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Republic of Ethiopia (2004) EPA Technical guidelines on the environmentally sound disposal of biomedical and healthcare wastes.pdf
Republic of Ethiopia (2004) EPA Technical guidelines on the environmentally sound disposal of biomedical and healthcare wastes
The Federal Environmental Protection
Authority
Technical Guidelines on the Environmentally Sound
Management of Biomedical and Healthcare Wastes
2004
Addis Ababa
Ethiopia
Table of Contents
Page
Table of Contents.....................................................................................................I
1.Introduction...................................................................................................................1
2. Purpose and scope of the guidelines......................................................................3
3. General definition of biomedical and health-care waste..................................4
3.1 Health-care.................................................................................................................4
3.2 Biomedical and health-care waste.............................................................................5
3.3 Hazardous health-care waste.....................................................................................5
3.4 Infectious health-care waste......................................................................................5
3.5 Biological health-care waste......................................................................................6
3.6 Sharps........................................................................................................................6
4. Hazards of biomedical and health-care waste.....................................................6
4.1 Types of hazards........................................................................................................6
4.2 Persons at risk............................................................................................................7
4.3 Hazards from infectious waste...................................................................................8
4.4 Hazards from sharps..................................................................................................8
4.5 Hazards from chemical and pharmaceutical waste....................................................8
4.6 Hazards from cytotoxic waste...................................................................................9
4.7 Hazards from radioactive waste.................................................................................9
5. Field of application/source identification...........................................................10
6. Waste identification and classification; waste groups....................................11
7. Applicable state-of-the-art management, treatment and disposal
technologies....................................................................................................................24
7.1 Avoidance/prevention..............................................................................................24
7.1.1 Packaging..........................................................................................................25
7.1.2 Kitchen and canteen waste................................................................................26
7.1.3 Laboratory waste and chemical residues..........................................................26
7.2 Segregation, collection, labeling and handling of biomedical and health-care waste
.......................................................................................................................................27
7.3 In-house transport and storage.................................................................................29
7.4 Special requirements for packaging and labelling for off-site transport.................32
7.4.1 Packaging requirements....................................................................................33
7.4.2 Labeling............................................................................................................33
7.5 Recycling/recovery..................................................................................................34
7.6 Disposal operation/technologies, accreditation and environmental impacts...........34
7.6.1 Methods of treatment or disposal.....................................................................36
7.6.1.1 Steam sterilization.........................................................................................38
7.6.1.2 Dry heat sterilization......................................................................................40
7.6.1.3 Chemical disinfections/sterilization...............................................................40
7.6.1.4 Other treatment/disposal methods.................................................................41
7.6.1.5 Incineration....................................................................................................42
7.6.1.6 Landfill..........................................................................................................43
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
7.7 Responsibility (including emergency response and contingency plan)...................47
7.7.1 Assignment of responsibilities..........................................................................47
7.7.1.1 Duties of the head of the hospital..................................................................47
7.7.1.2 Duties of the waste management officer (WMO)..........................................48
7.7.2 Emergency response.........................................................................................50
7.7.2.1 Response to injuries.......................................................................................51
7.7.2.2 Dealing with spills.........................................................................................51
7.7.2.3 Reporting accidents and incidents.................................................................53
8. Waste management auditing..................................................................................53
9. Capacity-building.....................................................................................................55
9.1 Education and training of personnel of health-care establishments........................55
9.1.1 Responsibility for training................................................................................57
9.1.2 The training package.........................................................................................57
9.1.3 Selection of participants...................................................................................57
9.1.4 Training recommendations...................................................................................58
9.1.4.1 Training recommendations for personnel providing health-care...................58
9.1.4.2 Training recommendations for waste-handling staff.....................................59
9.1.4.3 Training of health-care waste management operators...................................59
9.1.4.4 Training for members of staff who transport waste.......................................59
9.1.4.5 Training of incinerator operators...................................................................60
9.1.4.6 Training of operators of specially engineered landfill sites...........................61
Annex I: Glossary/terminology.................................................................................62
Annex II: Examples of specific waste reduction, reuse and recycling
activities..........................................................................................................................65
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
1.Introduction
Guidelines are preferably set based on country specific baseline information. However,
under the prevailing Ethiopian conditions, the necessary information required for the
preparation of the guidelines is inadequate, outdated and scanty. An alternative approach
is to adopt or adapt the guidelines of international organizations. Accordingly, it has
become imperative to adopt and use the Biomedical and Healthcare wastes of the United
Nation Environment Program.
Therefore, the UNEP guidelines on Biomedical and Healthcare wastes adopted and
introduced throughout the country. The guideline will be amended as more information
on the state of Biomedical and Healthcare wastes is obtained.
1. The disposal of wastes originating from health-care establishments (public and private)
can have an effect on human health and well-being, the environment (air, water, soil,
animals, plants, landscape) and issues relating to public security and order.
2. Nevertheless, experience has proven that wastes originating from health-care
establishments, when properly managed, generally pose no greater risks than that of
properly treated municipal or industrial wastes. This also pertains to the disposal of
biomedical and health-care wastes, in contrast to occasional public perception.
3. The guidelines provide information for the proper treatment of wastes from health-care
establishments (public and private). The information provided takes due consideration
of the waste management requirements of disposal and recovery measures as well as
hygiene requirements. In addition to ecological aspects, the information and
recommendations should be economically feasible and easy to undertake. It and also
makes allowances for technical progress.
4. It has become apparent that the introduction of improved solutions for the segregation
of waste within health-care facilities can result in reduced amounts of waste requiring
special treatment and therefore in reduced waste treatment costs. In addition, new
technologies have become available to treat and disinfect biomedical and health-care
wastes so that they can be of with low risk by landfilling finally.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
5. The safe management of biomedical and health-care waste is essential for community
and environmental health. It is also important that the standards for the protection of
the environment and human health are uniform across all health-care establishments,
irrespective of technologies used for treatment and disposal. This in turn ensures a
more viable and efficient industry. However, it should be noted that in many countries,
the national authorities, in addition to industry, are an active participant in health-care,
either providing services or paying for them. In addition, the lack of resources or of
experience in developing standards may be significant factors affecting the capacity to
treat biomedical and health-care wastes.
6. To manage biomedical and health-care waste effectively, the following should be taken
into consideration:
(a) Generation and minimization;
(b) Separation and segregation of sources;
(c) Identification and classification;
(d) Handling and storage;
(e) Packaging and labelling;
(f) Transportation inside and outside health-care establishments;
(g) Treatment;
(h)Disposal of residues (including emissions);
(i)Occupational health and safety; public and environmental health;
(j)Stakeholder and community awareness and education;
(k)Research into and development of improved technologies and environmentally
friendly practices.
7. These guidelines attempt to address all of these issues and provide support for the
achievement of improved environmental performance in managing biomedical and
health-care waste. To be successful, waste management strategies should always take
account of, and interact with, the process that generated the wastes in the first place.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
2. Purpose and scope of the guidelines
8. Biomedical and health-care waste is a term for all waste generated in health-care
establishments. Biomedical and health-care waste can briefly be described as waste
from medical or other related practices. In reality, only a small proportion of this
waste causes a higher risk of transmitting infectious diseases than normal household
or municipal waste. These guidelines deal with all biomedical and health-care waste,
with especial focus on the segregation and treatment of hazardous biomedical and
health-care waste.
9. Concern regarding the safe management and disposal of biomedical and health-care
waste has resulted from the perceived or real risk of potential transmission of
infectious diseases through accidental injury or contact with infected body fluids. The
disposal of sharps (needles, scalpels etc.) has attracted particular interest because of
the small number of occupationally acquired hepatitis and HIV human
immunodeficiency virus (HIV) infections suffered by health-care workers attributed
to sharps injuries. The majority of sharps injuries, however, do not result in infection.
It is therefore “good practice” in waste management to reduce the risk of injuries.
Figure 1 describes some possible action points to establish “good practice” in waste
management.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Figure 1 Biomedical and health-care waste strategy
3. General definition of biomedical and health-care waste
10. To get a better understanding of the waste management practice of health-care
facilities, there is a need to have a common and internationally accepted definition
for the waste generated in those facilities.
11. The general definitions below are set forth by these guidelines:
3.1 Health-care
12. Medical activities such as diagnosis, monitoring, treatment, prevention of disease or
alleviation of handicap in humans or animals, including related research, performed
under the supervision of a medical practitioner or veterinary surgeon or another
person authorized by virtue of his or her professional qualifications.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
3.2 Biomedical and health-care waste
13. The solid or liquid waste arising from health-care (including collected gaseous
waste).
3.3 Hazardous health-care waste
14. This includes:
(a) Infectious health-care waste;
(b)Chemical, toxic or pharmaceutical waste, including cytotoxic drugs
(antineoplastics)
(c) Sharps (e.g. needles, scalpels);
(d) Radioactive waste;
(e) Other hazardous waste.
3.4 Infectious health-care waste
15. All biomedical and health-care waste known or clinically assessed by a medical
practitioner or veterinary surgeon to have the potential of transmitting infectious
agents to humans or animals.
16. For the purpose of these guidelines, infectious health-care wastes are:
(a) Discarded materials or equipment contaminated with blood and its
derivatives, other body fluids or excreta from infected patients with
hazardous communicable diseases (specified in section 6.1, subsection B.5
below). Contaminated waste from patients known to have blood-borne
infections under going haemodialysis (e.g. dialysis equipment such as
tubing and filters, disposable sheets, linen, aprons, gloves or laboratory
coats contaminated with blood);
(b) Laboratory waste (cultures and stocks with any viable biological agents
artificially cultivated to significantly elevated numbers, including dishes
and devices used to transfer, inoculate and mix cultures of infectious
agents and infected animals from laboratories).
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
17. Wherever appropriate and applicable, waste from basic and fundamental biomedical
and other research shall be managed according to the principles set forth for health-
care waste.
3.5 Biological health-care waste
18. All body parts and other anatomical waste including blood and biological fluids and
pathological waste that are recognizable by the public or the health-care staff and that
demand, for ethical reasons, special disposal requirements.
3.6 Sharps
19. All biomedical and health-care waste with sharps or pointed parts able to cause an
injury or an invasion of the skin barrier in the human body. Sharps from infected
patients with hazardous communicable diseases (specified in section 6.1, subsection
B.5 below), isolated wards or other pointed parts contaminated with the above-
mentioned laboratory waste must be categorized as infectious waste.
4. Hazards of biomedical and health-care waste
4.1 Types of hazards
20. As mentioned in section 1, biomedical and health-care waste includes a large
component of non-risk waste and a smaller proportion of risk waste. Non-risk waste
is similar to municipal waste and does not create more health or other hazards than
mismanaged municipal waste. If the risk waste is not properly segregated from other
waste fractions (e.g. mixture of biological and pathological waste with sharps and
body fluids), the whole mixture has to be handled as infectious waste. In this section,
potential hazards related to exposure to biomedical and health-care waste will be
addressed.
21. Exposure to hazardous or potentially hazardous biomedical and health-care waste can
induce disease or injury. The hazardous nature of biomedical and health-care waste
may be due to the following or a mixture of the following properties:
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(a) It contains infectious agents, including contaminated sharps;
(b) It is cytotoxic or genotoxic;
(c) It contains toxic or hazardous chemicals or pharmaceuticals;
(d) It is radioactive;
(e) It contains sharps.
22. For the purposes of these guidelines, infectious substances are those substances
known or reasonably expected to contain pathogens. Pathogens are defined as micro-
organisms (including bacteria, viruses, rickettsia, parasites, fungi) or recombinant
micro-organisms (hybrid or mutant) that are known or reasonably expected to cause
infectious disease with a high risk for animals or humans. Note that not all pathogenic
micro-organisms can be transmitted by waste as a pathway.
4.2 Persons at risk
23. All persons exposed to hazardous biomedical and health-care waste are potentially at
risk of contamination through accidental exposure. This includes people within
health-care establishments or any other source of biomedical and health-care waste,
and people inside and outside these sources who either handle these wastes or are
exposed to them, for example as a consequence of careless management. The main
groups at risk are the following:
(a) Doctors, nurses, ambulance staff and hospital sweepers;
(b) Patients in health-care establishments or under home care;
(c) Workers in support services to health-care establishments, such as laundries,
waste handling and transportation, waste disposal facilities including incinerators
and other persons separating and recovering materials from waste;
(d) Inappropriate or inadvertent end-users such as scavengers and customers in
secondary markets for reuse (i.e. households, local medical clinics, etc.).
24. Owing to the extension of drug abuse and of home care including home dialysis, the
hazards associated with scattered small sources of biomedical and health-care waste
should not be overlooked.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
4.3 Hazards from infectious waste
25. Infectious waste may contain a great variety of pathogenic micro-organisms, but not
all can be transmitted to humans and animals by contact with waste.
26. The pathogens contained in the waste may infect the human body through the
following pathways: absorption through a crack or cut in the skin (injection),
absorption through the mucous membranes, and rarely by inhalation and ingestion.
27. Concentrated cultures of pathogens and contaminated sharps (in particular syringe
needles) are probably the waste items that create the most acute human health
hazards.
4.4 Hazards from sharps
28. Sharps may not only cause cuts and punctures but also infect the wounds by agents
which previously contaminated the sharps. Owing to this double risk of injury and
disease transmission, sharps are considered problematic. The main diseases of
concern are infections which may be transmitted by subcutaneous introduction of the
agent - for example, viral blood infections.
29. Syringe needles are of particular concern because they constitute an important part of
the sharps and are often contaminated with the blood of patients.
4.5 Hazards from chemical and pharmaceutical waste
30. Many chemicals and pharmaceuticals which are used in health-care establishments
are hazardous chemicals (e.g. toxic, corrosive, flammable, reactive, explosive, shock-
sensitive, cytotoxic or genotoxic). Fractions of these will be found in biomedical and
health-care waste after their use or when they are no longer required.
31. They may have toxic effects, either through acute or chronic exposure, and injuries,
including burns. Intoxications can result from absorption of the
chemicals/pharmaceuticals through the skin or the mucous membranes and from
inhalation or ingestion. Injuries can be provoked by contact of flammable, corrosive
or reactive chemicals with the skin, the eyes or the mucous membrane of the lung
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(e.g. formaldehyde and other volatile chemicals). The most common injuries are
burns.
32. Mercury is another hazardous product common within hospitals owing to its
prevalent use in literally hundreds of different devices. It is most concentrated in
diagnostic devices such as thermometers, blood pressure gauges and, oesophageal
dilators, Miller Abbott/Cantor tubes. It is also found in other sources such as
fluorescent light tubes and batteries.
33. Disinfectants constitute a particularly important group of hazardous chemicals, as
they are used in large quantities and are often corrosive. It should also be noted that
reactive chemicals may form highly toxic secondary compounds. Chemical residues
discharged into the sewage system may have toxic effects on the operation of
biological sewage treatment plants or on the natural ecosystems of receiving waters.
Pharmaceutical residues may have the same effects, as they may include antibiotics
and other drugs, heavy metals such as mercury, phenols and derivatives and other
disinfectants and antiseptics.
4.6 Hazards from cytotoxic waste
34. The severity of health hazards for health-care workers handling cytotoxic waste arises
from the combined effect of the substance toxicity and of the magnitude of exposure
that may occur during waste handling or disposal. Exposure to cytotoxic substances
in health care may also occur during preparation for treatment. The main pathways of
exposure are inhalation of dust or aerosols, skin absorption and ingestion of food
accidentally in contact with cytotoxic (antineoplastic) drugs, chemicals or waste, or
from contact with the secretions of chemotherapy patients.
4.7 Hazards from radioactive waste
35. Radioactive materials are unique in that they cause harm through both external
radiation (by approaching them or handling them) and through their intake into the
body. The degree of harm depends on the amount of radioactive material present or
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
taken into the body and on the type of material. Exposure to radiation from high-
activity sources, such as those used in radiotherapy, can cause severe injuries, ranging
from superficial burns to early fatalities. Radioactive waste arising from nuclear
medicine is much lower in activity than the sources referred to above and is unlikely
to cause such harm, but exposure to all levels of radiation is considered to be
associated with some risk of carcinogenesis, however small.
36. There are well-established procedures for minimizing the hazards arising from work
with radioactive materials, and these are normally implemented in hospitals and
laboratories where such materials are used. Similarly, the arrangements for safe
radioactive waste storage and disposal are well established. There should be a person
or persons appointed in the organization with responsibility for ensuring that
radiation protection is observed and that radioactive waste is properly and safely
managed.
5. Field of application/source identification
37. These guidelines shall be applicable for the generation of biomedical and health-care wastes from
health-care establishments. Health-care establishments shall specifically include the following:
(a) Large sources:
(i) University hospitals and clinics;
(ii) Maternity hospitals and clinics;
(iii) General hospitals.
(b) Medium sources:
(i) Medical centres;
(ii) Out-patient clinics
(iii) Mortuary/autopsy centres;
(iv) Farm and equine centres;
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(v) Hospices;
(vi) Abortion clinics
(vii) Medical laboratories
(viii) Medical research facilities;
(ix) Animal hospitals;
(x)
Blood banks and transfusion
centres;
(xi) Emergency services.
(c) Small sources:
(i) General medical practitioners;
(ii) Convalescent homes;
(iii) Nursing and remedial homes;
(iv) Medical consulting rooms;
(v) Dental practitioners;
(vi) Animal boarding and hunt kennels;
(vii) Tattooists;
(viii) Acupuncturists;
(ix) Veterinary practitioners;
(x) Pharmacies;
(xi) Cosmetic piercers;
(xii) Zoos, safari parks, etc.
6. Waste identification and classification; waste groups
38.For the purpose of this guidelines the following biomedical and health-care waste
classification is used:
A Health-care wastes with the same composition as household and municipal waste
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
A1 Normal household and municipal waste
B Biomedical and health-care waste requiring special attention
B1 Human anatomical waste (tissues, organs, body parts, blood and blood bags)
B2 Waste sharps (needles, syringes, scalpels, slides, ampoules, etc.)
