Hospital Waste Management

HOSPITAL WASTE MANAGEMENT
Dr Khin Khin Htwe

Deputy Medical Superintendent(DD)
OUTLINE OF PRESENTATION
* Definition
* Classification
* Categories of biomedical waste
* Importance of hospital waste
* Hospital waste management program
* Indicators for quality evaluation
* Summary
Definition
Hospital wastes are generated as a result of diagnostic,
therapeutic, immunization or research activities in the
hospitals.
Classification of hospital waste
(1) General Waste
(2) Sharps
(3) Infected Waste
(4) Chemical Waste
(5) Radioactive Waste
(6) Cytotoxic Drugs

Categories of Biomedical Waste
Category I
- human anatomical waste
Category II
- animal waste
- animal tissues/ organs/ body parts/ bleeding parts/

fluid/ blood
- experimental animals
Category III
-Microbiology and biotechnology wastes
(waste from laboratory culture/ live or attenuated vaccines/

human and cell cultures/ infectious agents/ biological toxins)
Category IV
-Sharp Waste(needles/ syringes/ scalpels/ blades/ glasses

of both used and unused)
Category V
-Discarded medicines and cytotoxic drugs
Category VI
-Solid wastes(items contaminated with blood and body fluids

including cotton, dressings, soiled plaster casts, linens, beddings,
etc.)
Category VII
-Waste generated from disposable items (tubings, catheters,

intravenous sets)
Category VIII
-Liquid Waste(waste generated from laboratory and washing,

cleaning, house keeping and disinfection activities)
Category IX
-Incineration ash
Category X
-Chemical Waste (eg. Chemicals used in disinfections,

insecticides)
Importance of Hospital Waste
1.Hospital staffs
Staffs are directly exposed to hospital wastes.
-generating/ segregating/ collecting/ storing/ treating of the

hospitals
-risk of transmissions of HIV/AIDS, Hepatitis B and C by

sharp wastes
-teaching and training program and immunizations for staffs

required
2. For general public
-Large numbers of visitors as a courtesy call Rag pickers
-Unscrupulous people (unsafe recycling process of disposable

syringes and needles)
-Responsibilities of hospital administration to safe guard the

general public
3.Environmental protection
-internal environment of the hospital is contaminated with the

bacteria, viruses, parasites which can pose a threat of spreading
infections to the outside environment
-foul gases from mortuary or foul smelling discharges from labor

room, pathology department, anatomy department are discharged
directly to outside environment, can cause environmental pollution
4.Nosocomial infection
-patients own flora
-flora of another patients
-fomites
-environmental sources
-contamination by patients, attendent, visitors and hospital

staffs
Hospital Waste Management System
Parameter used in management are-
(1) Generation and segregation of waste
(2) Collection and storage of waste
(3) Transportation of waste
(4) Treatment of waste
(5) Disposal of waste
(6) Disposal and ethical issues related with the

waste management program
I. Generation and Segregation of Biomedical
Waste
Generation of waste
1. Source of waste
-Hospitals and its departments
-Clinics
-Health care organizations
-Support services
-Veterinary hospitals, clinics and laboratories

Classification of waste
1. Non-hazardous waste
2. Hazardous waste
Quantity of Waste Generation
1. Developing countries= 1-2 kg/bed/ day

Segregation of waste
Separation of different types of wastes by sorting
-segregation of waste will depend upon the following factors:
1.size and type of hospital, availability of super specialty facilities in

the hospital
2.training level of health care workers (responsible for waste

generation)
3.Motivation of those health care workers
4.Hospital policy for waste management, support by top level

Collection and Storage of Waste
Pre-requisites are;
1. Safe water supply
2. Facilities for sanitation
3. Good housekeeping services
4. Zoning esp. OT
Color Coding Criteria for Segregation (WHO)
1.General non-hazardous waste -------------- Black
2.Sharps( whether infected or not) ----------- Yellow
3.Infected waste -------------------------------- Yellow
4.Chemical and pharmaceuticals ------------- Red
5.Clinical waste that requires autoclaving--- Blue

Storage of waste
The holding of biomedical waste for such period of time, at the
end of which waste is treated and disposed of.
(time duration from point of generation to point of disposal of

waste) Rules 1998 Guidelines
1. No untreated biomedical wastes shall be stored beyond a period

of 48 hours.
2. If for any reason—must take permission
(by ensuring not to affect human health and environment)

Characteristics of waste storage containers
-hard plastic/ metal, sturdy and leak proof
-appropriate size according to quantum of waste generated
-lid(closed)
-puncture proof
-interior smooth
-color-coding
III. Transportation of wastes
Types 1. Intramural
2. Extramural
IV. Treatment of Wastes
1) Chemical
2) Thermal
3) Mechanical
4) Irradiation
5) Biological
6) New Methods
Chemical Method
Mainly disinfection for
a. instruments and equipment
b. sharps
c. contaminated (floors/trolley tops/ table tops/ trays/ clothing/

bedding etc.)
d. wards/ OT/ ICU/etc.

