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Managing Medical Waste. Session 5: Infection Control Basics. Learning Objectives . Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority Learn ways to minimise waste

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managing medical waste

Managing Medical Waste

Session 5: Infection Control Basics

learning objectives
Learning Objectives
  • Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority
  • Learn ways to minimise waste
  • Know the criteria for safe management of sharps
definitions of waste
Definitions of Waste

Health care waste

  • All types of waste from all health care activities

Hazardous health care waste

  • Waste that presents a health hazard of some kind
  • Note: Most health care waste is no more hazardous than household waste
types of hazards to consider
Flammable

Toxic - mutagenic, cytotoxic, teratogenic, etc

Reactive

Allergen, contact sensitiser

Explosive

Infectious

Radioactive

Corrosive

Caustic

Alcohol

Cancer chemotherapy, tar-based products

Sulphuric acid, chlorine powder

Glutaraldehyde

Picric acid, fertiliser, ammonia

TB cultures

Barium enema, X-rays

Bleach

Lye

Types of Hazards to Consider
hazardous health care waste
Infectious hazard:

Anatomic waste

Laboratory cultures

Sharps

Live viruses

Corrosive, teratogenic, reproductive hazard:

Heavy metals

Pesticides

Cleaning products

Pressurised containers

Mercury

Cancer therapy

Hazardous Health Care Waste
is health care waste an important source of infectious disease
Yes!

IF needles and syringes are scavenged and re-used, then many diseases can be spread

Keep used sharps and syringes out of public access

No!

Most medical waste does not have more germs than household waste

It causes visual pollution, generates fear, but unless re-use of sharps occurs, medical waste causes little disease

Is Health Care Waste an Important Source of Infectious Disease?
then why does this waste matter
Then Why does this Waste Matter?
  • Sharps injuries may harm workers and communities
  • Medical waste potentially impacts patients, workers, community, and economy because of the volume and permanence of waste
health care institutions generate about 3 5 kg of waste per bed per day
Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day

Health care waste may:

  • Contain infectious organisms, including drug resistant ones
  • Place cancer causing agents into air or ground water
  • Cause radiation-related illnesses
  • Contribute to global warming harm atmosphere (CFC containing refrigerant gas)
  • Cause injury (sharps, explosion)
  • Cause congenital defects or stillbirth, prematurity, infertility
which waste to address first
Which Waste to Address First?
  • IC Committees should START with infectious waste, especially used sharps and microbiological culture waste
how to safely dispose of infectious sharps
How to Safely Dispose of Infectious Sharps
  • Do not recap sharps before disposal
  • Dispose of sharps at the point of use in a leak proof puncture proof container
  • Avoid handling, emptying or transferring used sharps between containers
  • Autoclave highly infectious waste before disposal
  • Control public access to syringes and medical equipment
  • Shred, encapsulate and bury according to national legislation
for non infectious hazardous waste the risks depend on
For Non-Infectious Hazardous Waste, the Risks Depend on:
  • Severity of acute or chronic exposure
    • Duration of exposure
    • Frequency of exposure
    • Concentration agent (1% versus 50%)
    • Individual vulnerability including pregnancy, weight
    • Route of exposure (skin, respiratory, oral, etc.)
    • Steps taken to protect (PPE, relieved from immediate contact etc.)
who is at risk
Who is at Risk?
  • Doctors - anesthesiologists, pathologists
  • Nurses - oncology nurses, OT, ER
  • Hospital support staff - X-ray assistants, pharmacy, morgue, and lab staff
  • Cleaning staff - those cleaning sewage lines
  • General public - those using sharps found in the waste
common hazards
Anesthetic gases

Glutaraldehyde

Formaldehyde/formalin

Cancer therapeutic agents

Ethylene Oxide

Radiation

Asbestos

Blood contaminated sharps

Bleach

Solvents (xylene, toluene, acetone, ethanol)

Pesticides, fungicides

Heavy metals (mercury, chronium, cobalt, cadmium, arsenic, lead)