B3 Pharmaceutical waste (e.g. expired medicines)
B4 Cytotoxic pharmaceutical wastes
B5 Blood and body fluid waste (materials contaminated with blood or other
body fluids, soiled cotton from non-infected patients) Wastes which only
require special measures to prevent the risk of infection during their
management.
C Infectious wastes
For the purpose of these guidelines, infectious health-care wastes are:
(a) Discarded materials or equipment contaminated with blood and its derivatives,
other body fluids or excreta from infected patients with hazardous
communicable diseases(specified in section 6.1, subsection B.5 below).
Contaminated waste from patients known to have blood- borne infections under
going haemodialysis(e.g. dialysis equipment such as tubing and filters,
disposable sheets, linen, aprons, gloves or laboratory coats contaminated with
blood);
(b) Laboratory waste (cultures and stocks with any viable biological agents
artificially cultivated to significantly elevated numbers, including dishes and
devices used to transfer, inoculate and mix cultures of infectious agents and
infected animals from laboratories).
D Other hazardous wastes.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Not exclusive to the medical health-care sector, e.g. solvents, chemicals, batteries,
fixer solutions, etc.
E Radioactive waste from health care.
B1. Human anatomical waste
Description
Non-infectious human body parts, organs and tissues and blood bags.
Examples of such wastes
Tissue waste, removed organs, amputated body parts, placentas, etc.
Waste management guidance
It is primarily for ethical reasons that special requirements must be placed on the
management of waste human body parts, organs and tissue. The waste must be collected
in appropriate containers or bags as soon as possible and at the place where it is
generated. The waste must be kept in tight receptacles (e.g. in the wooden coffins
commonly used in pathology) and under cooled conditions when stored temporarily for a
prolonged period of time, or else be handed over to a waste management facility within a
reasonable period. Intermediate storage takes place at a location which is accessible only
to trained personnel. Normally, the waste must always be incinerated completely, in an
appropriate facility. Household waste incineration plants are, as a rule, not suitable for the
incineration of amputated body parts, removed organs and placentas (cases of exceptions,
such as separate storage and direct feeding, have to be clarified with the responsible
authorities and the management of the incineration plant). In exceptional cases crematoria
can be used for the incineration (disposal) of amputated body parts.
Exemptions and special provisions
Where only small quantities of these wastes are generated (e.g. in medical practices), they
can be collected in appropriate containers (e.g. “hard box”) and managed jointly with
municipal waste at a volume of up to 1 litre per waste bag. The management of animal
waste body parts, organs and tissues is subject to the provisions of relevant special
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
legislation.
B2: Waste posing the risk of injury (sharps)
Description
Sharps are all objects and materials which are closely linked with health-care activities
and pose a potential risk of injury and/or infection.
Examples of such wastes
Needles, drain tubes, syringes with the attached needle, butterfly needles, spikes, broken
glassware, ampoules, pipettes, scalpel blades, lancets, vials without content, etc. Waste
management guidance Wastes posing the risk of injury require measures to be taken to
prevent injury and infection during the handling of these wastes within and outside of
health-care establishments. These wastes have to be collected and managed separately
from other waste. The collection containers must be puncture-resistant and leak tight.
Storage of these wastes takes place at a location which is accessible only to trained
personnel.
Note: Sharps from infected patients, isolated wards, infected patients undergoing
haemodialysis or other pointed parts contaminated with laboratory waste must be
categorized as infectious waste.
Exemptions and special provisions Syringes and needles should not be reused.
B3: Pharmaceutical waste
Description
Pharmaceutical wastes are pharmaceuticals, which have become unusable for the
following reasons:
Exceeded expiration date;
Expiration date exceeded after the packaging or the ready-to-use preparation
prepared by the user has been opened;
Cannot be used for other reasons (e.g. call-back campaign).
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Examples of such wastes
The term “pharmaceuticals” embraces a multitude of active ingredients and types of
preparations. The spectrum ranges from teas through heavy-metal-containing
disinfectants to highly specific medicines containing a large variety of different
hazardous or non-hazardous substances. Waste management may therefore be based on a
differentiated approach; for example, pharmaceutical waste could be divided into three
classes and its management carried out in a class-specific manner as follows:
Pharmaceutical wastes: Class 1
Pharmaceuticals such as camomile tea and cough syrup which pose no hazard during
collection, intermediate storage and waste management. Class 1 pharmaceutical
wastes are not considered hazardous wastes. They are managed jointly with municipal
waste.
Pharmaceutical wastes: Class 2
Pharmaceuticals which pose a potential hazard when used improperly by
unauthorized persons. Class 2 pharmaceutical wastes are considered to be hazardous
wastes. Their management takes place in an appropriate waste disposal facility.
Pharmaceutical wastes: Class 3
Heavy-metal-containing and unidentifiable pharmaceuticals, heavy-metal-containing
disinfectants, which, owing to their composition, require special management. Class 3
pharmaceuticalwastes are considered to be hazardous wastes. Their management
takes place in an appropriate waste disposal facility. However, owing to the fact that
medicines are not normally labelled in accordance with their hazardous
characteristics, the sorting of medicines into different classes, in particular classes 2
and 3, may often be too difficult in practice. Countries may therefore decide to
consider all or a major part of medicines as hazardous waste or waste requiring
special consideration.
Waste management guidance
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Waste prevention: To reduce the generation of pharmaceutical waste, stocks of
pharmaceuticals should be inspected periodically and checked for their durability
(expiration date).
Recovery by specialized facilities: Possibilities for returning old pharmaceuticals to the
producer or handing them over to a special collection system (e.g. pharmacies) for
possible subsequent use could be explored. Such a return of pharmaceuticals in their
original packaging prior to or within a reasonable period after the expiration date is
possible if it is ensured that the producer or collector examines possibilities for
subsequent use of the pharmaceuticals and that pharmaceuticals which are no longer
usable are disposed of in an environmentally sound manner.
Pharmaceutical wastes which are considered to be hazardous wastes have to be collected
separately in appropriate containers. Intermediate storage takes place at a location which
is accessible only to trained personnel. This should be done in a manner to avoid misuse.
Exemptions and special provisions
Cytotoxic pharmaceutical waste: See Group B4: Cytotoxic pharmaceutical wastes.
B4: Cytotoxic pharmaceutical wastes
Description
Cytotoxic (antineoplastic) pharmaceutical wastes are wastes which can arise from use
(administration to patients) and manufacture and preparation of pharmaceuticals with a
cytotoxic (antineoplastic) effect. These chemical substances can be subdivided into six
main groups: alkylated substances, antimetabolites, antibiotics, plant alkaloids, hormones
and others. A potential health risk to persons who handle cytotoxic pharmaceuticals
results above all from the mutagenic, carcinogenic and teratogenic properties of these
substances. Consequently, these wastes pose a hazard, and the measures to be taken must
also include those required by occupational health and safety provisions.
Examples of such wastes
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Specific lists of pharmaceuticals which contain cytotoxic substances are available.
Discernible liquid residues of cytotoxic concentrates, post-expiration-date cytotoxic
pharmaceuticals and materials proven to be visibly contaminated by cytotoxic
pharmaceuticals must be disposed of as cytotoxic pharmaceutical waste.
Waste management guidance
The risks posed by cytotoxic pharmaceuticals are primarily of relevance for persons who
come into contact with them during preparation and during or after their use. It has long
been common practice in hospitals to see to it that the number of persons who come into
contact with these products is small. Specific guidance on this is available. These wastes
usually arise at central locations, i.e. in pharmacies and laboratories and they are also
often found at places where the ready-to-use cytotoxic solutions are prepared.
Intermediate storage of these wastes takes place under controlled and locked conditions.
The precautions taken during the use of cytotoxic pharmaceuticals must also be applied
on their journey outside the respective establishment, as releases of these products can
have adverse environmental impacts. The management of these wastes, in covered and
impermeable containers, must therefore be strictly controlled. Solid containers must be
used for collection. The use of coded containers is recommended. For reasons of
occupational safety, cytotoxic pharmaceutical wastes must be collected separately from
pharmaceutical waste and disposed of in a hazardous waste incineration plant.
Exceptions and special provisions
None.
B5: Wastes with blood and body fluid
Description
These are wastes from health-care establishments not categorized as infectious wastes
which are contaminated with human or animal blood, secretions and excretions. It is
reasonable to assume that these wastes might be slightly contaminated with pathogens (in
nearly the same way as household waste).
Examples of such wastes
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Dressing material, swabs, syringes without the attached needle, infusion equipment
without spikes, bandages, etc.
Waste management guidance
Special requirements must be imposed on the management of these wastes from the
viewpoint of infection prevention inside the health-care establishments. Double bags or
containers made of strong and leak-proof material are used for the collection of these
wastes within health-care establishments.
Proper management of these wastes is by incineration in a household waste incineration
plant but they can also be disposed of together with household waste on a controlled
landfill site.
Exemptions and special provisions
This mixture of wastes should not be recycled.
C: Infectious wastes
Description
Special requirements regarding the collection and management of infectious wastes must
be imposed whenever waste is known or, on the basis of medical experience, expected to
be contaminated by causative agents of the diseases listed below and when this
contamination gives cause for concern that the disease might spread. The list comprises
diseases which make particular demands on infection prevention when the following
factors are taken into account:
The associated risk of infection (contagiousness, infection dose, epidemic potential);
The viability of the pathogen (infection capacity/infectiousness);
The route of transmission;
The extent and nature of the potential contamination;
The quantity of contaminated waste;
The severity and treatability of the disease that might be caused.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
The wastes belonging to this group may occur in the context of diagnosis and treatment
of patients suffering from the following diseases (relevant pathogen-containing
excretions are given in brackets):
Acquired immunodeficiency syndrome (AIDS)* (blood)
Viral hepatitis* (blood, faeces)
Creuzfeld-Jacob disease (CJD), transmissible spongiform encephalopathy (TSE)*
(tissue, cerebrospinal fluid)
Cholera# (faeces, vomit)
Typhoid fever/paratyphoid fever# (faeces, urine, bile)
Enteritis, dysentery, enterohaemorragic Escherichia coli (EHEC)-induced haemolytic
uraemicsyndrome (HUS)# (faeces)
For the purpose of these guidelines, infectious health-care wastes are:
(a) Discarded materials or equipment contaminated with blood and its derivatives, other
body fluids or excreta from infected patients with hazardous communicable diseases.
Contaminated waste from patients known to have blood-borne infections undergoing
haemodialysis (e.g. dialysis equipment such as tubing and filters, disposable sheets,
linen, aprons, gloves or laboratory coats contaminated with blood).
(b) Laboratory waste (cultures and stocks with any viable biological agents artificially
cultivated to significantly elevated numbers, including dishes and devices used to
transfer, inoculate and mix cultures of infectious agents and infected animals from
laboratories).
Active tuberculosis (respiratory tract secretions, urine, faeces)
Meningitis/encephalitis (respiratory tract secretions, cerebrospinal fluid)
Brucellosis (blood)
Diphtheria (respiratory tract secretions, secretions from infected wounds)
Leprosy (secretion from nose/infected wounds)
Anthrax (respiratory tract secretions, secretion from infected wounds)
Plague (respiratory tract secretions, secretion from infected wounds)
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Poliomyelitis (respiratory tract secretions, faeces)
Q fever (respiratory tract secretions, blood, dust)
Glanders (respiratory tract secretions, secretion from infected wounds)
Rabies (respiratory tract secretions)
Tularaemia (pus)
Virus-induced haemorrhagic fever, including hantavirus-induced renal (HFRS)
and pulmonary (HPS) syndromes (blood, respiratory tract secretions, secretion
from infected wounds, urine)
Waste of this kind is typically generated in the following places: isolation wards of
hospitals; dialysis wards or centres caring for patients infected with hepatitis viruses
(yellow dialysis); pathology departments; operating theatres; and medical practices and
laboratories which mainly treat patients suffering from the diseases specified above.
The relevant wastes are wastes contaminated with pathogen-containing blood, excretions
or secretions (see list) or containers containing blood in liquid form.
Examples
The infections marked with (*) are usually transmitted through inoculation. Therefore, the
wastes of relevance here are not taken to include dry contaminated waste from sporadic
patients suffering from diseases in question (AIDS, viral hepatitis, CJD), such as
contaminated swabs (e.g. from taking of blood samples), cotton plugs used in dental
practices, etc. However, they do include blood-filled vessels and waste drenched with
blood or secretions from surgeries performed on infected patients, used dialysis systems
from yellow dialysis as well as wastes drenched with blood/secretions from medical
practices and laboratories mainly treating patients who have contracted the diseases in
question.
The infections marked with (#) are transmitted via faeces and oral ingestion of
contaminated material. Relevant bodily discharges may be fed to the waste-water stream
in observance of hygienic requirements. Management under conditions that would result
from categorization as infectious waste must be considered only when the waste is
heavily contaminated with excretions from diagnosed patients.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Infectious wastes in any case include the following:
(a) All microbiological cultures generated, for example, in institutes working in the
fields of hygiene, microbiology and virology as well as in medical laboratories,
medical practices and similar establishments and in which a multiplication of
pathogens of any kind has occurred;
(b) Experimental animals as well as litter and animal faeces from animal test
laboratories, if transmission of the above-mentioned diseases is to be expected.
Waste management guidance
Infectious wastes must be collected in tear-resistant and leakproof containers and
transported to a central storage facility/delivery point in carefully sealed condition and
without any transfer into other containers or sorting (containers marked with the
“biohazard” symbol). They must be collected and transported in a way that precludes
direct contact, and they may not be transferred into other containers at the central storage
facility or during delivery. They must be stored in such a way that gas formation in the
collection containers is avoided. To this end, efforts must be made to ensure that storage
periods are as short as possible depending on climatic conditions (e.g. storage at
temperatures below +15°C for not more than one week or at a temperature of 3°C to 8°C
for a longer storage period).
Infectious waste must either be incinerated (approved incineration plant) or be disinfected
prior to final disposal using a recognized method, preferably treatment with saturated live
steam. Disinfected wastes may be disposed of in the same way as domestic waste. The
disinfection plants must be operated under the operating parameters prescribed for waste
disinfection, and this mode of operation must be documented. The use of a mobile
disinfection plant to treat infectious waste is permissible only if the waste disposer
furnishes proof that the plant has been checked by the competent authority or an
approved institution for its functional and operational reliability on a regular basis.
Exceptions and special provisions
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Body fluids and excreta of infected patients with hazardous communicable diseases can
be discharged to the sewerage system if there is a strict separation between the waste and
drinking water installations and the sewerage system is connected to a waste-water plant.
In other cases, the body fluids and excreta have to be disinfected before being discharged
to the sewerage system. Exceptionally if wastewater plant doesn’t exist , infectious waste
can be disposed of by using a special area in a controlled landfill if there is no risk of
contamination of ground or drinking water and the infectious waste is directly covered
with earth or other material.
E: Radioactive waste
Description
Material contaminated with a radioisotope which arises from the medical or research use
of radionuclides. It is produced, for example, during nuclear medicine, radio
immunoassay and bacteriological procedures, and may be in a solid, liquid or gaseous
form.
Examples of such wastes
Radioactive waste includes solid, liquid and gaseous waste contaminated with
radionuclides generated from in vitro analysis of body tissue and fluid, in vivo body
organ imaging and tumour localization, and investigative and therapeutic procedures.
Waste management guidance
Where activity limits for immediate or simple disposal methods cannot be met (clearance
levels), health-care establishments should segregate radioactive waste and store it during
the required period to reduce the activity level. If the activity concentration is below these
clearance levels, the material may be disposed of by normal methods. Since the half-life
of most radioactive materials used in hospitals is in the range of hours or days, storage for
a period of one or two months can be followed by disposal to the ordinary waste system
with appropriate monitoring. Decayed non-infectious radioactive waste is placed inside
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
black plastic bags if they are intended for landfilling. Decayed but infectious radioactive
wastes are placed in yellow plastic bags in preparation for disinfection. They should not
be used as landfill prior to disinfection.
All radioactive waste designated for storage to allow decay should be kept in suitable
containers which prevent dispersion of the content. A plastic bag in a large can or drum is
an appropriate container. Containers used for the storage of radioactive waste should be
clearly labelled to show the activity of the radionuclide on a given date and the period of
storage required. These containers should be stored in a specifically marked area in a
lead-shielded storage room for radioactive substances or for radioactive waste. The
storage record should be endorsed specifically to indicate which items are “radioactive
waste”. Containers of radioactive waste should be marked “RADIOACTIVE WASTE”
and should carry the radiation symbol.
High-level and usually long-half-life radionuclides used in health-care activities are used
for therapeutic purposes, conditioned as sealed sources, in the format of pills, seeds,
ribbons, tubes or needles. These sealed sources are recovered after use, washed,
disinfected and stored under lead-shielding for reuse on other patients. These items may,
however, become waste if their conditioning is damaged, if they have lost too much of
their activity, or if they are no longer required. Spent radionuclide generators also
become waste. In countries without a nuclear industry equipped to dispose of high-level
radioactive waste, hospitals should package these items appropriately or place them
inside the same boxes in which they were originally supplied, and send them back to their
original supplier for reprocessing, eventual recycling or safe final disposal. In countries
with the appropriate nuclear industry, hospitals may alternatively send non-recyclable
high-level waste to the national radioactive waste disposal agency, which will take care
of them. These items are usually valuable, and, in most cases, it is possible to reprocess
them for recycling.
Exceptions and special provisions
Any health-care establishment using radioactive substances should hire a specialized
radiation officer who, among other duties, will monitor the management and disposal of
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
radioactive waste and the storage of radioactive items.
7. Applicable state-of-the-art management, treatment and disposal
technologies
39. It is generally recognized that waste management plans provide the best mechanism
for improvement of environmental performance in waste management. A waste
management plan can help generators to conserve resources and minimize waste
through improved purchasing and reuse practices and through cost-effective,
environmentally sound source separation, segregation, collection, transport, treatment
and disposal of all waste streams generated within their facilities.
