Health Care Waste Management

Anne Margaret J. Ang, MD

Outline
1. Impact of healthcare waste to the public and environment.
2. Categories of Infectious waste
3. Principles of Health Care Waste Management
4. Wastewater Treatment

Healthcare Waste
- includes all waste that is generated or produced as a result of any the following:
➢ Diagnosis, treatment and immunization of human
beings or animals.
➢ Research pertaining to above activities
➢ Production or testing of biologicals
➢ Waste originating from minor or scattered resources.

Impact of Healthcare Waste to the Public and Environment

1. Exposure to pathologic microorganisms

2. Risk of acquiring blood borne disease
e.g. HIV, Hepatitis B and C
3. Chemicals- burns, irritations
4. Radioactive waste- Malignancy & genetic alterations.
5.Pollution to air, water and soil

Environmental Management Bureau and other universally accepted hazard symbols

 Categories of Health Care Waste
1. General Waste
- comparable to domestic waste, not hazardous to humans.
- dealt with by municipal waste disposal system
e.g from administrative & housekeeping function

2. Infectious Waste
- suspected to contain pathogens (bacteria, virus, fungi or parasites) can cause disease.
e.g. waste from surgery autopsies blood lines, dialyzers, disposable gowns, gloves

Survival of Pathogens in the Environment

Hepatitis B Virus
-Persistent in dry air
-Survive several weeks on a surface
-Viable at a temperature of 60 0C up to 10 hours
- Survive despite some antiseptic
-Hep B & C can survive for up to a week in a blood droplet trapped inside a hypodermic
needle

HIV:
- Survive only for not more than 15 minutes when exposed to 70% ethanol and only 3-7 days
at ambient temperature
- Can be inactive at 56 0C temperature

3. Pathological Waste
- tissues, organs, body parts, human fetus, animal carcass, blood and body fluids.
4. Sharps
- needles, syringes, scalpels, saws, blades, broken glass, infusion sets, knives, nails, and
any items that can CUT or PUNCTURE wounds

5. Pharmaceutical Waste
- expired, unused, spilt and contaminated pharmaceutical products, drugs, vaccines and sera
that are no longer required.

6. Genotoxic/Cytotoxic Waste
- may include certain cytostatic drugs, vomit, or feces from patients treated by cytostatic
drugs, chemicals, radioactive materials.
“HIGHLY Hazardous”
- with Mutagenic, Teratogenic or Carcinogenic properties

7. Chemical Waste
- discarded solid, liquid and gaseous chemicals,
- may be Hazardous or non hazardous
e.g. from diagnostic, experimental work and from cleaning., housekeeping and disinfecting
procedures.

8. Radioactive waste
- from disused sealed radiation source, liquid or gaseous materials contaminated w/
radioactivity, excreta of patient who underwent radionuclide test.

Principles of Health Care Waste Management

Laws Classifying Health Care Waste as Hazardous Waste

1. Basel Convention on the Control of the Transboundary
2. Movements of Hazardous waste and their disposal
3. Stockholm Convention on Persistent Organic Pollutants- R.A 6969 An Act to Control Toxic
4. Substances and Hazardous and Nuclear waste.

Hierarchy of Waste Management

1. Source reduction
2. Recycling
3. Treatment
4. Residue disposal

Methods of Waste Minimization

1. Reduction at source
2. Re-use
3. Recycling
4. Segregation of waste
5. Composting
Waste Segregation
• Process of separation of different types of waste at point of generation until its proper
disposal.
• Hazardous waste must be placed in clearly marked bins with plastic liners that meet the
standard thickness of 0.009 mm
• Sharps shall be placed in puncture proof containers
• Chemicals and liquid waste can be placed in amber disposal bottles or its equipment
• Label all bins ( i.e. Infectious/ Pharmaceutical/Chemical )
• Yellow plastic liner should also be labeled with a symbol appropriate for the type of
waste it contain.
•

Color Coding Scheme for Containers

Principles in Health Care Waste Management

• HCW must be segregated, collected, stored and transported in a safe manner
considering the risk and occupational safety in accordance with the laws, policies,
guidelines.
• The HCF must have a Waste Management Officer (WMO) who will be responsible for
HCWM.
• Hazardous and general waste must not be mixed during collection, transport and
storage.
• Staff must be trained on the risk and safety procedures on handling waste.
• Appropriate labeling, signage, route and segregation system must be established.
• Plastic liners preferably containing ¾ full of waste must be sealed when transported
from waste generating source to the waste storage area
• Highly infectious waste must be disinfected at source
• Anatomical waste including recognizable body parts, placenta and fetus are disposed of
through safe burial or cremation.
 • Pathological waste must be refrigerated if not collected/treated with in 24 hours
• Sharps must be shredded or crushed before transport to landfill
• Chemical and pharmaceutical wastes shall be segregated and collected separately.
Wastes with high content of heavy metals, except mercury, shall be collected
separately.
• Hazardous chemical waste shall never be mixed or disposed down the drain but stored
in strong chemical resistant leak-proof container or amber disposal bottles.
• Expired and discolored pharmaceuticals shall be returned to the pharmacy for
temporary storage and be returned to the manufacturer/supplier.
• The storage area must be designed based on the volume of waste generated by the HCF
and must be provided with compartments for general, hazardous and recyclable
wastes.
• A separate storage area for phase-out mercury containing devices and products must
be provided (Administrative Order 2008-21)
• The HCF must register as waste generator with the DENR and secure a DENR waste
generator identification number.
•