Common chemical used for disinfection
1. Bleaching powder
2. 1% solution of bleach
3. Alcohol
4. Gluteraldehyde 2%
4. Detergents
5. Salons
Thermal Method
a. low heat system(150 C)
B. high heat system(5500 C)
Autoclave
- Gravity method
- Pre vacuum
- Retort type
Hydroclave ( low heat)
-final volume is reduced
Microwave(low heat)
Incinerators (high heat)
-combustion concept
-final volume is reduced

Types of Incinerator
1. Conventional
2. Electrical
3. Oil fired
According to stages of combustion

a. Stage I( above 800 C)
b. Stage II(1050-1100 C)
c. Stage III
Incineration Process
1. waste preparation
2. waste charging
3. waste combustion
4. treatment of combustion gases
5. residue ash handling

Mechanical Methods
For easier to handle
1. Compaction
2. Grinding and shredding
3. Pulverization
4. Irradiation
5. Biological
6. New methods
V. Disposal of Wastes
1. General/ non-hazardous waste
-For small quantity( landfill/ pits/ composting)
-For large quantity( NADEP composting/ Pillarization/ Bio press

and manure/Pyrolysis)
2. Waste water and liquid waste
-(sewers/ soak pits/ waste stabilizing ponds)

3. Human anatomical, blood and body fluids
4. Sharps
( melting/ sterilization >250 C)
5. Microbiological and bio-technical (incineration)
6. Pharmaceutical (incineration)
7. Infectious solid
(convert to non-hazardous and as general)

8. Chemical
-non-hazardous-----------------------
-hazardous to non-hazardous----- as general
9. Radioactive (BARC Guidelines)
10. Pressurized containers (as general)

VI. Managerial Issues, Policy and Procedures in Biomedical Waste
Management
1. System approach
2. Human resource
3. Education of general public
4. Hospital waste management committee/team
5. Manual
6. policy
7. SOP
8. Implementation program
9. Social responsibility
10. Public health responsibility
11. Occupational safety measures
Indicators for evaluation
1. Irregularities observed
2. Incidence of needle stick injuries
3. Observations by governmental agencies
4. complaints from public
5. Increase in HAI incidence

1) Many hospitals are lack of operational aspect of the system
2) ( establishing policies and procedures for safe waste management/
3) Continuous training of staff/
4) Monitoring the implementation of procedures as per the rules)
5) Safe management=social, moral and legal responsibility for

hospital management
Summary
Two important aims
1. To provide clean and pleasant atmosphere
2. To reduce the bio burden and
neutralize the infection potential of the waste generated

Hospital Waste suitable for Incineration
1. Surgical waste/ autopsy waste/ from LR.
2. Human and animal tissues
3. from dialysis
4. from isolation
5. Blood and Blood products
6. from labs
THANK YOU

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HOSPITAL WASTE MANAGEMENT

Dr Khin Khin Htwe

(1) General Waste

(3) Infected Waste

(4) Chemical Waste

(5) Radioactive Waste

(6) Cytotoxic Drugs

- human anatomical waste

- animal tissues/ organs/ body parts/ bleeding parts/

-Microbiology and biotechnology wastes

(waste from laboratory culture/ live or attenuated vaccines/

-Sharp Waste(needles/ syringes/ scalpels/ blades/ glasses

-Discarded medicines and cytotoxic drugs

-Solid wastes(items contaminated with blood and body fluids

-Waste generated from disposable items (tubings, catheters,

-Liquid Waste(waste generated from laboratory and washing,

-Chemical Waste (eg. Chemicals used in disinfections,

Staffs are directly exposed to hospital wastes.

-generating/ segregating/ collecting/ storing/ treating of the

-risk of transmissions of HIV/AIDS, Hepatitis B and C by

-teaching and training program and immunizations for staffs

-Large numbers of visitors as a courtesy call Rag pickers

-Unscrupulous people (unsafe recycling process of disposable

-Responsibilities of hospital administration to safe guard the

-internal environment of the hospital is contaminated with the

-foul gases from mortuary or foul smelling discharges from labor

-patients own flora

-flora of another patients

-contamination by patients, attendent, visitors and hospital

(1) Generation and segregation of waste

(2) Collection and storage of waste

(3) Transportation of waste

(4) Treatment of waste

(5) Disposal of waste

(6) Disposal and ethical issues related with the

-Hospitals and its departments

-Health care organizations

-Veterinary hospitals, clinics and laboratories

Quantity of Waste Generation

1. Developing countries= 1-2 kg/bed/ day

Separation of different types of wastes by sorting

-segregation of waste will depend upon the following factors:

1.size and type of hospital, availability of super specialty facilities in

2.training level of health care workers (responsible for waste

3.Motivation of those health care workers

4.Hospital policy for waste management, support by top level

1. Safe water supply

2. Facilities for sanitation

3. Good housekeeping services

1.General non-hazardous waste -------------- Black

2.Sharps( whether infected or not) ----------- Yellow

3.Infected waste -------------------------------- Yellow

4.Chemical and pharmaceuticals ------------- Red

5.Clinical waste that requires autoclaving--- Blue

(time duration from point of generation to point of disposal of

1. No untreated biomedical wastes shall be stored beyond a period

2. If for any reason—must take permission

(by ensuring not to affect human health and environment)

-hard plastic/ metal, sturdy and leak proof

-appropriate size according to quantum of waste generated