40. It is recommended that the plan be in the form of an environmental management
system based on the ISO 14001 series of environmental management standards. This
systems approach helps to ensure that auditable, verifiable documentation is available
to demonstrate that operations are taking place as required. Such a system will also
assist with the provision of quality data and information on which a state-of-the-
environment report can be prepared. A prerequisite for developing or updating such a
plan is adequate characterization and analysis of the existing waste stream and a
detailed assessment of existing waste management practices. This process is
commonly referred to as a waste audit.
7.1 Avoidance/prevention
41. The generation of hazardous wastes and other wastes within it is reduced to a
minimum and that adequate disposal facilities for the environmentally sound
management of hazardous wastes and other wastes are available.
42. For the various health-care establishments, waste management in observance of the
waste avoidance and recovery obligation presupposes a system that is practice-
oriented, clearly structured and manageable with clearly defined logistics. This can
be achieved only if everyone who works in the health services sector gives increased
thought to this issue and takes action to ensure that the volume and hazardousness of
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
wastes are minimized.
43. The increasing relevance of the waste management problem demands an ecologically
oriented reorganization. This should start with procurement, by giving preference to
environmentally sounder products and replacing harmful or disposable products with
reusable or alternative products, if these meet the relevant requirements in terms of
hygiene and patient safety.
44. A noticeable reduction in waste volume can be achieved only if disposable products
already in use are scrutinized as to their necessity. In principle, disposables such as
disposable cutlery, disposable linen (including covering sheets), disposable
instruments and equipment (scissors, scalpels, forceps) and disposable containers
(kidney dishes, infusion bottles) should be replaced by reusable products and long-
lived alternatives. For examples of specific reuse, waste reduction and waste
recycling activities, see annex III?
7.1.1 Packaging
45. An issue closely related to the procurement of products is their packaging. It is
possible to reduce the amount of waste generated noticeably if attention is paid in the
selection of products to the associated amount of packaging. The latter should not
exceed the minimum necessary to meet transportation, storage, hygiene and sterility
requirements. Before orders are placed, the material input for the product and the
packaging as well as the resulting input required for waste management should be
taken into account.
46. The input required for the management of packaging waste can be reduced when:
(a) Preference is given to products involving small amounts of packaging;
(b) Preference is given to product packaging which can be refilled, reused or
otherwise used as a supply or disposal receptacle within or outside the
facility at which the product is used;
(c) Preference is given to demand-oriented package sizes;
(d) The manufacturer or supplier of the product is required, when placing the
order, to take back the associated transport packaging and containers.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
47. Where it cannot be avoided, packaging should be collected separately and fed to an
appropriate recovery process. Appropriate recovery is common for cardboard, paper,
glass and metals. Plastics can best be recovered if they are collected as type-specific
fractions.
7.1.2 Kitchen and canteen waste
48. Kitchen and canteen waste can be utilized as feed substitute if it is disinfected in a
manner that is appropriate for such use or if such use conforms with the conditions
imposed by the authorities.
7.1.3 Laboratory waste and chemical residues
49. An effort should be made to establish which hazardous products and substances in the
health-care industry can be avoided completely. Chemical residues can be reduced by
adapting laboratory apparatus to the “state of the art” and performing laboratory tests
and analyses if they meet medical needs. In the procurement of laboratory devices,
attention should be paid to the aspect of relative chemical consumption.
50. The use of mercury contained in hospital diagnosis devices such as blood pressure
gauges and thermometers has been targeted for elimination and future avoidance in
many countries. Elemental mercury is toxic and such uses present hazards during use
and at end-of-life. Mercury can neither be safely landfilled nor incinerated.
Fortunately, safer alternatives now exist for each of these mercury-containing
products. Thus the problem is best avoided in the first instance through procurement
policies.
51. With regard to laboratory chemicals, a priority task is to find out whether the use of
chlorinated hydrocarbons as solvents is unavoidable. The aim should be to replace
such laboratory procedures. Laboratory chemicals and solvents should be collected
and recovered, if the cost of recovery entailed is reasonable in comparison with that
of other forms of waste management. The best possibilities for solvent recovery exist
in pathology, histology and anatomy because relatively large amounts of fat and
blood-contaminated solvents (xylene, toluene and others) arise in these sectors.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
7.2 Segregation, collection, labeling and handling of biomedical
and health-care waste
52. Segregation is the key to effective biomedical and health-care waste management. It
ensures that the correct disposal routes are taken, personnel safety is maintained,
environmental harm is minimized and recycling consumes the least resources.
Biomedical and health-care waste should be segregated and collected in accordance
with the specific treatment or disposal requirements.
53. Segregation should be carried out under the supervision of the waste producer and as
close as possible to the point of generation. Segregation must therefore take place at
source, that is, in the ward, at the bedside, in the theatre, in the laboratory, in the
delivery room, etc., and must be carried out by the person generating the waste, for
example the nurse, the doctor or the specialist, in order to secure the waste imme-
diately and to avoid dangerous secondary sorting. It should be undertaken on the basis
of the types of waste listed in the definition for biomedical and health-care waste.
54. Each health-care institution should prepare and follow a waste plan. Correct and
efficient segregation will be achieved only through rigorous training and education of
employees, supervisors and managers, and policies should take this into account.
55. The segregation must be applied from the point of generation throughout the entire
waste stream to the point of final disposal, whether or not it is on-site. All storage and
transportation methods must also follow this segregation system.
56. Segregated wastes of different categories need to be collected in identifiable
containers. Every room, such as wards, laboratories and operating theatres, should
have containers/bags for the types of wastes that are generated in that room. The
waste segregation and identification instructions should be placed at each waste
collection point to ensure proper procedure. Waste containers made of non-
halogenated leakproof combustible materials should always be given preference.
Plastic bags for storing the waste may be suspended inside a frame or placed inside a
sturdy container. A lid should be provided to cover the opening of the bag. Sharps
must always be collected in puncture-proof containers (not made of glass) to avoid
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
injuries to and infection of the workers handling them.
57. Clinical and sanitary personnel should ensure that the waste bags are removed and
sealed when they are not more than three-quarters full. The preferred method of
sealing involves a plastic sealing tag of the self-locking type; bags should never be
closed by stapling. Each bag should be labelled with the point of generation (ward
and hospital) and content.
58. A common system of labelling and coding of packaging should be developed for
biomedical and health-care waste. A possible way of identifying biomedical and
health-care waste categories is by sorting the waste into colour-coded bags or
containers. As an example, a WHO-recommended colour coding is given in table 1.
The use of internationally recognized symbols and signs is of very basic importance
and is essential for the safety of handling and disposal of waste. It is recommended
that the colour coding, the symbols and signs should be part of the waste management
instructions and should be made known, e. g. by a poster on the wall at the waste
collection points.
Table 1
WHO - recommended colour coding for biomedical and health-care waste as an example
of a colour-coding system
TYPE OF WASTE Colour of container and markings* Type of container
Highly infectious waste Yellow, marked “HIGHLY
INFECTIOUS” Strong, leak proof plastic bag, or
container capable of being
autoclaved
Other infectious waste, pathological Yellow
Plastic bag or containers
Sharps Yellow, marked “SHARPS” Puncture-proof containers
Chemical and pharmaceutical waste Brown Plastic bag or container
Radioactive waste** Lead box
General health-care waste Black Plastic bags
* Proposed colour coding and marking system; the use of other colour coding in a
country is possible.
** Generated only in major hospitals.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
59. Certain recommendations should be followed by the ancillary workers in charge of
waste collection. They include:
(a) Waste should be collected daily from the wards, or as frequently as required,
and transported to the central storage place;
(b) No bags should be removed without labelling indicating the point of generation
(hospital and ward) and content;
(c) The workers should immediately replace the bags or containers with new ones
of the same type.
60. Empty collection bags or containers should be readily available at the point of
waste generation.
7.3 In-house transport and storage
61. It is important to ensure that waste does not accumulate at the point of generation. A
routine for the collection of waste should be established in the waste management
plan. Wastes should be moved through the facility in such a manner as to prevent
unnecessary exposure to staff and others. Handling and transportation of waste
containers should be minimized to reduce the likelihood of exposure to the waste.
Specific routes should be planned through the facility to minimize the passage of
loaded carts through patient care and other clean areas.
62. Carts used for moving biomedical and health-care waste through the health-care
facility should be designed to prevent spills, and should be made of materials able to
withstand exposure to common cleaning agents. They should have the following
attributes:
(a) Easy loading and deloading;
(b) No sharp edges which could damage waste bags or containers during loading and
deloading;
(c) Easy to clean.
63. All seals should be in place when movement of the bag has been completed. The carts
should be cleaned regularly to prevent odour and as soon as possible if the waste
material leaks or spills in the carts. The biohazard symbol should be clearly displayed
on carts for the transport of infectious waste. These carts must be thoroughly cleaned
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
before any maintenance work is performed on them. The facility’s infection control
committee, biosafety officer or other appointed person should be consulted about the
frequency of cleaning and the type of cleaning agent to be used.
64. After biomedical and health-care waste has been collected and moved from the point
of generation, it must be held in storage areas to await disposal. These storage areas -
either a separate area, room or building - should be dimensioned according to the
quantities of waste generated and the frequency of collection. These areas must be
totally enclosed and separate from supply rooms or food preparation areas. Re-
commendations for properties and equipment of the storage facilities are listed in box
1.
65. Storage areas must be identified as containing infectious waste, with the biohazard
symbol clearly displayed. It is unacceptable for materials other than waste to be
placed in the same storage area as infectious waste. Floors, walls and ceilings of
storage areas must be thoroughly cleaned in accordance with the established
procedures of the facility.
Box 1 Recommendations for storage facilities for biomedical and health-care waste in
health-care establishments, e.g. hospitals
Properties and equipment
Impermeable hard-standing base with good drainage, easy to clean and disinfect and
equipped with water supply;
Readily accessible to staff in charge of handling the waste;
Fitted with a lock, to prevent access by unauthorized persons;
Easily accessible to collection vehicles (carts);
· Inaccessible to animals, insects and birds;
· Good lighting and ventilation;
· Not situated in the proximity of fresh food stores or food preparation areas;
Situated close to the supply of cleaning equipment, protective clothing and waste bags or
containers.
66. Unless a cooled storage room is available the proposed storage periods recommended
by WHO between the generation and treatment of biomedical and health-care waste
are the following:
Temperate climate: maximum 72 hours in winter maximum 48 hours in summer
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Warm climate: maximum 48 hours during the cool seasond maximum 24 hours
during the hot season
67. Anatomical waste should be stored at a temperature of 3° C to 8° C. All infectious
waste must be refrigerated at a temperature of 3° C to 8° C if stored for more than a
week. Health-care facilities should determine the maximum storage time of
refrigerated or frozen biomedical and health-care waste based in the light of their
storage capacity, rate of waste generation and any applicable local regulatory
requirements.
68. Facilities refrigerating or freezing stored waste should use a lockable, closed storage
facility or a lockable domestic-type freezer unit. Either type must be used only for
storing anatomical and infectious waste, must display the biohazard symbol visibly
and must be identified as containing infectious waste. Note that glass or plastic items
containing infectious agents may fracture at lower temperatures.
69. The compacting of untreated infectious waste or waste with a high content of blood or
other body fluids destined for off-site disposal (for which there is a risk of spilling) is
not permitted. Cytotoxic waste should be stored in a specific place, separate from the
storage room devoted to other biomedical and health-care waste.
70. Depending on the local legislation, radioactive waste should be stored in containers
preventing dispersion, behind lead shielding. Waste designated for storage to allow
decay should be labelled with the type of radionuclide, date and required storage
details.
7.4 Special requirements for packaging and labelling for off-site
transport
70. Risks may occur during the storage, handling, transportation and disposal of the
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
infectious waste. For this reason, biomedical and health-care waste generators are
responsible for safe packaging, adequate labelling and authorization of the
destination of the waste to be transported off-site. Hazardous biomedical and health-
care waste should be packaged and labelled to comply with national regulations
regarding the transport of hazardous wastes (dangerous goods), and with
international agreements if they are shipped abroad for treatment. Where there are no
such national regulations, the responsible authorities may refer to the
“Recommendations on the Transport of Dangerous Goods” published by the United
Nations, and specifically section 2.6.3 on infectious substances.
71. The control strategy for hazardous biomedical and health-care waste shall have the
following components:
(a) A consignment note should accompany the waste from production to final
disposal; after the journey, the transporter should complete the part of the
consignment note especially reserved for him and return it to the generator;
(b) The transporting organization should be registered with, or known to, the waste
regulation authority;
(c) Handling and disposal facilities should hold a permit issued by a waste
regulation authority, allowing the facilities to handle and dispose of hazardous
biomedical and health-care waste.
72. The consignment note should be designed taking into account the waste control
system in operation in the State concerned and also taking into account the forms
issued in pursuance of the Basel Convention. 9 Anyone involved in biomedical and
health-care waste generation, handling or disposal should be subject to a general
“duty of care”, i.e. ensure that documentation and transmission of waste comply with
the national regulations.
7.4.1 Packaging requirements
73. In general, the waste should be packaged in resistant and sealed bags or containers to
prevent spilling during handling and transportation. The bags or containers should be
resistant to their content (puncture proof for sharps, resistance to aggressive
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
chemicals) and to normal conditions of handling and transportation such as vibration
and changes in temperature, humidity or pressure (resulting from altitude, for
example)
In general packaging should include the following essential elements:
(a) An inner packaging comprising:
(i) Watertight primary receptacle of metal or plastics with leakproof seal (e.g. a
heat seal, a skirted stopper or a metal crimp seal);
(ii) A watertight secondary packaging;
(iii) Absorbent material in sufficient quantity to absorb the entire contents placed
between the primary receptacle and the secondary packaging; if several
primary receptacles are placed in a single secondary packaging, they shall be
individually wrapped so as to prevent contact between them;
(b) An outer packaging of adequate strength for its capacity, mass and intended use,
and with a minimum external dimension of 100 mm.
7.4.2 Labeling
74. All waste bags or containers should be identified by labels containing basic
information on producer and content. This information may be directly written on
the bag or container or by pre-printed labels. The following major information
should appear on the label:
the type of waste;
the total quantity of waste covered by the description (by mass or volume);
the packaging should be appropriately marked with the month and the year of
manufacture; and
the body authorizing
7.5 Recycling/recovery
75. Recovery and recycling constitute one step in a systematic priority approach for
environmentally sound waste management. Waste segregation at source is the basic
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
requirement for cost-effective normal recycling operations on the non-hazardous
component of biomedical and health-care waste. Some examples for the recycling of
non-hazardous waste components are given in annex II.
76. Opportunities for chemical waste recycling can be described as follows:
(a) Unused or waste chemicals in quantity can often be returned to the supplier
for reprocessing;
(b) Larger health-care facilities should establish internal reuse of chemicals;
(c) Certain material such as mercury from broken thermometers, unused batteries
containing mercury, cadmium, nickel and lead-acid and halogenated or non-
halogenated solvents should be given to specialized recyclers.
7.6 Disposal operation/technologies, accreditation and
environmental impacts
77. Biomedical and health-care waste should, if required, be inactivated or rendered safe
before final disposal or discharge. The decision to treat biomedical and health-care
waste and the choice of treatment method should be determined in accordance with
the following considerations:
(a) The type and nature of the waste material;
(b) The hazard and viability of the organisms in the waste;
(c) The efficiency of the treatment method;
(d) The operating conditions of the treatment method.
Table2 Examples of waste treatment methods related to the type of waste
Type of waste
Treatment
Gas Liquid Solid
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Thermal Possible Recommended Recommended
Chemical Appropriate Appropriate a/
Irradiation b/ b/ b/
Incineration Appropriate c/ Recommended
Filtration Recommended Possible Not applicable
a/ Not possible for mixed wastes.
b/ Only for small amounts of wast
c/ Recommended if the calorific value is high enough to reach a sufficiently high
temperature.
78. The treatment method should be amenable to validation and independent of any
packaging, and should be monitored. Monitoring can involve sampling and analysis
or testing of the effluent for hazardous organisms or the use of suitable physical
engineering or other process controls to demonstrate effective operation within the
prescribed operating criteria.
79. Treatment of the waste should be validated with regard to the inactivation of the
organisms and of any residual contamination of the packaging or containers. The
process should not significantly increase the risk of exposure of laboratory staff or
other waste handlers to the hazard itself or to other risks from the concomitant
hazardous agents, equipment and substances which are employed in the treatment.
Outlines of the main advantages and drawbacks of the treatment and disposal options
addressed in these guidelines are shown in table 3.
7.6.1 Methods of treatment or disposal
80. The validated chemical and physical methods for the treatment or inactivation of
waste include: steam sterilization, chemical disinfection/sterilization, dry heat
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
sterilization and other methods.
81. The relative effectiveness of these and other treatment methods depends on a number
of factors including the volume, concentration, type and hazard caused by the
organisms and the physiological state, the diffusion resistance of the material to be
disinfected and the operating parameters and conditions of the treatment method. In
general, steam sterilization should preferably be used in the treatment of infectious
waste. Thermal methods are generally easier to validate and monitor than chemical
treatment and are less damaging to the environment.
82. Methods other than steam sterilization should be selected only if this is impracticable
or inappropriate. For example, effluent from veterinary research, contaminated
laboratory equipment, fixtures and furniture which cannot readily be removed may
be effectively treated using a gaseous fumigant such as formaldehyde. These
methods of treatment can be used alone or in combination, depending on the risk
assessment requirements and/or discharge consent standards, to enable the waste to
be inactivated and safely discharged.
Table 3: Summary of the main advantages and drawbacks of treatment and
disposal options
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Treatment/disposal
methods
Advantages Drawbacks
Pyrolytic incineration/two-
stage incineration with
efficient gas cleaning
Very high disinfection
efficiency; adequate for all
infectious waste and most
pharmaceutical and
chemical waste.