Specification of Waste bin & Plastic Liner

• Shall be sturdy and lead-proof
• Shall have well fitted lids
• Preferably have foot pedal
• Both bins and plastics liners shall preferably of same color for the type of waste
intended to be placed to avoid confusion and poor segregation
• Waste in plastic liners must be stored in separate area, room or building of size
appropriate to the quantity of waste

Requirements for Storage Room

1. Be located within the HCF
• must be located away from the dietary section, patient rooms, laboratories, hospital
functions/ operation rooms or any public areas.
• It shall be protected from rains, strong wind, floods, etc.
2. Allow easy access to staff in charge of handling waste.
3. Allow easy access for waste collection vehicle without entering the hospital /center
Premises
4. Have floor level higher than the anticipated flood level of the area during the heavy rainfall
➢ with concrete flooring
➢ waterproofed and adequately sloped for the easy
➢ cleaning and finished with ceramic tiles.
5 . Have good drainage system and connected to Wastewater Treatment Plant (WTP)
6. Have continuous water supply for cleaning purposes
7. Locked at all times to prevent access
8. Be inaccessible to animals, insects and birds
9. Have adequate ventilation, lighting, electrical supply
 10. Must have supplies of cleaning implement (water hose, scrubber, disinfectant, PPE,
waste bags, bins, fire fighting equipment)
11. Cleaning of floors, walls and ceilings at all times
12. Placement of warning sign:
13. Post the HCW route plan from point of generation to storage

Collection and Transport of HCW

1.There shall be schedule of collection based on quantity of waste and size of storage room.
2.Treatment shall be imposed prior to collection
3. Replace liners immediately with new ones and same color
4.Ensure that plastic liners are tightly closed and tagged with source and weight.
5.HCW shall be transported from center to off-site waste treatment only by a DENR accredited
Transporter
6.Collection frequency from stations shall be once every shift or as often as necessary
depending upon the volume and size of bins.
7.Disinfection of waste at source in dialysis center
8.Trash bin shall be disinfected after waste has been collected.

Healthcare Waste Treatment

Purpose of Treatment of HCW

- Change the biological and chemical character of the waste to minimize its potential to cause
to harm.
Objectives :
1. To ensure the safety and protection of HCF, personnel and general public
2. To protect the environment from hazards of HCW

Incineration – generate dioxins and furans toxin- leading to damage immune and Endocrine
system. Previously used to treat healthcare waste. But is now NOT recommended

1.Thermal- high heat to destroy pathogens

A. Pyrolysis
- thermal decomposition of subs & materials in the absence of supplied O2 in the
Destruction chamber-> converted to gaseous, liquid or solid form
B. Wet & dry Thermal treatment
- exposure of shredded infectious waste to high temp, high pressure steam. e.g. Autoclave,
Microwave

2. Chemical Disinfection
- Aldehydes, Chlorine cpd, phenolic cpd added to waste to kill or inactivate pathogens.
 - for blood urine, stools, sewage
- for chemotherapy waste

3. Biological process
- uses enzyme mixture to decontaminate HCW & resulting by product is put through an
extruder to remove waste for sewage disposal

4. Radiation Technology
- for disposal of biologically contaminated waste from hospitals, clinics & lab.
- use irradiation systems.

5. Encapsulation
- filling up of containers w/ waste, add & immobilizing material, & sealing the containers.
- for sharps, chem or pharmaceutical residues
6. Inertization
-mixing waste w/ cement & other subs before disposal.
-minimize risk of toxic subs migrating in to the surface water.

Wastewater
- liquid waste discharged from health care facility to individual disposal systems or to municipal
sewer pipes & w/c contain mainly human excreta and used water.

Composition of waste water

- organic particles (feces, hairs, food, vomit, paper fiber)
- soluble organic material (urea, proteins, pharmaceutical), -
- inorganic particles (sand grit metal), soluble inorganic materials (NH3, cyanide, Hydrogen
sulfide)

Wastewater from HDU

Sources:
- Body fluids
- Disinfectants
- Dialyzer solutions
- Waste water from R.O

• Body fluids, blood and rinsing liquids should be first disinfected preferably by thermal
method (especially if with infectious disease)

Water Treatment
Types of Treatment:
1.Sterilization - is a 6log10 (.000001 ) survival probability of the most resistant microorganism
2. Disinfection - low, intermediate or high depending on the survival probability of the specific
microbial groups
3.Decontamination

Can be discharged in to domestic sewers w/o pre-treatment provided:

1. Municipal sewers are connected to efficiently operate sewage treatment plant that ensures
at least

95% removal of bacteria.

3. Sludge from sewage is subjected to anaerobic digestion, leaving no >1 helminth egg/L in
the digested sludge

Waste water w/ significant toxic chemicals

- discharge to pre-treatment/neutralization tank for neutralization & disinfection by
Chlorination prior to discharge to sewage treatment plant
Basic Steps in Health Care Waste Handling
References : World Health Organization
US MOH-CDC
DOH Manual of Health Waste Management