container Waste category Treatment options

Yellow Plastic bag Human anatomical wastes, Animal Incineration/deep burial

wastes, Microbiology &
biotechnology wastes, Solid wastes
(Items contaminated with blood
and fluids)

Red Disinfected Microbiology & biotechnology Autoclaving/Microwaving/Ch

container/plastic bag wastes, Solid wastes (Items emical treatment
contaminated with blood and
fluids), Solid wastes (catheters, i.v.
sets etc )

Blue/White Plastic bag/puncture Sharp wastes, Solid wastes Autoclaving/Microwaving/Ch

translucent proof container (catheters, i.v. needles etc) emical treatment
/Shredding

Black Plastic bag Discarded medicines & cytotoxic Disposal in secured landfill
agents, Incineration ash, Chemicals
used in production of, insecticides
etc
20
3. Waste Collection and Storage
- waste should be collected and transported to a
central storage area within the HCF on a regular basis
before being treated or removed. All the collected HCWs
should be stored in waste storage area until transported
to a designated off-site treatment facility.
4. Waste Transportation
- Health care waste collection and transportation
practices should be designed to achieve an efficient
movement of waste from point of generation to storage
or treatment.

21
5. Waste Treatment and Disposal

- The bulk of HCW falls into the category of non-risk

HCW can be recycled or reused.
- The hazardous waste and infectious waste must be
managed by approved treatment methods. Once
treated, the waste may be re-classified accordingly
for disposal.

22
•Treatment and disposal technologies for health-care
waste
•I. Incineration
• Incineration converts combustible materials into non-
combustible residue or ash. Incinerators can be oil-fired
or electrically powered or a combination of both.
• Gases are ventilated through the incinerator stacks, and the
residue or ash is disposed in a sanitary landfill.
• The temperature must be at least of 850 degree C to ensure
minimal emission of toxic gases.

23
•Type of incinerators:
a. Double-chamber
b. Single-chamber
c. Rotary kilns

24
•Wastes types not to be incinerated are:
(a) pressurized gas containers
(b) large amount of reactive chemical waste
(c) photographic or radiographic wastes
(d) Halogenated plastics such as PVC
(e) waste with high mercury or cadmium content such as
broken thermometers, used batteries, and lead-lined
wooden panels
(f) sealed ampoules containing heavy metals.

25
II) Chemical disinfection

- Chemical disinfection is most suitable for treating

liquid waste such as blood, urine, stools or hospital
sewage. Chemical disinfectants (Aldehydes, chlorine
compounds, phenolic compounds) are added to HCW
to kill or inactivate pathogens. It can also be used in
treating solid waste .

26
III) Wet and dry thermal treatment:
• Wet-thermal treatment: It is similar to the autoclave
sterilization process. Wastes are treated in high
temperature and high pressure steam. Afterward, it
can be taken to landfills as regular non-biomedical
waste.
• Screw-feed technology: non- burn thermal
disinfection process in which waste is shredded and
heated in a rotating auger.

27
IV) Microwave irradiation
-Most microorganisms are destroyed by the
action of microwaves. Neutralized non-pathological
biomedical waste can be disposed in solid waste
landfills.

V ) Land disposal
- Disposal in open dumping or sanitary landfills.

28
VI) Inertization:
- It involves mixing waste with cement and other
substances before disposal in order to minimize the
risk of toxic substance contained in the waste
migrating into surface water or ground water. It is
transported to storage sites in the form of cubes or
pellets to dispose off.

29
 Categories of bio-medical wastes
Option Waste Category Treatment & Disposal

Category 1 Human anatomical wastes Incineration /deep burial

Category 2 Animal wastes Incineration /deep burial

Category 3 Microbiology & biotechnology wastes Autoclaving/microwaving/

incineration
Category 4 Sharp wastes Disinfection/microwaving

Category 5 Discarded medicines & cytotoxic Incineration/sanitary landfills

agents
Category 6 Solid wastes (Items contaminated Incineration/autoclaving/
with blood and fluids) microwaving

Category 7 Solid wastes (catheters, i.v. sets etc) Disinfection/autoclaving/

30
microwaving
Option Waste Category Treatment & Disposal

Category 8 Liquid waste Chemical treatment &

discharge into drain

Category 9 Incineration ash Sanitary landfill

Category 10 Chemicals used in Chemical

production of, treatment/discharge into
insecticides etc drain or sanitary landfill

31
32
33
34
Thank You

35