Incineration temperature above
800°C, destruction of cytotoxics;
relatively high costs of investment
and ope-ration. Care has to be taken
on the management of the
incineration residues (e.g. bottom
ashes, fly ashes) because they can ex-
hibit hazard characteristics.
Single chamber
incineration with dust
reduction
Good disinfection
efficiency; Drastic
reduction of the weight
and volume of waste; the
residues may be disposed
of in a
Generation of significant emissions
of atmospheric pollutants and
periodic slag and soot removal; with
temperature below 800°C, inefficient
in destruction of
landfill; no need for highly
qualified operators;
relatively low investment
and operation
thermally resistant chemicals and
drugs such as cytotoxics.
costs.
Drum or brick incinerator Reduction of the weight
and volume of the waste;
the residues may be
disposed of in a landfill;
no need for highly
qualified operators; very
low investment and
operating costs.
Only 99 per cent destruction of
microorganisms; no complete
destruction of many chemicals and
pharmaceuticals; massive emission of
black smoke, fly ash and toxic flue
gas. Exception only for disposal of
infectious waste under certain
circumstances outside urban areas
(e.g., no other treatment method
available during an emergency
situation like acute outbreak of
communicable) diseases).
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Table 3 cont…
Treatment/disposal
methods
Advantages Drawbacks
Chemical disinfection Efficient disinfection
under good operating
conditions with special
waste; costly if the
chemical disinfectants are
expensive.
Requirement of highly qualified
technicians for operation of the
process; use of hazardous substances
which require comprehensive safety
measures; inadequate for
pharmaceutical, chemical and most
types of infectious waste (mixed
solid waste).
Autoclave wet-thermal
treatment
Environmentally sound;
relatively low investment
and operation costs. Good
for infec-
Shredders are subjected to many
breakdowns and bad functioning;
operation requires qualified
technicians; inadequate
tious and microbiological
wastes.
for pharmaceutical and chemical
waste or waste which is not easily
penetrable
by steam; without shredding or other
methods of destruction although
inad
equate for anatomic waste.
Microwave irradiation Good disinfection
efficiency under
appropriate operational
conditions;
environmentally sound.
High investment and operation costs;
potential operation and maintenance
problems; only for wet infectious
waste or for infectious waste with a
high water con
tent.
Encapsulation(e.g. with Simple and safe; low costs. Only for sharps.
concrete or gypsum)
Special engineered landfill Safe if access is restricted
and where natural
infiltration is limited.
Safe if access to site is limited and
there is no risk of water
contamination.
7.6.1.1 Steam sterilization
83. Steam sterilizing or autoclaving is the exposure of waste to saturated steam under
pressure in a pressure vessel or autoclave. Autoclaves should meet the requirements
of internationally agreed standards. Autoclavable waste containers should be of a
design and material, which allows steam to penetrate the load. They should have
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
sufficient stability and resistance to the maximum operating temperature and
pressure.
84. In addition to any devices such as gauges or indicators which measure and record the
basic operating criteria (e. g. temperature, vacuum, pressure), a biological or chemical
indicator should be placed in the waste load for validation to indicate that the
necessary sterilization conditions have been achieved. The operational parameters, e.
g. time, pressure and temperature, should be maintained and checked during the
sterilization cycle.
85. While the temperature and time depend upon the total volume of the material to be
treated, the number and type of organisms and their resistance against steam, it is
necessary first to remove all the air from the autoclave, the waste and the waste
containers to ensure that the required sterilization temperature will be maintained. In
the case of closed containers included in waste material, the validation (with
biological indicators) should take place within the material being sterilized.
Sterilization should commence only when the air has been removed from the
autoclave and the operating temperature has been reached.
86. The potential of complete air removal is affected by factors such as the type of waste,
the amount of waste, the packaging, the water content of the waste and the form and
material of the container. The whole treatment process, including loading, the load,
the suitability of the packaging or the container, air removal and filtration of the
removing gas and liquid effluent discharge should be validated.
87. A record should be retained of all monitoring, maintenance and performance tests
carried out on the autoclave together with a logbook or similar record of all routine
disposals including the temperature charts and details of the load. When appropriate,
air removed from the autoclave should be discharged into the environment after
passing through a microbiologically validated filter.
88. Details of sterilization procedures, including the operational parameters and
conditions, should be written down as a standard operating procedure document or
operating manual which is to be used by all waste handlers. The document should be
kept under review. A suitable biological indicator for steam sterilization is the spores
of Bacillus stearothermophilus. Autoclaving may not change the visible appearance
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
of the waste and it may be necessary to distinguish treated from untreated waste by
careful removal or obliteration of biohazard warning labels from treated containers
or by labeling such containers as “autoclaved” or “sterilized”.
89. Alternatively, chemical indicators may be added to the load to indicate that the load
has been autoclaved. Aesthetic concerns may require that the autoclaved waste is
further treated to render it acceptable for final disposal, e.g. if the waste contains
human or animal material or tissue. Autoclaving may not remove or reduce the non-
biological hazards arising from the presence of chemical or physical agents or other
materials in the waste.
7.6.1.2 Dry heat sterilization
90. Dry heat sterilization is the exposure of the waste to heat at a temperature and for a
time sufficient to ensure sterilization of the entire waste load. The sterilization
process should be monitored by the addition of a suitable indicator or measuring
device to the waste load, and where appropriate by monitoring the organism(s)
present in the waste. The sterilizing unit or equipment should incorporate a suitable
thermal cut-out device which is independent of the device used for indicating or
monitoring.
7.6.1.3 Chemical disinfections/sterilization
91. This method involves the exposure of waste to chemical agents which possess
antimicrobial activity. General disinfectants may not inactivate organisms such as
spores, some fungi and viruses and should not be used as the principal treatment
methods unless thermal procedures are inappropriate because of the nature of waste
or contaminated material. Thermal sterilization should be given preference over
chemical disinfections for reasons of efficiency and environmental considerations.
92. The choice of an appropriate chemical agent and conditions of use should be
determined by the risk assessment, taking into account the identity of the
organism(s) to be treated, the nature of the waste and the presence of organic, protein
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
or particulate matter, and the nature of the surfaces, items or equipment which will
be exposed to the chemical disinfectant.
93. Chemical agents should be used at the manufacturers’ recommended concentrations
and exposure times according to the requirements and conditions of use. The
chemical agent selected should be compatible with other substances or material that
may be present in the waste load so that its efficiency is not reduced, and also to
ensure that toxic or hazardous products are not thereby formed or released. The
efficiency of any chemical agent against a particular organism or type of organism
may be confirmed by reference and adherence to manufacturers’ data and
instructions. Ethylene oxide, formaldehyde (alone or with low-temperature steam)
and certain other agents may be used as gaseous fumigants, particularly for
equipment and items that should be treated in situ. This method can also be used for
the disinfection of body fluids and excreta before being released to the sewer system
if no thermal treatment is available.
7.6.1.4 Other treatment/disposal methods
94. The options available for the treatment/disposal of waste and waste effluent which
cannot be recycled or reused are incineration and landfill.
95 Other waste treatment methods are available but are not yet validated for general use
and have only limited application. These include irradiation (e. g. with microwave,
gamma and ultraviolet radiation) and other treatment methods (e. g. encapsulation
and filtration). If such methods are used, validation and monitoring procedures should
be performed.
96 The selection of an appropriate option should be based on a number of considerations,
including:
(a) The nature of the waste and its intrinsic hazard;
(b) Whether the waste has been inactivated by a reliable and validated method;
(c) The aesthetic acceptability of the discharged waste;
(d) The potential deleterious effect of the discharged waste on the environment;
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(e) The ease and reliability of the disposal method;
(f) The disposal and other costs;
(g) The general occupational hazards and risks to waste producers, handlers and
operators;
(h) The overall impact of the disposal or discharge plant or equipment on the local
and general environment.
7.6.1.5 Incineration
97. Incineration can be used as one important method for the treatment and
decontamination of biomedical and health-care waste. Oxidation at high temperature
converts the organic compounds into their gaseous oxides, mainly carbon dioxide
and water. Inorganic components are mineralized and converted into ash, unless they
pass into the flue gas.
98. Depending on the type of incinerator, the following objectives can be achieved:
(a) Destruction of pathogens;
(b) Reduction of the hazard and pollution potentials as far as possible;
(c) Reduction of volume and quantity;
(d) Conversion of remaining residues into a form which is utilizable or suitable
for landfill;
(e) Use of the released heat.
99. For reasons of emission control and operational safety and reliability, it is desirable to
incinerate the biomedical and health-care waste from as many hospitals as possible in
one central unit. In specific cases, even smaller separate incinerators may be justified.
With a view to minimizing the environmental impact of incineration plants, emissions
in the air, water and soil shall be reduced by the use of effective and advanced
incineration and emission control techniques under technically and economically
viable conditions, taking into account the location of the plant.
100. Incineration leads to a significant reduction of the volume and quantity of the treated
waste. Waste which has not been previously treated to inactivate it or to render it
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
safe should be incinerated in a plant suitably designed and operated for the
destruction of biomedical and health-care waste or other hazardous waste. If
biomedical and health-care waste can be incinerated only in inadequate conditions
(low temperature, inadequate emission control system), waste fractions like
cytotoxic drugs, chemicals, halogenated materials or waste with a high content of
heavy metals (batteries, broken mercury thermometers, etc.) should not be consigned
to such an incinerator.
7.6.1.6 Landfill
101. To date, there is no adequate risk assessment of the use of landfills for untreated
biomedical and health-care waste which may contain infectious organisms and
hazardous chemicals. Best practice would require that any landfill used for
biomedical and health-care wastes be engineered and secured (specially engineered
landfill).
102. There are ongoing health and safety issues (and hence legal implications) associated
with disposal of untreated biomedical and health-care wastes. With the availability
of suitable landfill sites being reduced, the physical problem of disposing of large
volumes of waste must be considered.
103. Disposing of infectious wastes into a landfill greatly increases the risks to human
health and the environment of exposure to infection from this source. If the waste is
disturbed by any means, or not properly covered, further risks will arise. It is
therefore not good practice to dispose of infectious waste directly into a landfill. To
guard against these risks, where landfill is the only available option, infectious
wastes should be treated in order to destroy/remove their infectivity, preferably at
the site of generation of the waste. This can be done by using known effective
techniques such as autoclaving, microwave treatment, dry heat sterilization or
chemical disinfection.
104. The following is a description of the features of a “specially engineered landfill”
which are necessary for the safe and environmentally acceptable disposal of
biomedical and health-care wastes:
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(a) Impermeable clay and/or synthetic liner to minimize groundwater pollution;
(b) Collection, treatment and environmentally acceptable disposal of leachate;
(c) Monitoring systems for groundwater surrounding the site to check integrity of
leachate contamination protection;
(d) Daily and final covers to restrict the potential for disease vectors, reduce
odours and reduce water infiltration;
(e) Monitoring for gas migration in the unsaturated zone surrounding the site,
together with control measures if necessary.
105. It is generally accepted that untreated biomedical and infectious health-care waste
disposal into landfills is not “best practice”. Where health-care wastes are disposed
of at a specially engineered landfill site, the following should apply:
(a) Biomedical and infectious health-care wastes should be deposited at the lowest
edge of the working face of the landfill or in an excavation;
(b) An operator or representative should supervise immediate cover with solid
waste or cover soil to a depth of at least 1 metre;
(c) Any compacting should be only on the cover material;
0 (d) Biomedical and health-care disposal areas should be at least 3 metres from
the proposed
1 edge of the landfill;
(e) No access of unauthorized persons to the site of the landfill;
(f) Any biomedical and health-care waste should be at least 2 metres below the
final surface of the landfill i.e. not in the final lift.
106. The following biomedical and hazardous health-care wastes are generally
considered unsuitable for disposal at a landfill site:
(a) Identifiable body tissue;
(b) Cytotoxic wastes;
(c) Pharmaceutical, laboratory or domestic chemicals;
(d) Radioactive wastes;
(i) Infectious wastes.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
107. Landfill is recognized as the terminal site for all wastes including ash from
incineration and residues from other processes. Some residues of the treatment
process residues may contain chemicals that could interact with other materials in a
landfill. Consideration needs to be given to the stability and nature of such process
residues and any potential impacts prior to disposal into a landfill. Some of the
treatment processes may also contribute excess water to the landfill. Resultant
leachate considerations require that engineered landfills should be used to ensure
maximum environmental protection.
108. The application of treatment and disposal methods to biomedical and hazardous
health-care waste categories is shown in table 4. It provides a broad overview of
suitable treatment and disposal methods for the different health-care waste
categories.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Table 4 Overview of disposal and treatment methods suitable for hazardous health-care waste categories
Method
Waste types
Pyrolytic
incineration/two-stage
incineration (with after
burning zone, e.g.
rotary kiln)
Single-chamber
incineration or
municipal
waste
incineration
Chemical
disinfection
Autoclavewet-
thermal
treatment
Microwave
irradiation
Encapsulation
(e.g. with con-
crete,
gypsum, etc.
only minimal
programmes)
Specially
engineered
landfill
Infectious
waste
Yes Yes (special
requirements,
like direct
Small
quantities
Yes Yes (wet
waste)
No Yes b/
Anatomic Yes Yes b/ No c/ c/ No Yes b/
Sharps Yes Yes b/ Yes Yes No Yes Yes b/
Pharmaceut
ical waste
Small quantities or (at
high temperature >850
°C)
Yes b/ No No No Yes Small
quantities
Cytotoxic
waste
At high temperature
>850 °C
No No No No No In excep-
tional cases
if special
requirements
Chemical
waste
Small quantities c/ No No No No In excep-
tional cases
if special
requirements
are met
Radioactive
waste d/
Low-level infectious
waste
Low-level infec-
tious waste
No No No No No
b/ Not the preferred method.
c/ Uncertainty still prevails as to the unsuitability of the disposal operation. There could be cases where the disposal option could be used, provided a number
of safeguards are in place. d/ Only if the clearance levels set by IAEA are met. Note: Entries in bold indicate preferred methods.
7.7 Responsibility (including emergency response and
contingency plan)
7.7.1 Assignment of responsibilities
109. The proper management of biomedical and health-care waste is largely dependent
on good administration and organization. These should be supported by adequate
legislation and financing as well as active participation of trained and informed
staff.
110. The head of the hospital /clinic should establish a waste management team to
develop a waste management plan. The head of the establishment should formally
appoint the members of the waste management team in writing, informing each of
them of their duties and responsibilities as outlined below.
111. In institutions where no direct patient care service is available, such as medical
research institutions, the head of the establishment should use his discretion to
appoint members of the waste management team. Depending on the availability of
relevant staff, the post of waste management officer may be assigned to the hospital
engineer, the hospital manager, or any other appropriate staff member, at the
discretion of the head of the hospital.
7.7.1.1 Duties of the head of the hospital
112 The head of the health-care establishment is responsible for the following tasks:
(a) Formation of a waste management team to formulate a written waste
management plan for the hospital; within this plan, the duties and
responsibilities of all members of staff, both clinical and non-clinical, shall
be clearly defined in respect of the handing of health-care waste. A clear line
of accountability shall be indicated in both the clinical and non-clinical
management structures;
(b) Designation of the waste management officer (WMO) to supervise and
coordinate the waste management plan; such an appointment shall not relieve
him of his overall responsibilities in ensuring that biomedical and health-care
and other waste are disposed of in accordance with the national guidelines;
(c) Keeping the management plan up to date;
(d) Allocation of sufficient financial and manpower resources to ensure efficient
operation of the plan for example, he has to ensure that adequate manpower
is assigned to the WMO to ensure efficient operation of the waste
management plan;
(e) Ensuring that monitoring procedures are incorporated to assess the
efficiency and effectiveness of the disposal system and to effect the
continuous improvement and updating of the system where appropriate;
(f) Appointing a successor immediately in the event of personnel leaving key
positions in the waste management team, or assigning temporary
responsibility until a successor is appointed;
(g) Ensuring adequate training for key staff members; he shall designate staff
responsible for coordinating and implementing training courses;
(h) Ensuring adequate emergency response planning.
7.7.1.2 Duties of the waste management officer (WMO)
113. The WMO is responsible for the day-to-day operation and monitoring of the waste
management system. He shall have direct access to all members of hospital staff to
facilitate his control function. The WMO will be directly responsible to the head of
the hospital. He shall liaise with the infection control officer, the pharmaceutical
officer and the radiation protection officer to familiarize himself with the correct
procedures for handling and disposing of pathological, pharmaceutical, chemical
and radiological wastes.
114. Concerning waste collection, the WMO should undertake the following tasks:
(a) Controlling internal collection of waste containers and their transport to the
central waste storage facility of the hospital, on a day-to-day basis;
(b) Ensuring the supply of items required for waste collection and handling; he
should liaise with the supplies department to ensure that an appropriate and
acceptable range of health-care waste bags and containers, protective
clothing and collection trolleys are available at all times;
(c) Ensuring that hospital attendants and ancillary staff immediately replace used
bags and con tainers with the correct new bag or container as appropriate;
(d) Directly supervising hospital attendants and ancillary workers assigned to
collect and trans port health-care waste.
115. Concerning waste storage, the WMO should:
(a) Ensure the correct use of the central storage facility for health-care waste at
the health-care establishment, which shall be fenced with a lock on the
entrance; hospital attendants and ancillary staff should always have
immediate access to the storage area;
(b) Prevent unsupervised dumping of waste containers on the hospital grounds,
even for short periods of time.
116. To supervise evacuation or disposal of the waste, the WMO should:
(a) Coordinate and monitor all waste disposal operations;
(b) Monitor methods of transportation of wastes on-site and off-site and ensure
that wastes collected from the hospital are transported by an appropriate
vehicle to the designated incinerator;
(c) Ensure that waste is not stored on the hospital grounds for periods longer
than specified in the guidelines and that the required frequency of collection
is maintained; he should therefore liaise with the transport organization,
which may be the local authority or a private contractor.