Latex

Strychnine and cyanide

Common Hazards
12 steps to manage hazardous wastes before disposal
12 Steps to Manage Hazardous Wastes before Disposal

1. Know what hazards you have

2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists

**Use mercury-free thermometers

12 steps to manage hazardous wastes cont d
12 Steps to Manage Hazardous Wastes (cont’d)

3. Limit use and access to trained persons with personal protective gear

5 get rid of unnecessary stuff
5. Get Rid of Unnecessary Stuff
  • Don’t accumulate unneeded products
  • Don’t let peroxides and oxidising agents turn into bombs

Photo of bomb robot called into hospital to dispose of picric acid.

7 communicate about workplace hazards
7. Communicate about Workplace Hazards
  • Job description
  • Posters on doors
  • Labels on hazards
  • Give feedback on use of PPE and disposal in evaluation
  • Role model safe use and disposal
  • Contact point who is responsible
group discussion recycling
Group Discussion: Recycling
  • Why should recycling be promoted?
  • Which products can be safely and cost effectively recycled in your facility?
9 segregate hazards at the source
9. Segregate Hazards at the Source
  • Separate sharps and infectious waste where they are used
    • This prevents injuries that can occur when people sort the trash after it is disposed
  • Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members
10 have written policies on waste disposal
10. Have Written Policies on Waste Disposal
  • Sharps and infectious waste
  • Chemotherapy (cancer)
  • Heavy metals (batteries)
  • Chemicals

Post brief, colorful instructions on walls to remind workers

11 minimise the handling of wastes
11. Minimise the Handling of Wastes
  • Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly
12 conduct walk around interviews
12. Conduct Walk-Around Interviews
  • Ask about the hazardous substances staff work with, how they dispose of them, and what they need to be able to dispose of them properly
  • Have a no-blame philosophy that strives to solve problems, NOT to assign blame
options for specific types of waste
Options for Specific Types of Waste
  • Pharmaceutical
  • Cytotoxic
  • Other chemical wastes
  • Heavy metals
  • Pressurised containers
  • Radiation
  • Infectious
pharmaceutical waste
Pharmaceutical Waste

Small amounts:

  • Disperse in landfill sites, encapsulate or bury on site
  • Discharge to sewer
  • Incinerate

Large amounts

  • Incinerate at high temperatures or encapsulate
  • LANDFILL IS NOT RECOMMENDED
cytotoxic waste
Cytotoxic Waste
  • NEVER LANDFILL or DISPOSE TO SEWER

Disposal Options:

  • Return to supplier
  • Incinerate at high temperature
  • Chemical degradation
chemical waste further recommendations
Chemical Waste - Further Recommendations
  • Keep different hazardous chemicals separate
  • Do not dispose into the sewers or street
  • Do not encapsulate large amounts of disinfectants as they are corrosive and flammable
  • Do not bury large amounts of chemicals
wastes with heavy metals
Wastes with Heavy Metals
  • Wastes with mercury, cadmium, lead, arsenic, strychnine, are poisonous (e.g., thermometers, batteries, lead paints, dyes)
  • Never incinerate or burn
  • Never dispose of in municipal landfills

Best solution: Avoid purchase

OR

  • Recycle in specialised cottage industry or export to countries with specialised facilities
  • Encapsulation
pressurised gas containers
Pressurised Gas Containers
  • NEVER INCINERATE
  • Return undamaged gas cylinders and cartridges to the manufacturer for reuse
  • Damaged containers: empty completely and crush, landfill
radioactive waste
Radioactive Waste

Use requires a national strategy including:

  • Appropriate legislation
  • A competent regulatory organisation
  • Trained radiation protection officer to monitor exposures
  • Return to the manufacturer

Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme

simple chemical disinfection
Simple Chemical Disinfection
  • Requires shredding of waste
  • May introduce strong chemicals into the environment (chorine bleach turns into dioxin when burned)
  • Efficiency varies
  • Only the surface is disinfected
  • Does not disinfect human tissue
  • Special disposal required to avoid pollution
waste disposal options include
Waste Disposal Options Include
  • Disinfection – Autoclaving/ Microwaving, treatment, shredding
  • Land Disposal
  • Burial
  • Encapsulation
  • Incineration
  • Inertisation
  • Managed Land-fill
  • On-site disposal
infectious waste autoclaving
Infectious Waste: Autoclaving
  • Pressure and temperature
  • Holding time
  • Sterility indicators
  • Type of waste
  • Followed by shredding / burial / recycled
commercial disinfection systems
Commercial Disinfection Systems

Shred waste, treat chemically, encapsulate

Possible advantages:

  • Encapsulated residue can be placed in landfill
  • Environmentally friendly
  • Easy to operate

Possible disadvantages:

  • Requires specialised operators
  • May be expensive
burying inside hospital premises
Burying Inside Hospital Premises

Apply the following rules:

  • Access to the site restricted and controlled

If waste is retained on site, ensure rapid burial to isolate from animal or human contact

  • Only hazardous HC Waste to be buried

Management controls on what is dumped

  • Each deposit covered with soil
  • Site lined with low permeable material-concrete
  • Groundwater pollution must be avoided

Not recommended for untreated hazardous waste

disposal to land by encapsulation
Disposal to Land by Encapsulation
  • Fill metal or plastic containers to 3/4, add:
    • plastic foam
    • bituminous sand
    • cement mortar
    • clay material
  • When dry, label and seal containers and landfill
  • May be used for sharps, chemicals, drugs etc.
incineration
Incineration

Combustible waste turned to ash at temps >800 C

  • Reduces volume and weight
  • Residues are transferred to final disposal site
  • Treatment efficiency depends on incineration temperature and type of incinerator
  • Not all wastes can be incinerated
  • Costs vary greatly according to type of incinerator
  • Produces combustion gases
do not incinerate
Do not Incinerate

Do not incinerate the following:

  • Plastics especially halogenated plastics (e.g. PVC)
  • Pressurised gas containers
  • Large amounts of reactive chemical waste
  • Radioactive waste
  • Silver salts or radiographic waste
  • Mercury or cadmium
  • Ampoules of heavy metals
advantages of incineration of hc waste
Advantages of Incineration of HC Waste:
  • Good disinfection efficiency
  • Drastic reduction of weight and volume
  • Good for chemical + pharmaceutical waste
disadvantages of incineration of hc waste
Disadvantages of Incineration of HC Waste:
  • Doesn’t destroy chemical waste at lower temperature for rotary kiln
  • Toxic air emissions if no control devices in place
  • Maintaining temperature levels (and efficiency) in field incinerators is difficult, need to balance loads with non-hazardous materials
  • High costs for high temperature incineration
land fill in municipal landfills
Land-fill in Municipal Landfills

If hazardous health-care waste cannot be treated or disposed elsewhere:

  • Designate a site for hazardous HC Waste
  • Limit access to this place
  • Bury the waste rapidly to avoid human or animal contact
  • Investigate more suitable treatment methods
because no disposal method is easy or completely safe
Because no Disposal Method is Easy or Completely Safe…

Prevention is best!

  • Eliminate purchase by buying safer alternatives
  • Recycle
  • Use smallest quantities possible, use with engineering controls and Personal Protective Equipment
  • Segregate hazards into separate waste streams at source
  • Supervise disposal using best available ecologic option
for more information
For More Information:
  • Safe Management of wastes from health-care activities. Edited by A Prüss, E Giroult, P Rushbrook. Geneva World Health Organisation. 1999. 228 p. Available online. Includes a teachers guide
  • www.healthcarewaste.org. A website managed by the working group on waste
more free references
More Free References
  • http://www.healthcarewaste.org, Health Care Waste Management at a Glance
  • “First, do no harm.” WHO/V&B/02.26
    • Available at www.healthcarewaste.org/linked/onlinedocs/4-bd-704.pdf. Contains information about the disposal options for sharps
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