117. For staff training and information, the WMO should:
(a) Liaise with the matron and the hospital supervisor to ensure that the nursing
staff and medical assistants are familiar with their responsibilities for
segregation and storage of waste and of the limited responsibilities of hospital
attendants and ancillary staff in the handling and trans port of sealed waste
bags and containers;
(b) Liaise with departmental heads to ensure that all doctors and other qualified
clinical staff are aware of their responsibilities regarding segregation and
storage of waste and of the limited responsibilities of hospital attendants and
ancillary staff in the handling and transport of sealed bags and containers;
(c) Ensure that hospital attendants and ancillary staff are not involved in waste
segregation and that they handle only waste bags and containers sealed in the
correct manner.
118.For incident management and control, the WMO should:
(a) Ensure that emergency procedures are available and in place at all times and
that personnel are aware of the appropriate action to be taken;
(b) Investigate or review incidents reported during the handling of health-care
waste.
7.7.2 Emergency response
119. For health-care establishments, spills of infectious or other hazardous material or
waste are probably the most common emergencies related to hazardous material.
Basically, the same response procedures are applied, regardless of whether the
spills are from material or waste. The response to emergencies should ensure the
following:
(a) The waste management plan should be respected;
(b) Contaminated areas should be cleared and, if necessary, disinfected;
(c) The exposure of workers should be limited as much as possible during the
operation;
(d) The impact on the environment should be limited to the extent possible.
120. The staff should be well prepared for emergency response, and the required
equipment should be easily available at all points in time and within reasonable
distance to ensure that an adequate response can be made safely and routinely. The
procedures for the different types of emergencies should be written down. For
dangerous spills, clean-up should be carried out by designated, specifically trained
personnel.
7.7.2.1 Response to injuries
121. A response programme should be established for immediate reaction to injuries or
exposure to a hazardous substance. All staff handling biomedical and health-care
waste should be trained in dealing with injuries. Such a programme should include
the following elements:
(a) Immediate first aid measures, such as cleansing of wounds and skin and
splashing of eyes;
(b) Immediate reporting to a responsible designated person;
(c) Retention, if possible, of the item and details of its source for identification
of possible infection;
(d) Additional medical care from an accident, emergency or occupational health
department as soon as possible;
(e) Medical surveillance;
(f) Blood or other tests if indicated;
(g) Recording of the incident;
(h) Investigation, determination and implementation of remedial action.
7.7.2.2 Dealing with spills
122. Spills usually require only clean-up of the contaminated area. In spills of infectious
agents, it is important to determine the type of infectious agent, as some may
require immediate evacuation of the area, whereas others require fewer precautions.
The more hazardous spills usually occur in laboratories rather than in health-care
departments.
123. Spill-cleaning procedures should specify safe handling operations and appropriate
protective clothing. An example of such a procedure is provided in box 2.
Appropriate equipment for collecting the waste and placing it in new containers,
and for disinfection, should be provided. Table 6 provides an example of the
required items.
Box 2 Example of general procedure for spill-cleaning
(a) Evacuate the contaminated area;
(b) Eye and skin decontamination (disinfection) of exposed personnel should take place
immediately;
(c) Inform the designated person (usually the waste management officer);
(d) Determine the nature of the spill;
(e) Evacuate all the people not involved in cleaning up if agent is particularly hazardous;
(f) Provide first aid and medical care to injured persons (see response to injuries);
(g) Secure the area to prevent additional exposure of persons;
(h) Provide adequate clothing to personnel involved in cleaning up;
(i) Limit the spread of the spill;
(j) Neutralize or disinfect the spill or contaminated material if indicated;
(k) Collect the spill and the contaminated material; Sharps should never be picked up by hand, but
with tools, e.g. pans or brushes. Spilled material and contaminated items used for cleaning
should be placed into the appropriate bags or containers;
(l) Decontaminate or disinfect the area, and absorb; (m)Rinse the area, and absorb;
(n) Decontaminate or disinfect the used tools;
(o) Take off protective clothing and decontaminate or disinfect it if necessary;
(p) Seek medical care if exposure to hazardous material has occurred during the operation.
Table 5 Example of a list of items for spillage-cleaning
Action Tools or items
Approaching the spillage Protective equipment
Containing the spillage
Neutralizing or disinfecting the
spillage (if necessary)
Absorbent material (e.g. absorbent paper, towels, gauze pads) For
infectious material: disinfectant a/
For acids: sodium or calcium carbonate or other base
For cytotoxic material: special chemical degradation substances
For bases: citric acid powder or other acid
Collecting the spillage
For liquids: absorbent paper, gauze pads, wood shavings, calcium
bentonite, diatomaceous earth
For solids: forceps, broom, dust pan or shovel
Containment for disposal Mercury: mercury sponge or vacuum pump
Plastic bag (red, yellow or brown, as appropriate), sharps container
Decontamination or For infectious material: disinfectants a/
disinfection of the area For hazardous chemicals: suitable solvent or water
Source: WHO.
a/ Such as bleaching powder, which is a mixture of calcium hydroxide, calcium chloride
and sodium hypochlorite, used in the powder form or in solution of varying dilutions (1:1
to 1:100), depending on the nature of the spilled material.
7.7.2.3 Reporting accidents and incidents
124. All waste management staff should be trained in emergency response and made
aware of the correct procedure for prompt reporting of accidents and incidents.
Accidents or incidents, including near-misses, spillages, damaged containers,
inappropriate segregation or any incidents involving sharps should be reported by
the WMO if waste is involved, or otherwise to another designated person. The
report should include:
(a) The nature of the accident or incident;
(b) Where and when it occurred;
(c) Which staff were directly involved;
(d) Other relevant circumstances.
125. The incident should be investigated by the responsible officer (WMO in cases of
waste) to establish its causes and if possible action taken to prevent recurrence.
Records should be kept.
8. Waste management auditing
126. The purpose of a waste audit is to help a hospital to determine which initiatives will
be most beneficial. It does this by developing a detailed picture of the current status
of waste generation and disposal for the hospital. It then identifies potential areas
for improvement and develops action plans for each area. The ultimate impact of
environmental action is judged in terms of a positive impact on the environment and
cost savings for the institution.
127. There are three major steps involved in the waste audit. They include information
gathering, waste stream analysis and the development of action plans. First, a waste
audit must collect information on the following:
(a) The total volume of each type of waste generated by the entire hospital;
(b) The volume of each type of waste generated by each specific area in the
hospital;
(c) The current costs associated with the disposal of each type of waste;
(d) The waste management initiatives currently in place. Typically, these include
reuse, reduction, recycling and recovery programmes.
128. Much of the information can be found in purchase records and requisitions,
estimates made by the facility, and a search of the literature, and from interviews
with staff concerning their experience in handling waste in the facility.
129. The next step in the waste audit is to proceed with the sorting and weighing of the
components of the waste stream or to conduct a waste stream analysis. This second
task will be referred to as the comprehensive study of general waste. This task is
usually accomplished by personnel from the housekeeping staff over a period of
two weeks. For safety reasons, no types of waste that could threaten the staff in any
way are sorted - that is, biomedical waste, sharps, chemicals and so on are weighed
only.
130. The third stage of a waste audit is to develop action plans for reuse, reduction,
recycling and recovery initiatives. This involves analysing the data collected and, in
the first part of the audit, identifying potential areas of opportunity. Each of these
areas is then investigated to identify potential benefits associated with realistic
initiatives.
131. For each area where benefits can be achieved, an action plan is developed to
implement the initiative. The plan identifies where existing systems and work habits
can be modified and where new systems could be introduced to achieve the desired
results. While the action plan covers the entire hospital, the recommendations for
action may focus on specific areas within the hospital where the most benefit can be
gained.
132. Hospital managers or personnel making decisions need specific information about
which types of waste are being generated, the volumes of these wastes and the
locations of their generation. This information allows initiatives to be targeted to the
specific hospital locations and/or types of waste for which the most significant
benefits can be obtained. For example, waste recycling is most effective when the
segregation of recyclables from non-recyclables occurs at the point where the waste
is generated. By the time waste has reached the disposal hopper or compactor, it is
too late to consider waste reduction, reuse or recycling options. Knowing the
specific locations where most of the recyclable waste is generated permits
assessment of the recycling opportunity and the development of appropriate plans.
9. Capacity-building
133. The objectives of a comprehensive capacity-building strategy could include the
following:
(a) To provide a basic legal, technical and logistical framework;
(b) To introduce options for the sound management of biomedical and health-care
wastes;
(c) To develop a logical framework for the completion of national biomedical and
health-care waste profiles and the preparation of national health-care waste
plans.
134. The elements of a comprehensive capacity-building programme are:
(a) Establishment of a committee for the environmentally sound
management of bio medical and health-care wastes; Completion of
national (local) health-care waste profiles;
(b) Development of a national (local) health-care waste management
programme, including a technical and financial plan;
(c) Preparation of national regulations on the environmentally sound
management of biomedical and health-care wastes;
(d) Undertaking of training programmes for health-care personnel, waste
disposers, enforcement institutions, etc., including development of
decision-supportive tools for policy makers and waste handlers.
9.1 Education and training of personnel of health-care
establishments
135. A biomedical and health-care waste management policy is not effective unless it is
applied daily by all involved staff in a consistent and accurate way. Training
employees in implementing the policy is a critical step for a successful biomedical
and health-care waste management programme. The overall aim of the training is to
develop in the participants awareness of health, safety and environmental protection
issues relating to biomedical and health-care waste and how these can affect them in
their daily work. It should highlight the responsibilities and role of the employees in
the overall management programme. Health and safety at the workplace and
environmental awareness are the responsibility of everyone.
136. All hospital personnel, including senior medical doctors, should be educated with a
view to convincing them of the importance of the comprehensive health-care waste
management policy of the hospital and of its value for the health and safety of
everyone. This is the best way to obtain their collaboration in the implementation of
this policy.
137. Training activities should be designed for and targeted at four main categories of
personnel: managers and regulatory staff, e.g. safety advisers; medical doctors;
nurses and assistant nurses; and hospital cleaners, waste handlers and drivers.
138. Medical doctors may be educated through high-level workshops chaired by the head
of the hospital, while general hospital staff may be educated through formal
seminars. The training of waste managers and/or regulators does not usually take
place in the hospitals but in public health schools or university departments of
hospital engineering.
139. Education programmes should include: information on each aspect of the health-care
waste policy and its justification; informing each hospital staff member of his or her
responsibilities and role in implementing this policy; and technical instructions on
the application of the practices relevant to the target group.
140. As the best way of learning is probably through practice, hands-on training in small
groups should be considered where relevant. Testing the participants at the end of
the course, by simple true/false or multiple-choice questions, often provides an
incentive for learning and gives the course organizers an idea of the actual
knowledge acquired by the participants. The more detailed course contents are
presented below.
141. The instructors should have experience in teaching and training, be familiar with the
hazards and practices of biomedical and health-care waste management and, ideally,
have experience in waste handling.
142. Periodic repetition of courses will refresh the acquired knowledge, provide
orientation for new employees and for existing employees with new responsibilities,
and provide continuous updating on policy changes. Follow-up training will provide
data about the retention of information and the need for refresher courses.
9.1.1 Responsibility for training
143. The head of the health-care establishment should appoint a responsible person such
as the infection control officer, the doctor for hygiene or the WMO for all training
related to segregation, collection, storage and disposal of health-care waste. He
should ensure that staff at all levels are aware of the hospital waste management
plan and policy and of their responsibilities and obligations within the framework of
this plan and policy. A record of all training sessions should be kept. The content
of the training programmes should be periodically reviewed and updated where
necessary. For smaller sources of biomedical and health-care waste, a central
training function could be established at the regional health authority.
9.1.2 The training package
144. A training package could be developed by the national government agency
responsible for the disposal of biomedical and health-care wastes.
145. The training package on biomedical and health-care waste should be suitable for
various types of health-care establishment, including government hospitals,
teaching hospitals, dental hospitals, polyclinics, health centres, health-care research
institutions, clinical laboratories and other establishments where health-care wastes
are generated. Such a training package would also be useful for educational
establishments and the sectors providing services for biomedical and health-care
waste disposal. The package should contain numerous illustrations, such as
drawings, figures, photographs, slides or overhead transparencies.
9.1.3 Selection of participants
146. The ideal number of participants for a training course is 20 to 30 because larger
groups may render discussions and exercises difficult. Training courses should be
organized and targeted for all personnel categories. The discussions may, however,
be easier if the group is composed of personnel from various disciplines (e.g.
supervisors, medical and nursing staff, laboratory staff, engineers, ancillary staff) or
if the group is laced with one or two medical assistants and nurses.
147. It may be beneficial to include senior administration staff and heads of department
in certain training groups to demonstrate their commitment to the policy to other
staff members and to show that the policy is the responsibility of all personnel of
health-care establishments. Line managers may find it worthwhile to run the
training sessions themselves, with their own personnel attending.
9.1.4 Training recommendations
9.1.4.1 Training recommendations for personnel providing health-care
148. As mentioned above, the content of the training course should provide an overview
of the waste management policy and its inherent rationale and provide information
on relevant practices for the targeted group. For example, personnel providing
health-care will mainly be informed that with respect to waste segregation practices:
(a) Care should be taken while removing needles from syringes during operations
which require this;
(b) In no event should the staff correct segregation mistakes by removing items
from a bag or container once disposed of, or by placing a bag into a bag of
another colour;
(c) Hazardous and general waste should not be mixed. However, where this has
occurred, the mixture should be treated as health-care risk waste;
(d) Nursing and clinical staff should ensure that adequate numbers of bag holders
and health-care waste containers are provided for the collection and on-site
storage of medical waste in the wards, clinics, operating theatres and other
sources of waste generation. These on-site receptacles should be located close
to the source of waste generation.
149. Upon completion of the training course, the members of staff should be aware of
their responsibilities.
9.1.4.2 Training recommendations for waste-handling staff
150. Relevant training chapters may constitute a basis for the training course. Topics
covered may include the waste management policy, health hazards, on-site
transportation, storage, safety practices and emergency response. The attention of
members of staff who routinely handle biomedical and health-care waste may
decrease with time, which will increase the risk of injury. Periodic training is
therefore recommended.
9.1.4.3 Training of health-care waste management operators
151. The minimal training requirements for waste management operators should
include the following:
(a) Information on the risks associated with the handling of biomedical and
health-care waste;
(b) Training on the procedures for dealing with spillages and accidents;
(c) Instructions on the use of protective clothing.
152. The training needs will depend on the type of operations the staff perform.
Depending on the duties, training on specific areas (e.g. operation of incinerators,
waste transportation) will be required.
9.1.4.4 Training for members of staff who transport waste
153. The health-care establishment may either transport the waste itself or contract an
authorized waste transporter. Drivers and waste handlers should be specifically
trained and be aware of the nature and risks of the waste being transported. In
particular, transport staff should be trained in the following issues, and be able to
carry out the procedures and respect the instructions without any help from others:
(a) Correct procedures for handling, loading and unloading waste bags and
containers;
(b) Procedures for dealing with spillages or accidents; for these procedures, written
instructions should be available in the vehicle;
(c) Protective clothing and footwear should be worn at all times.
154. The vehicles dedicated to waste collection should at all times carry a supply of
plastic bags, protective clothing, cleaning tools and disinfectants to clean and
disinfect any spillage which may occur during loading, transport or unloading.
Documentation and recording of health-care waste, e.g. by using a consignment
note system, are necessary because they make it possible to trace the waste from the
point of collection to the final disposal facility. The head of the health-care
establishment should liaise with the transport contractor to ensure that the waste
collection crew is well trained. Untrained personnel should never be allowed to
handle biomedical and hazardous health-care waste.
9.1.4.5 Training of incinerator operators
155. Operation of incinerators requires qualified incinerator operators. It should be
remembered that the availability of such operators in certain regions should be
verified before purchasing high-technology incinerators. If qualified operators are
not available, health-care establishments should either resort to alternative health-
care waste disinfection technologies or contract the incineration out through a
regional facility.
156. Incinerator operators should have received at least secondary technical education.
They should be specifically trained in the following subjects:
(a) Overall functioning of the incineration facility, including heat recovery and
flue-gas cleaning technologies, if they exist;
(b) Health, safety and environmental implications of their operations;
(c) Technical procedures for the operation of the plant;
(d) Emergency response, e.g. in case of equipment failures, alarms;
(e) Maintenance of the plant;
(f) Surveillance of ash quality and emissions according to the specifications.
9.1.4.6 Training of operators of specially engineered landfill sites
157. The training of landfill operators is important for limiting subsequent risks presented
by buried biomedical and health-care waste, both in relation to preventing
scavenging and to protecting the quality of water. Operators should be trained in the
following areas:
(a) Health risks related to biomedical and hazardous health-care waste;
(b) Hazards related to sorting of this type of waste, which should in no event be
practised by the landfill operators or other people;
(c) Handling of biomedical and health-care waste by drivers or site operators,
which should be limited to a minimum;
(d) Use of protective equipment and personal hygiene;
(e) Application of safe procedures to dispose the wastes into a landfill;
(f) Procedures for emergency response.
Annex I: Glossary/terminology
Activity Disintegration of an amount of a radionuclide in a particular
energy state at a given time per time interval at a given moment.
Air pollution The presence of a material or substance in the air which may be
harmful to either the natural or human environment, which
includes any material present in sufficient concentrations for a
sufficient time, and under certain circumstances, to interfere
significantly with the comfort, health or welfare of persons or with
the full use and enjoyment of property.
Air quality standards The level of pollutants that cannot by law be exceeded during a
specified time in a defined area.
Solid or liquid waste arising from health-care (medical) activities
such as diagnosis, monitoring, treatment, prevention of disease or
alleviation of handicap in humans or animals, including related
research, performed under the supervision of a medical practitioner
or veterinary surgeon or another person authorized by virtue of his
professional qualifications.
Bottom ash The non-airborne combustion residue from burning fuel and other
materials in an incinerator. The material falls to the bottom of the
incinerator and is removed mechanically.
Capacity The quantity of solid waste that can be processed in a given time
under certain specified conditions, usually expressed in terms of
mass per 24 hours.
Chemical waste Wastes generated from the use of chemicals in medical, veterinary
and laboratory procedures, during sterilization processes and
research.
Collection The act of removing accumulated containerized solid waste from
the generating source. Private collection of solid and liquid waste
by individuals or companies from residential, commercial, health
facility or industrial premises; the arrangements for the service are
made directly between the owner or occupier of the premises and
the collector.
Cytotoxic waste Material which is visibly contaminated with a cytotoxic drug
during the preparation, transport or administration of cytotoxic
therapy.
Decontamination The process of reducing or eliminating the presence of harmful
substances such as infectious agents so as to reduce the likelihood
of disease transmission from those substances.
Disinfection Process of reducing the viability of micro-organisms by various physical and chemical methods.
Emergency A situation created by an accidental release or spill of hazardous chemicals
or infectious material which poses a threat to the safety of workers,
residents, the environment or property.
Exposure
The amount of radiation or pollutant present in a particular environment
(i.e. human, natural) which represents a potential health threat to the living
organisms in that envi ronment.
Fly ash
The finely divided particles of ash entrained in the flue gases arising from
com bustion. The particles of ash may contain incompletely burned material.
The par ticles are frequently glassy spheres but may also be crystalline or
even fibrous in structure.
Health-care waste See biomedical and health-care waste.
Human tissue
The tissue, organs, limbs, blood, and other body fluids that are removed
during surgery and autopsy.
Incineration
The controlled burning of solid, liquid or gaseous combustible wastes to
produce gases and residues containing little or no combustible material.
Irradiation Exposure to radiation of wavelengths shorter than those of visible light
(gamma, x-ray or ultraviolet) for medical purposes, the destruction of
bacteria in milk or other foodstuffs or initiation of polymerization of
monomers or vulcanization of rubber.
Liquid wastes Any waste material that is determined to contain “free liquids” - liquids
which readily separate from the solid portion of waste under ambient
temperature and pressure.
Monitoring
Periodic or continuous surveillance or testing to determine the level of
compliance with statutory requirements and/or pollutant levels in various
media or in humans, animals and other living things.
Off-site facility
A clinical and related waste treatment, storage or disposal facility that is
located away from the generating site.
On-site facility
A clinical and related waste treatment, storage or disposal facility that is
located on the generating site.
Pharmaceutical
waste
Wastes from the production, preparation and use of pharmaceutical
products.
Pyrolysis
The decomposition of organic material by heat in the absence of or with a
limited supply of oxygen.
Radioactive waste Material contaminated with a radioisotope which arises from the medical or
research useof radionuclides. It is produced, for example, during nuclear
medicine, radio immunoassay and bacteriological procedures, and may be
in a solid, liquid or gaseous form.
Residual wastes Those materials (solid or liquid) which still require disposal after the
completion of
a treatment or resource recovery activity, e.g., slag and liquid effluents
following a
pyrolysis operation and the discards from front-end separation systems.
Sanitation
The control of all the factors in the physical environment that exercise or can
exercise
a deleterious effect on human physical development, health, and survival.
Sharps
All objects and materials which are closely linked with health-care activities
and
pose a potential risk of injury and/or infection.
Sterilization A process used to reach a state free of viable micro-organisms. Note that in a
sterilization process, the nature of microbiological death or reduction is
described
by an experimental function. Therefore, the number of micro-organisms that
survive
a sterilization process can be expressed in terms of probability. While the
probability
may be reduced to a very low number, it can never be reduced to zero.
Waste
minimization
The application of activities such as waste reduction, reuse and recycling to
minimize
the amount of waste that requires disposal.
Waste
segregation
The process of keeping source-separated wastes apart during handling,
accumula
tion (interim storage), storage and transport to assist resource recovery and to en
sure that appropriate designated treatment and/or disposal methods are utilized.
Waste segregation should be practised by both generators and waste-handling com
panies for efficient waste management.
Annex II: Examples of specific waste reduction, reuse and recycling
activities
Purchasing practices
· Purchase recycled content material where appropriate (e.g. office paper, envelopes,
toilet tissue, paper towels) and look for environmental labels. Work with purchasing
committees to determine which products may be suitable
· Work with suppliers to have oversized packaging materials returned or recycled
·
Use building construction products with recycled content materials (e.g. drywall,
asphalt)
· Use environmentally responsible vehicles and maintenance products (e.g. propane as
fuels, re-refined oils, retreated tyres, recycled antifreeze).
Reduction
Use two-sided photocopying
Use electronic mail (i.e. personal computers or phone messages)
Buy in bulk (e.g. food and drink containers in the cafeteria and soaps and detergents
in house keeping)
Avoid products with excess packaging and work with suppliers to reduce it
Reroute publications such as magazines, newspapers and journals
Circulate memos or documents
Use bulletin boards for posting announcements
Single-space texts
Use two-way envelopes for billing
Make sure staff understand how to use equipment to reduce wastage
Use the reduction feature on your copier to fit more than one paper per page
Use permanent tape dispensers, not disposable ones
Use refillable pens instead of disposable ones
Purchase durable equipment, furnishings and supplies
Install energy-efficient appliances (e.g. lighting)
Use water-saving devices
Turn off lights and office equipment when not in use
Use incinerators that meet the new discharge guidelines and have an energy
recovery system
Use computer fax software to send facsimiles without making hard copies
Use non-solvent liquid scintillation cocktails in laboratories
Use less hazardous radioactive materials where appropriate
Develop microtesting procedures to reduce chemical usage
Make sure biomedical waste is properly segregated from general waste to reduce dis-
posal costs and increase materials for recycling
Explore opportunities to reduce formalin usage in sample analysis by replacing with
cold, physiological saline solutions where appropriate
Replace formalin solutions with commercially available, less toxic cleaning solutions
in dialysis machines.
Recycling
· Newspapers and telephone books can be given to farmers or
charitable organizations as bedding
· Give used towels and rags to rag recyclers · Use plain-paper
fax machines; the paper is recyclable and the messages
will not fade
· Recycle juice bottles or baby formula; juice and food material
containers; newspapers; and plastic containers (e.g.
polyethylene containers or other types where
appropriate)
· Recycle cardboard with a commercial recycler or through your
supplier · Recycle pallets with a commercial recycler or
through your supplier · Include pick-up of containers as
part of the supplier’s role in your contracts
· Work with suppliers to help them design workable packages
that are recyclable
· Pool local businesses that recycle material and contract for the
services of the same recycler t o reduce pick-up costs
· When purchasing products, ensure that all packages can be
returned to the supplier or recycled at your facility
· Use a distribution network to recycle materials back to a
central location for better marketing of material
· Explore waste-recycling options for food waste either as
human food, as animal feed either directly or through a
commercial processor - or as composting or for
vermiculture, and use compost at your facility in
landscaping
· Contract a shredding company that recycles your shredded
paper
· Involve ambulatory patients in waste minimization
programmes (e.g. psychiatric and geriatric patients in
composting projects)
· For large waste generators, explore processing equipment such
as balers or compactors for recyclable materials
· Locate markets for recyclable materials which are generated in sufficient quantities,
such as office paper, cardboard, plastics, solvents (xylenes, toluenes, CFCs),
oils (vegetable and hydraulic) and construction and demolition materials such
as drywalls, asphalt, concrete, wood Install silver recovery units for photo
processing waste waters
· Evaluate opportunities for anaesthetic gas recycling.
Reuse
· Donate used publications to doctors’ surgeries, nursing homes or the local library.
· Reuse worn cloth nappies and towels as rags.
· Reuse scrap paper for notepads and draft copies.
· Reuse old envelopes by applying labels (with non-solvent glues) on top of old
addresses.
· Use reusable nappies, incontinence pads and underpads where appropriate.
· Use reusable urine trays.
· Use reusable drapes and gowns where appropriate.
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Biomedical
and health
care waste
ZOrHearP ORF OED
risk waste waste
Use 7
Treatment/
reprocessing
a
Risk + Non- Reuse - recycling of
a Possible action points a
Classification/ Transport/
Definition > 4 Risk ) < Treatment > Disposal
Non-risk waste < > >
Municipal
[Neutralization fwaste
INFECTIOUS —p i for landfill or, A disposal
Infectious lif necessary for
incineration
SHARPS -—> Physical Incineration
BIOLOGICAL - . UB
fe Ethical religious
ANATOMICAL Seperate
specific
DRUGS F disposal
REAGENTS P Toxic options
RADIOACTIVE 2 J
COMPOUNDS i> Radioactive
The Federal Environmental Protection
Authority
Technical Guidelines on the Environmentally Sound
Management of Biomedical and Healthcare Wastes
2004
Addis Ababa
Ethiopia
Table of Contents
Page
Table of Contents.....................................................................................................I
1.Introduction...................................................................................................................1
2. Purpose and scope of the guidelines......................................................................3
3. General definition of biomedical and health-care waste..................................4
3.1 Health-care.................................................................................................................4
3.2 Biomedical and health-care waste.............................................................................5
3.3 Hazardous health-care waste.....................................................................................5
3.4 Infectious health-care waste......................................................................................5
3.5 Biological health-care waste......................................................................................6
3.6 Sharps........................................................................................................................6
4. Hazards of biomedical and health-care waste.....................................................6
4.1 Types of hazards........................................................................................................6
4.2 Persons at risk............................................................................................................7
4.3 Hazards from infectious waste...................................................................................8
4.4 Hazards from sharps..................................................................................................8
4.5 Hazards from chemical and pharmaceutical waste....................................................8
4.6 Hazards from cytotoxic waste...................................................................................9
4.7 Hazards from radioactive waste.................................................................................9
5. Field of application/source identification...........................................................10
6. Waste identification and classification; waste groups....................................11
7. Applicable state-of-the-art management, treatment and disposal
technologies....................................................................................................................24
7.1 Avoidance/prevention..............................................................................................24
7.1.1 Packaging..........................................................................................................25
7.1.2 Kitchen and canteen waste................................................................................26
7.1.3 Laboratory waste and chemical residues..........................................................26
7.2 Segregation, collection, labeling and handling of biomedical and health-care waste
.......................................................................................................................................27
7.3 In-house transport and storage.................................................................................29
7.4 Special requirements for packaging and labelling for off-site transport.................32
7.4.1 Packaging requirements....................................................................................33
7.4.2 Labeling............................................................................................................33
7.5 Recycling/recovery..................................................................................................34
7.6 Disposal operation/technologies, accreditation and environmental impacts...........34
7.6.1 Methods of treatment or disposal.....................................................................36
7.6.1.1 Steam sterilization.........................................................................................38
7.6.1.2 Dry heat sterilization......................................................................................40
7.6.1.3 Chemical disinfections/sterilization...............................................................40
7.6.1.4 Other treatment/disposal methods.................................................................41
7.6.1.5 Incineration....................................................................................................42
7.6.1.6 Landfill..........................................................................................................43
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
7.7 Responsibility (including emergency response and contingency plan)...................47
7.7.1 Assignment of responsibilities..........................................................................47
7.7.1.1 Duties of the head of the hospital..................................................................47
7.7.1.2 Duties of the waste management officer (WMO)..........................................48
7.7.2 Emergency response.........................................................................................50
7.7.2.1 Response to injuries.......................................................................................51
7.7.2.2 Dealing with spills.........................................................................................51
7.7.2.3 Reporting accidents and incidents.................................................................53
8. Waste management auditing..................................................................................53
9. Capacity-building.....................................................................................................55
9.1 Education and training of personnel of health-care establishments........................55
9.1.1 Responsibility for training................................................................................57
9.1.2 The training package.........................................................................................57
9.1.3 Selection of participants...................................................................................57
9.1.4 Training recommendations...................................................................................58
9.1.4.1 Training recommendations for personnel providing health-care...................58
9.1.4.2 Training recommendations for waste-handling staff.....................................59
9.1.4.3 Training of health-care waste management operators...................................59
9.1.4.4 Training for members of staff who transport waste.......................................59
9.1.4.5 Training of incinerator operators...................................................................60
9.1.4.6 Training of operators of specially engineered landfill sites...........................61
Annex I: Glossary/terminology.................................................................................62
Annex II: Examples of specific waste reduction, reuse and recycling
activities..........................................................................................................................65
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
1.Introduction
Guidelines are preferably set based on country specific baseline information. However,
under the prevailing Ethiopian conditions, the necessary information required for the
preparation of the guidelines is inadequate, outdated and scanty. An alternative approach
is to adopt or adapt the guidelines of international organizations. Accordingly, it has
become imperative to adopt and use the Biomedical and Healthcare wastes of the United
Nation Environment Program.
Therefore, the UNEP guidelines on Biomedical and Healthcare wastes adopted and
introduced throughout the country. The guideline will be amended as more information
on the state of Biomedical and Healthcare wastes is obtained.
1. The disposal of wastes originating from health-care establishments (public and private)
can have an effect on human health and well-being, the environment (air, water, soil,
animals, plants, landscape) and issues relating to public security and order.
2. Nevertheless, experience has proven that wastes originating from health-care
establishments, when properly managed, generally pose no greater risks than that of
properly treated municipal or industrial wastes. This also pertains to the disposal of
biomedical and health-care wastes, in contrast to occasional public perception.
3. The guidelines provide information for the proper treatment of wastes from health-care
establishments (public and private). The information provided takes due consideration
of the waste management requirements of disposal and recovery measures as well as
hygiene requirements. In addition to ecological aspects, the information and
recommendations should be economically feasible and easy to undertake. It and also
makes allowances for technical progress.
4. It has become apparent that the introduction of improved solutions for the segregation
of waste within health-care facilities can result in reduced amounts of waste requiring
special treatment and therefore in reduced waste treatment costs. In addition, new
technologies have become available to treat and disinfect biomedical and health-care
wastes so that they can be of with low risk by landfilling finally.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
5. The safe management of biomedical and health-care waste is essential for community
and environmental health. It is also important that the standards for the protection of
the environment and human health are uniform across all health-care establishments,
irrespective of technologies used for treatment and disposal. This in turn ensures a
more viable and efficient industry. However, it should be noted that in many countries,
the national authorities, in addition to industry, are an active participant in health-care,
either providing services or paying for them. In addition, the lack of resources or of
experience in developing standards may be significant factors affecting the capacity to
treat biomedical and health-care wastes.
6. To manage biomedical and health-care waste effectively, the following should be taken
into consideration:
(a) Generation and minimization;
(b) Separation and segregation of sources;
(c) Identification and classification;
(d) Handling and storage;
(e) Packaging and labelling;
(f) Transportation inside and outside health-care establishments;
(g) Treatment;
(h)Disposal of residues (including emissions);
(i)Occupational health and safety; public and environmental health;
(j)Stakeholder and community awareness and education;
(k)Research into and development of improved technologies and environmentally
friendly practices.
7. These guidelines attempt to address all of these issues and provide support for the
achievement of improved environmental performance in managing biomedical and
health-care waste. To be successful, waste management strategies should always take
account of, and interact with, the process that generated the wastes in the first place.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
2. Purpose and scope of the guidelines
8. Biomedical and health-care waste is a term for all waste generated in health-care
establishments. Biomedical and health-care waste can briefly be described as waste
from medical or other related practices. In reality, only a small proportion of this
waste causes a higher risk of transmitting infectious diseases than normal household
or municipal waste. These guidelines deal with all biomedical and health-care waste,
with especial focus on the segregation and treatment of hazardous biomedical and
health-care waste.
9. Concern regarding the safe management and disposal of biomedical and health-care
waste has resulted from the perceived or real risk of potential transmission of
infectious diseases through accidental injury or contact with infected body fluids. The
disposal of sharps (needles, scalpels etc.) has attracted particular interest because of
the small number of occupationally acquired hepatitis and HIV human
immunodeficiency virus (HIV) infections suffered by health-care workers attributed
to sharps injuries. The majority of sharps injuries, however, do not result in infection.
It is therefore “good practice” in waste management to reduce the risk of injuries.
Figure 1 describes some possible action points to establish “good practice” in waste
management.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Figure 1 Biomedical and health-care waste strategy
3. General definition of biomedical and health-care waste
10. To get a better understanding of the waste management practice of health-care
facilities, there is a need to have a common and internationally accepted definition
for the waste generated in those facilities.
11. The general definitions below are set forth by these guidelines:
3.1 Health-care
12. Medical activities such as diagnosis, monitoring, treatment, prevention of disease or
alleviation of handicap in humans or animals, including related research, performed
under the supervision of a medical practitioner or veterinary surgeon or another
person authorized by virtue of his or her professional qualifications.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
3.2 Biomedical and health-care waste
13. The solid or liquid waste arising from health-care (including collected gaseous
waste).
3.3 Hazardous health-care waste
14. This includes:
(a) Infectious health-care waste;
(b)Chemical, toxic or pharmaceutical waste, including cytotoxic drugs
(antineoplastics)
(c) Sharps (e.g. needles, scalpels);
(d) Radioactive waste;
(e) Other hazardous waste.
3.4 Infectious health-care waste
15. All biomedical and health-care waste known or clinically assessed by a medical
practitioner or veterinary surgeon to have the potential of transmitting infectious
agents to humans or animals.
16. For the purpose of these guidelines, infectious health-care wastes are:
(a) Discarded materials or equipment contaminated with blood and its
derivatives, other body fluids or excreta from infected patients with
hazardous communicable diseases (specified in section 6.1, subsection B.5
below). Contaminated waste from patients known to have blood-borne
infections under going haemodialysis (e.g. dialysis equipment such as
tubing and filters, disposable sheets, linen, aprons, gloves or laboratory
coats contaminated with blood);
(b) Laboratory waste (cultures and stocks with any viable biological agents
artificially cultivated to significantly elevated numbers, including dishes
and devices used to transfer, inoculate and mix cultures of infectious
agents and infected animals from laboratories).
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
17. Wherever appropriate and applicable, waste from basic and fundamental biomedical
and other research shall be managed according to the principles set forth for health-
care waste.
3.5 Biological health-care waste
18. All body parts and other anatomical waste including blood and biological fluids and
pathological waste that are recognizable by the public or the health-care staff and that
demand, for ethical reasons, special disposal requirements.
3.6 Sharps
19. All biomedical and health-care waste with sharps or pointed parts able to cause an
injury or an invasion of the skin barrier in the human body. Sharps from infected
patients with hazardous communicable diseases (specified in section 6.1, subsection
B.5 below), isolated wards or other pointed parts contaminated with the above-
mentioned laboratory waste must be categorized as infectious waste.
4. Hazards of biomedical and health-care waste
4.1 Types of hazards
20. As mentioned in section 1, biomedical and health-care waste includes a large
component of non-risk waste and a smaller proportion of risk waste. Non-risk waste
is similar to municipal waste and does not create more health or other hazards than
mismanaged municipal waste. If the risk waste is not properly segregated from other
waste fractions (e.g. mixture of biological and pathological waste with sharps and
body fluids), the whole mixture has to be handled as infectious waste. In this section,
potential hazards related to exposure to biomedical and health-care waste will be
addressed.
21. Exposure to hazardous or potentially hazardous biomedical and health-care waste can
induce disease or injury. The hazardous nature of biomedical and health-care waste
may be due to the following or a mixture of the following properties:
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(a) It contains infectious agents, including contaminated sharps;
(b) It is cytotoxic or genotoxic;
(c) It contains toxic or hazardous chemicals or pharmaceuticals;
(d) It is radioactive;
(e) It contains sharps.
22. For the purposes of these guidelines, infectious substances are those substances
known or reasonably expected to contain pathogens. Pathogens are defined as micro-
organisms (including bacteria, viruses, rickettsia, parasites, fungi) or recombinant
micro-organisms (hybrid or mutant) that are known or reasonably expected to cause
infectious disease with a high risk for animals or humans. Note that not all pathogenic
micro-organisms can be transmitted by waste as a pathway.
4.2 Persons at risk
23. All persons exposed to hazardous biomedical and health-care waste are potentially at
risk of contamination through accidental exposure. This includes people within
health-care establishments or any other source of biomedical and health-care waste,
and people inside and outside these sources who either handle these wastes or are
exposed to them, for example as a consequence of careless management. The main
groups at risk are the following:
(a) Doctors, nurses, ambulance staff and hospital sweepers;
(b) Patients in health-care establishments or under home care;
(c) Workers in support services to health-care establishments, such as laundries,
waste handling and transportation, waste disposal facilities including incinerators
and other persons separating and recovering materials from waste;
(d) Inappropriate or inadvertent end-users such as scavengers and customers in
secondary markets for reuse (i.e. households, local medical clinics, etc.).
24. Owing to the extension of drug abuse and of home care including home dialysis, the
hazards associated with scattered small sources of biomedical and health-care waste
should not be overlooked.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
4.3 Hazards from infectious waste
25. Infectious waste may contain a great variety of pathogenic micro-organisms, but not
all can be transmitted to humans and animals by contact with waste.
26. The pathogens contained in the waste may infect the human body through the
following pathways: absorption through a crack or cut in the skin (injection),
absorption through the mucous membranes, and rarely by inhalation and ingestion.
27. Concentrated cultures of pathogens and contaminated sharps (in particular syringe
needles) are probably the waste items that create the most acute human health
hazards.
4.4 Hazards from sharps
28. Sharps may not only cause cuts and punctures but also infect the wounds by agents
which previously contaminated the sharps. Owing to this double risk of injury and
disease transmission, sharps are considered problematic. The main diseases of
concern are infections which may be transmitted by subcutaneous introduction of the
agent - for example, viral blood infections.
29. Syringe needles are of particular concern because they constitute an important part of
the sharps and are often contaminated with the blood of patients.
4.5 Hazards from chemical and pharmaceutical waste
30. Many chemicals and pharmaceuticals which are used in health-care establishments
are hazardous chemicals (e.g. toxic, corrosive, flammable, reactive, explosive, shock-
sensitive, cytotoxic or genotoxic). Fractions of these will be found in biomedical and
health-care waste after their use or when they are no longer required.
31. They may have toxic effects, either through acute or chronic exposure, and injuries,
including burns. Intoxications can result from absorption of the
chemicals/pharmaceuticals through the skin or the mucous membranes and from
inhalation or ingestion. Injuries can be provoked by contact of flammable, corrosive
or reactive chemicals with the skin, the eyes or the mucous membrane of the lung
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(e.g. formaldehyde and other volatile chemicals). The most common injuries are
burns.
32. Mercury is another hazardous product common within hospitals owing to its
prevalent use in literally hundreds of different devices. It is most concentrated in
diagnostic devices such as thermometers, blood pressure gauges and, oesophageal
dilators, Miller Abbott/Cantor tubes. It is also found in other sources such as
fluorescent light tubes and batteries.
33. Disinfectants constitute a particularly important group of hazardous chemicals, as
they are used in large quantities and are often corrosive. It should also be noted that
reactive chemicals may form highly toxic secondary compounds. Chemical residues
discharged into the sewage system may have toxic effects on the operation of
biological sewage treatment plants or on the natural ecosystems of receiving waters.
Pharmaceutical residues may have the same effects, as they may include antibiotics
and other drugs, heavy metals such as mercury, phenols and derivatives and other
disinfectants and antiseptics.
4.6 Hazards from cytotoxic waste
34. The severity of health hazards for health-care workers handling cytotoxic waste arises
from the combined effect of the substance toxicity and of the magnitude of exposure
that may occur during waste handling or disposal. Exposure to cytotoxic substances
in health care may also occur during preparation for treatment. The main pathways of
exposure are inhalation of dust or aerosols, skin absorption and ingestion of food
accidentally in contact with cytotoxic (antineoplastic) drugs, chemicals or waste, or
from contact with the secretions of chemotherapy patients.
4.7 Hazards from radioactive waste
35. Radioactive materials are unique in that they cause harm through both external
radiation (by approaching them or handling them) and through their intake into the
body. The degree of harm depends on the amount of radioactive material present or
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
taken into the body and on the type of material. Exposure to radiation from high-
activity sources, such as those used in radiotherapy, can cause severe injuries, ranging
from superficial burns to early fatalities. Radioactive waste arising from nuclear
medicine is much lower in activity than the sources referred to above and is unlikely
to cause such harm, but exposure to all levels of radiation is considered to be
associated with some risk of carcinogenesis, however small.
36. There are well-established procedures for minimizing the hazards arising from work
with radioactive materials, and these are normally implemented in hospitals and
laboratories where such materials are used. Similarly, the arrangements for safe
radioactive waste storage and disposal are well established. There should be a person
or persons appointed in the organization with responsibility for ensuring that
radiation protection is observed and that radioactive waste is properly and safely
managed.
5. Field of application/source identification
37. These guidelines shall be applicable for the generation of biomedical and health-care wastes from
health-care establishments. Health-care establishments shall specifically include the following:
(a) Large sources:
(i) University hospitals and clinics;
(ii) Maternity hospitals and clinics;
(iii) General hospitals.
(b) Medium sources:
(i) Medical centres;
(ii) Out-patient clinics
(iii) Mortuary/autopsy centres;
(iv) Farm and equine centres;
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(v) Hospices;
(vi) Abortion clinics
(vii) Medical laboratories
(viii) Medical research facilities;
(ix) Animal hospitals;
(x)
Blood banks and transfusion
centres;
(xi) Emergency services.
(c) Small sources:
(i) General medical practitioners;
(ii) Convalescent homes;
(iii) Nursing and remedial homes;
(iv) Medical consulting rooms;
(v) Dental practitioners;
(vi) Animal boarding and hunt kennels;
(vii) Tattooists;
(viii) Acupuncturists;
(ix) Veterinary practitioners;
(x) Pharmacies;
(xi) Cosmetic piercers;
(xii) Zoos, safari parks, etc.
6. Waste identification and classification; waste groups
38.For the purpose of this guidelines the following biomedical and health-care waste
classification is used:
A Health-care wastes with the same composition as household and municipal waste
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
A1 Normal household and municipal waste
B Biomedical and health-care waste requiring special attention
B1 Human anatomical waste (tissues, organs, body parts, blood and blood bags)
B2 Waste sharps (needles, syringes, scalpels, slides, ampoules, etc.)
B3 Pharmaceutical waste (e.g. expired medicines)
B4 Cytotoxic pharmaceutical wastes
B5 Blood and body fluid waste (materials contaminated with blood or other
body fluids, soiled cotton from non-infected patients) Wastes which only
require special measures to prevent the risk of infection during their
management.
C Infectious wastes
For the purpose of these guidelines, infectious health-care wastes are:
(a) Discarded materials or equipment contaminated with blood and its derivatives,
other body fluids or excreta from infected patients with hazardous
communicable diseases(specified in section 6.1, subsection B.5 below).
Contaminated waste from patients known to have blood- borne infections under
going haemodialysis(e.g. dialysis equipment such as tubing and filters,
disposable sheets, linen, aprons, gloves or laboratory coats contaminated with
blood);
(b) Laboratory waste (cultures and stocks with any viable biological agents
artificially cultivated to significantly elevated numbers, including dishes and
devices used to transfer, inoculate and mix cultures of infectious agents and
infected animals from laboratories).
D Other hazardous wastes.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Not exclusive to the medical health-care sector, e.g. solvents, chemicals, batteries,
fixer solutions, etc.
E Radioactive waste from health care.
B1. Human anatomical waste
Description
Non-infectious human body parts, organs and tissues and blood bags.
Examples of such wastes
Tissue waste, removed organs, amputated body parts, placentas, etc.
Waste management guidance
It is primarily for ethical reasons that special requirements must be placed on the
management of waste human body parts, organs and tissue. The waste must be collected
in appropriate containers or bags as soon as possible and at the place where it is
generated. The waste must be kept in tight receptacles (e.g. in the wooden coffins
commonly used in pathology) and under cooled conditions when stored temporarily for a
prolonged period of time, or else be handed over to a waste management facility within a
reasonable period. Intermediate storage takes place at a location which is accessible only
to trained personnel. Normally, the waste must always be incinerated completely, in an
appropriate facility. Household waste incineration plants are, as a rule, not suitable for the
incineration of amputated body parts, removed organs and placentas (cases of exceptions,
such as separate storage and direct feeding, have to be clarified with the responsible
authorities and the management of the incineration plant). In exceptional cases crematoria
can be used for the incineration (disposal) of amputated body parts.
Exemptions and special provisions
Where only small quantities of these wastes are generated (e.g. in medical practices), they
can be collected in appropriate containers (e.g. “hard box”) and managed jointly with
municipal waste at a volume of up to 1 litre per waste bag. The management of animal
waste body parts, organs and tissues is subject to the provisions of relevant special
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
legislation.
B2: Waste posing the risk of injury (sharps)
Description
Sharps are all objects and materials which are closely linked with health-care activities
and pose a potential risk of injury and/or infection.
Examples of such wastes
Needles, drain tubes, syringes with the attached needle, butterfly needles, spikes, broken
glassware, ampoules, pipettes, scalpel blades, lancets, vials without content, etc. Waste
management guidance Wastes posing the risk of injury require measures to be taken to
prevent injury and infection during the handling of these wastes within and outside of
health-care establishments. These wastes have to be collected and managed separately
from other waste. The collection containers must be puncture-resistant and leak tight.
Storage of these wastes takes place at a location which is accessible only to trained
personnel.
Note: Sharps from infected patients, isolated wards, infected patients undergoing
haemodialysis or other pointed parts contaminated with laboratory waste must be
categorized as infectious waste.
Exemptions and special provisions Syringes and needles should not be reused.
B3: Pharmaceutical waste
Description
Pharmaceutical wastes are pharmaceuticals, which have become unusable for the
following reasons:
Exceeded expiration date;
Expiration date exceeded after the packaging or the ready-to-use preparation
prepared by the user has been opened;
Cannot be used for other reasons (e.g. call-back campaign).
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Examples of such wastes
The term “pharmaceuticals” embraces a multitude of active ingredients and types of
preparations. The spectrum ranges from teas through heavy-metal-containing
disinfectants to highly specific medicines containing a large variety of different
hazardous or non-hazardous substances. Waste management may therefore be based on a
differentiated approach; for example, pharmaceutical waste could be divided into three
classes and its management carried out in a class-specific manner as follows:
Pharmaceutical wastes: Class 1
Pharmaceuticals such as camomile tea and cough syrup which pose no hazard during
collection, intermediate storage and waste management. Class 1 pharmaceutical
wastes are not considered hazardous wastes. They are managed jointly with municipal
waste.
Pharmaceutical wastes: Class 2
Pharmaceuticals which pose a potential hazard when used improperly by
unauthorized persons. Class 2 pharmaceutical wastes are considered to be hazardous
wastes. Their management takes place in an appropriate waste disposal facility.
Pharmaceutical wastes: Class 3
Heavy-metal-containing and unidentifiable pharmaceuticals, heavy-metal-containing
disinfectants, which, owing to their composition, require special management. Class 3
pharmaceuticalwastes are considered to be hazardous wastes. Their management
takes place in an appropriate waste disposal facility. However, owing to the fact that
medicines are not normally labelled in accordance with their hazardous
characteristics, the sorting of medicines into different classes, in particular classes 2
and 3, may often be too difficult in practice. Countries may therefore decide to
consider all or a major part of medicines as hazardous waste or waste requiring
special consideration.
Waste management guidance
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Waste prevention: To reduce the generation of pharmaceutical waste, stocks of
pharmaceuticals should be inspected periodically and checked for their durability
(expiration date).
Recovery by specialized facilities: Possibilities for returning old pharmaceuticals to the
producer or handing them over to a special collection system (e.g. pharmacies) for
possible subsequent use could be explored. Such a return of pharmaceuticals in their
original packaging prior to or within a reasonable period after the expiration date is
possible if it is ensured that the producer or collector examines possibilities for
subsequent use of the pharmaceuticals and that pharmaceuticals which are no longer
usable are disposed of in an environmentally sound manner.
Pharmaceutical wastes which are considered to be hazardous wastes have to be collected
separately in appropriate containers. Intermediate storage takes place at a location which
is accessible only to trained personnel. This should be done in a manner to avoid misuse.
Exemptions and special provisions
Cytotoxic pharmaceutical waste: See Group B4: Cytotoxic pharmaceutical wastes.
B4: Cytotoxic pharmaceutical wastes
Description
Cytotoxic (antineoplastic) pharmaceutical wastes are wastes which can arise from use
(administration to patients) and manufacture and preparation of pharmaceuticals with a
cytotoxic (antineoplastic) effect. These chemical substances can be subdivided into six
main groups: alkylated substances, antimetabolites, antibiotics, plant alkaloids, hormones
and others. A potential health risk to persons who handle cytotoxic pharmaceuticals
results above all from the mutagenic, carcinogenic and teratogenic properties of these
substances. Consequently, these wastes pose a hazard, and the measures to be taken must
also include those required by occupational health and safety provisions.
Examples of such wastes
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Specific lists of pharmaceuticals which contain cytotoxic substances are available.
Discernible liquid residues of cytotoxic concentrates, post-expiration-date cytotoxic
pharmaceuticals and materials proven to be visibly contaminated by cytotoxic
pharmaceuticals must be disposed of as cytotoxic pharmaceutical waste.
Waste management guidance
The risks posed by cytotoxic pharmaceuticals are primarily of relevance for persons who
come into contact with them during preparation and during or after their use. It has long
been common practice in hospitals to see to it that the number of persons who come into
contact with these products is small. Specific guidance on this is available. These wastes
usually arise at central locations, i.e. in pharmacies and laboratories and they are also
often found at places where the ready-to-use cytotoxic solutions are prepared.
Intermediate storage of these wastes takes place under controlled and locked conditions.
The precautions taken during the use of cytotoxic pharmaceuticals must also be applied
on their journey outside the respective establishment, as releases of these products can
have adverse environmental impacts. The management of these wastes, in covered and
impermeable containers, must therefore be strictly controlled. Solid containers must be
used for collection. The use of coded containers is recommended. For reasons of
occupational safety, cytotoxic pharmaceutical wastes must be collected separately from
pharmaceutical waste and disposed of in a hazardous waste incineration plant.
Exceptions and special provisions
None.
B5: Wastes with blood and body fluid
Description
These are wastes from health-care establishments not categorized as infectious wastes
which are contaminated with human or animal blood, secretions and excretions. It is
reasonable to assume that these wastes might be slightly contaminated with pathogens (in
nearly the same way as household waste).
Examples of such wastes
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Dressing material, swabs, syringes without the attached needle, infusion equipment
without spikes, bandages, etc.
Waste management guidance
Special requirements must be imposed on the management of these wastes from the
viewpoint of infection prevention inside the health-care establishments. Double bags or
containers made of strong and leak-proof material are used for the collection of these
wastes within health-care establishments.
Proper management of these wastes is by incineration in a household waste incineration
plant but they can also be disposed of together with household waste on a controlled
landfill site.
Exemptions and special provisions
This mixture of wastes should not be recycled.
C: Infectious wastes
Description
Special requirements regarding the collection and management of infectious wastes must
be imposed whenever waste is known or, on the basis of medical experience, expected to
be contaminated by causative agents of the diseases listed below and when this
contamination gives cause for concern that the disease might spread. The list comprises
diseases which make particular demands on infection prevention when the following
factors are taken into account:
The associated risk of infection (contagiousness, infection dose, epidemic potential);
The viability of the pathogen (infection capacity/infectiousness);
The route of transmission;
The extent and nature of the potential contamination;
The quantity of contaminated waste;
The severity and treatability of the disease that might be caused.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
The wastes belonging to this group may occur in the context of diagnosis and treatment
of patients suffering from the following diseases (relevant pathogen-containing
excretions are given in brackets):
Acquired immunodeficiency syndrome (AIDS)* (blood)
Viral hepatitis* (blood, faeces)
Creuzfeld-Jacob disease (CJD), transmissible spongiform encephalopathy (TSE)*
(tissue, cerebrospinal fluid)
Cholera# (faeces, vomit)
Typhoid fever/paratyphoid fever# (faeces, urine, bile)
Enteritis, dysentery, enterohaemorragic Escherichia coli (EHEC)-induced haemolytic
uraemicsyndrome (HUS)# (faeces)
For the purpose of these guidelines, infectious health-care wastes are:
(a) Discarded materials or equipment contaminated with blood and its derivatives, other
body fluids or excreta from infected patients with hazardous communicable diseases.
Contaminated waste from patients known to have blood-borne infections undergoing
haemodialysis (e.g. dialysis equipment such as tubing and filters, disposable sheets,
linen, aprons, gloves or laboratory coats contaminated with blood).
(b) Laboratory waste (cultures and stocks with any viable biological agents artificially
cultivated to significantly elevated numbers, including dishes and devices used to
transfer, inoculate and mix cultures of infectious agents and infected animals from
laboratories).
Active tuberculosis (respiratory tract secretions, urine, faeces)
Meningitis/encephalitis (respiratory tract secretions, cerebrospinal fluid)
Brucellosis (blood)
Diphtheria (respiratory tract secretions, secretions from infected wounds)
Leprosy (secretion from nose/infected wounds)
Anthrax (respiratory tract secretions, secretion from infected wounds)
Plague (respiratory tract secretions, secretion from infected wounds)
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Poliomyelitis (respiratory tract secretions, faeces)
Q fever (respiratory tract secretions, blood, dust)
Glanders (respiratory tract secretions, secretion from infected wounds)
Rabies (respiratory tract secretions)
Tularaemia (pus)
Virus-induced haemorrhagic fever, including hantavirus-induced renal (HFRS)
and pulmonary (HPS) syndromes (blood, respiratory tract secretions, secretion
from infected wounds, urine)
Waste of this kind is typically generated in the following places: isolation wards of
hospitals; dialysis wards or centres caring for patients infected with hepatitis viruses
(yellow dialysis); pathology departments; operating theatres; and medical practices and
laboratories which mainly treat patients suffering from the diseases specified above.
The relevant wastes are wastes contaminated with pathogen-containing blood, excretions
or secretions (see list) or containers containing blood in liquid form.
Examples
The infections marked with (*) are usually transmitted through inoculation. Therefore, the
wastes of relevance here are not taken to include dry contaminated waste from sporadic
patients suffering from diseases in question (AIDS, viral hepatitis, CJD), such as
contaminated swabs (e.g. from taking of blood samples), cotton plugs used in dental
practices, etc. However, they do include blood-filled vessels and waste drenched with
blood or secretions from surgeries performed on infected patients, used dialysis systems
from yellow dialysis as well as wastes drenched with blood/secretions from medical
practices and laboratories mainly treating patients who have contracted the diseases in
question.
The infections marked with (#) are transmitted via faeces and oral ingestion of
contaminated material. Relevant bodily discharges may be fed to the waste-water stream
in observance of hygienic requirements. Management under conditions that would result
from categorization as infectious waste must be considered only when the waste is
heavily contaminated with excretions from diagnosed patients.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Infectious wastes in any case include the following:
(a) All microbiological cultures generated, for example, in institutes working in the
fields of hygiene, microbiology and virology as well as in medical laboratories,
medical practices and similar establishments and in which a multiplication of
pathogens of any kind has occurred;
(b) Experimental animals as well as litter and animal faeces from animal test
laboratories, if transmission of the above-mentioned diseases is to be expected.
Waste management guidance
Infectious wastes must be collected in tear-resistant and leakproof containers and
transported to a central storage facility/delivery point in carefully sealed condition and
without any transfer into other containers or sorting (containers marked with the
“biohazard” symbol). They must be collected and transported in a way that precludes
direct contact, and they may not be transferred into other containers at the central storage
facility or during delivery. They must be stored in such a way that gas formation in the
collection containers is avoided. To this end, efforts must be made to ensure that storage
periods are as short as possible depending on climatic conditions (e.g. storage at
temperatures below +15°C for not more than one week or at a temperature of 3°C to 8°C
for a longer storage period).
Infectious waste must either be incinerated (approved incineration plant) or be disinfected
prior to final disposal using a recognized method, preferably treatment with saturated live
steam. Disinfected wastes may be disposed of in the same way as domestic waste. The
disinfection plants must be operated under the operating parameters prescribed for waste
disinfection, and this mode of operation must be documented. The use of a mobile
disinfection plant to treat infectious waste is permissible only if the waste disposer
furnishes proof that the plant has been checked by the competent authority or an
approved institution for its functional and operational reliability on a regular basis.
Exceptions and special provisions
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Body fluids and excreta of infected patients with hazardous communicable diseases can
be discharged to the sewerage system if there is a strict separation between the waste and
drinking water installations and the sewerage system is connected to a waste-water plant.
In other cases, the body fluids and excreta have to be disinfected before being discharged
to the sewerage system. Exceptionally if wastewater plant doesn’t exist , infectious waste
can be disposed of by using a special area in a controlled landfill if there is no risk of
contamination of ground or drinking water and the infectious waste is directly covered
with earth or other material.
E: Radioactive waste
Description
Material contaminated with a radioisotope which arises from the medical or research use
of radionuclides. It is produced, for example, during nuclear medicine, radio
immunoassay and bacteriological procedures, and may be in a solid, liquid or gaseous
form.
Examples of such wastes
Radioactive waste includes solid, liquid and gaseous waste contaminated with
radionuclides generated from in vitro analysis of body tissue and fluid, in vivo body
organ imaging and tumour localization, and investigative and therapeutic procedures.
Waste management guidance
Where activity limits for immediate or simple disposal methods cannot be met (clearance
levels), health-care establishments should segregate radioactive waste and store it during
the required period to reduce the activity level. If the activity concentration is below these
clearance levels, the material may be disposed of by normal methods. Since the half-life
of most radioactive materials used in hospitals is in the range of hours or days, storage for
a period of one or two months can be followed by disposal to the ordinary waste system
with appropriate monitoring. Decayed non-infectious radioactive waste is placed inside
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
black plastic bags if they are intended for landfilling. Decayed but infectious radioactive
wastes are placed in yellow plastic bags in preparation for disinfection. They should not
be used as landfill prior to disinfection.
All radioactive waste designated for storage to allow decay should be kept in suitable
containers which prevent dispersion of the content. A plastic bag in a large can or drum is
an appropriate container. Containers used for the storage of radioactive waste should be
clearly labelled to show the activity of the radionuclide on a given date and the period of
storage required. These containers should be stored in a specifically marked area in a
lead-shielded storage room for radioactive substances or for radioactive waste. The
storage record should be endorsed specifically to indicate which items are “radioactive
waste”. Containers of radioactive waste should be marked “RADIOACTIVE WASTE”
and should carry the radiation symbol.
High-level and usually long-half-life radionuclides used in health-care activities are used
for therapeutic purposes, conditioned as sealed sources, in the format of pills, seeds,
ribbons, tubes or needles. These sealed sources are recovered after use, washed,
disinfected and stored under lead-shielding for reuse on other patients. These items may,
however, become waste if their conditioning is damaged, if they have lost too much of
their activity, or if they are no longer required. Spent radionuclide generators also
become waste. In countries without a nuclear industry equipped to dispose of high-level
radioactive waste, hospitals should package these items appropriately or place them
inside the same boxes in which they were originally supplied, and send them back to their
original supplier for reprocessing, eventual recycling or safe final disposal. In countries
with the appropriate nuclear industry, hospitals may alternatively send non-recyclable
high-level waste to the national radioactive waste disposal agency, which will take care
of them. These items are usually valuable, and, in most cases, it is possible to reprocess
them for recycling.
Exceptions and special provisions
Any health-care establishment using radioactive substances should hire a specialized
radiation officer who, among other duties, will monitor the management and disposal of
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
radioactive waste and the storage of radioactive items.
7. Applicable state-of-the-art management, treatment and disposal
technologies
39. It is generally recognized that waste management plans provide the best mechanism
for improvement of environmental performance in waste management. A waste
management plan can help generators to conserve resources and minimize waste
through improved purchasing and reuse practices and through cost-effective,
environmentally sound source separation, segregation, collection, transport, treatment
and disposal of all waste streams generated within their facilities.
40. It is recommended that the plan be in the form of an environmental management
system based on the ISO 14001 series of environmental management standards. This
systems approach helps to ensure that auditable, verifiable documentation is available
to demonstrate that operations are taking place as required. Such a system will also
assist with the provision of quality data and information on which a state-of-the-
environment report can be prepared. A prerequisite for developing or updating such a
plan is adequate characterization and analysis of the existing waste stream and a
detailed assessment of existing waste management practices. This process is
commonly referred to as a waste audit.
7.1 Avoidance/prevention
41. The generation of hazardous wastes and other wastes within it is reduced to a
minimum and that adequate disposal facilities for the environmentally sound
management of hazardous wastes and other wastes are available.
42. For the various health-care establishments, waste management in observance of the
waste avoidance and recovery obligation presupposes a system that is practice-
oriented, clearly structured and manageable with clearly defined logistics. This can
be achieved only if everyone who works in the health services sector gives increased
thought to this issue and takes action to ensure that the volume and hazardousness of
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
wastes are minimized.
43. The increasing relevance of the waste management problem demands an ecologically
oriented reorganization. This should start with procurement, by giving preference to
environmentally sounder products and replacing harmful or disposable products with
reusable or alternative products, if these meet the relevant requirements in terms of
hygiene and patient safety.
44. A noticeable reduction in waste volume can be achieved only if disposable products
already in use are scrutinized as to their necessity. In principle, disposables such as
disposable cutlery, disposable linen (including covering sheets), disposable
instruments and equipment (scissors, scalpels, forceps) and disposable containers
(kidney dishes, infusion bottles) should be replaced by reusable products and long-
lived alternatives. For examples of specific reuse, waste reduction and waste
recycling activities, see annex III?
7.1.1 Packaging
45. An issue closely related to the procurement of products is their packaging. It is
possible to reduce the amount of waste generated noticeably if attention is paid in the
selection of products to the associated amount of packaging. The latter should not
exceed the minimum necessary to meet transportation, storage, hygiene and sterility
requirements. Before orders are placed, the material input for the product and the
packaging as well as the resulting input required for waste management should be
taken into account.
46. The input required for the management of packaging waste can be reduced when:
(a) Preference is given to products involving small amounts of packaging;
(b) Preference is given to product packaging which can be refilled, reused or
otherwise used as a supply or disposal receptacle within or outside the
facility at which the product is used;
(c) Preference is given to demand-oriented package sizes;
(d) The manufacturer or supplier of the product is required, when placing the
order, to take back the associated transport packaging and containers.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
47. Where it cannot be avoided, packaging should be collected separately and fed to an
appropriate recovery process. Appropriate recovery is common for cardboard, paper,
glass and metals. Plastics can best be recovered if they are collected as type-specific
fractions.
7.1.2 Kitchen and canteen waste
48. Kitchen and canteen waste can be utilized as feed substitute if it is disinfected in a
manner that is appropriate for such use or if such use conforms with the conditions
imposed by the authorities.
7.1.3 Laboratory waste and chemical residues
49. An effort should be made to establish which hazardous products and substances in the
health-care industry can be avoided completely. Chemical residues can be reduced by
adapting laboratory apparatus to the “state of the art” and performing laboratory tests
and analyses if they meet medical needs. In the procurement of laboratory devices,
attention should be paid to the aspect of relative chemical consumption.
50. The use of mercury contained in hospital diagnosis devices such as blood pressure
gauges and thermometers has been targeted for elimination and future avoidance in
many countries. Elemental mercury is toxic and such uses present hazards during use
and at end-of-life. Mercury can neither be safely landfilled nor incinerated.
Fortunately, safer alternatives now exist for each of these mercury-containing
products. Thus the problem is best avoided in the first instance through procurement
policies.
51. With regard to laboratory chemicals, a priority task is to find out whether the use of
chlorinated hydrocarbons as solvents is unavoidable. The aim should be to replace
such laboratory procedures. Laboratory chemicals and solvents should be collected
and recovered, if the cost of recovery entailed is reasonable in comparison with that
of other forms of waste management. The best possibilities for solvent recovery exist
in pathology, histology and anatomy because relatively large amounts of fat and
blood-contaminated solvents (xylene, toluene and others) arise in these sectors.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
7.2 Segregation, collection, labeling and handling of biomedical
and health-care waste
52. Segregation is the key to effective biomedical and health-care waste management. It
ensures that the correct disposal routes are taken, personnel safety is maintained,
environmental harm is minimized and recycling consumes the least resources.
Biomedical and health-care waste should be segregated and collected in accordance
with the specific treatment or disposal requirements.
53. Segregation should be carried out under the supervision of the waste producer and as
close as possible to the point of generation. Segregation must therefore take place at
source, that is, in the ward, at the bedside, in the theatre, in the laboratory, in the
delivery room, etc., and must be carried out by the person generating the waste, for
example the nurse, the doctor or the specialist, in order to secure the waste imme-
diately and to avoid dangerous secondary sorting. It should be undertaken on the basis
of the types of waste listed in the definition for biomedical and health-care waste.
54. Each health-care institution should prepare and follow a waste plan. Correct and
efficient segregation will be achieved only through rigorous training and education of
employees, supervisors and managers, and policies should take this into account.
55. The segregation must be applied from the point of generation throughout the entire
waste stream to the point of final disposal, whether or not it is on-site. All storage and
transportation methods must also follow this segregation system.
56. Segregated wastes of different categories need to be collected in identifiable
containers. Every room, such as wards, laboratories and operating theatres, should
have containers/bags for the types of wastes that are generated in that room. The
waste segregation and identification instructions should be placed at each waste
collection point to ensure proper procedure. Waste containers made of non-
halogenated leakproof combustible materials should always be given preference.
Plastic bags for storing the waste may be suspended inside a frame or placed inside a
sturdy container. A lid should be provided to cover the opening of the bag. Sharps
must always be collected in puncture-proof containers (not made of glass) to avoid
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
injuries to and infection of the workers handling them.
57. Clinical and sanitary personnel should ensure that the waste bags are removed and
sealed when they are not more than three-quarters full. The preferred method of
sealing involves a plastic sealing tag of the self-locking type; bags should never be
closed by stapling. Each bag should be labelled with the point of generation (ward
and hospital) and content.
58. A common system of labelling and coding of packaging should be developed for
biomedical and health-care waste. A possible way of identifying biomedical and
health-care waste categories is by sorting the waste into colour-coded bags or
containers. As an example, a WHO-recommended colour coding is given in table 1.
The use of internationally recognized symbols and signs is of very basic importance
and is essential for the safety of handling and disposal of waste. It is recommended
that the colour coding, the symbols and signs should be part of the waste management
instructions and should be made known, e. g. by a poster on the wall at the waste
collection points.
Table 1
WHO - recommended colour coding for biomedical and health-care waste as an example
of a colour-coding system
TYPE OF WASTE Colour of container and markings* Type of container
Highly infectious waste Yellow, marked “HIGHLY
INFECTIOUS” Strong, leak proof plastic bag, or
container capable of being
autoclaved
Other infectious waste, pathological Yellow
Plastic bag or containers
Sharps Yellow, marked “SHARPS” Puncture-proof containers
Chemical and pharmaceutical waste Brown Plastic bag or container
Radioactive waste** Lead box
General health-care waste Black Plastic bags
* Proposed colour coding and marking system; the use of other colour coding in a
country is possible.
** Generated only in major hospitals.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
59. Certain recommendations should be followed by the ancillary workers in charge of
waste collection. They include:
(a) Waste should be collected daily from the wards, or as frequently as required,
and transported to the central storage place;
(b) No bags should be removed without labelling indicating the point of generation
(hospital and ward) and content;
(c) The workers should immediately replace the bags or containers with new ones
of the same type.
60. Empty collection bags or containers should be readily available at the point of
waste generation.
7.3 In-house transport and storage
61. It is important to ensure that waste does not accumulate at the point of generation. A
routine for the collection of waste should be established in the waste management
plan. Wastes should be moved through the facility in such a manner as to prevent
unnecessary exposure to staff and others. Handling and transportation of waste
containers should be minimized to reduce the likelihood of exposure to the waste.
Specific routes should be planned through the facility to minimize the passage of
loaded carts through patient care and other clean areas.
62. Carts used for moving biomedical and health-care waste through the health-care
facility should be designed to prevent spills, and should be made of materials able to
withstand exposure to common cleaning agents. They should have the following
attributes:
(a) Easy loading and deloading;
(b) No sharp edges which could damage waste bags or containers during loading and
deloading;
(c) Easy to clean.
63. All seals should be in place when movement of the bag has been completed. The carts
should be cleaned regularly to prevent odour and as soon as possible if the waste
material leaks or spills in the carts. The biohazard symbol should be clearly displayed
on carts for the transport of infectious waste. These carts must be thoroughly cleaned
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
before any maintenance work is performed on them. The facility’s infection control
committee, biosafety officer or other appointed person should be consulted about the
frequency of cleaning and the type of cleaning agent to be used.
64. After biomedical and health-care waste has been collected and moved from the point
of generation, it must be held in storage areas to await disposal. These storage areas -
either a separate area, room or building - should be dimensioned according to the
quantities of waste generated and the frequency of collection. These areas must be
totally enclosed and separate from supply rooms or food preparation areas. Re-
commendations for properties and equipment of the storage facilities are listed in box
1.
65. Storage areas must be identified as containing infectious waste, with the biohazard
symbol clearly displayed. It is unacceptable for materials other than waste to be
placed in the same storage area as infectious waste. Floors, walls and ceilings of
storage areas must be thoroughly cleaned in accordance with the established
procedures of the facility.
Box 1 Recommendations for storage facilities for biomedical and health-care waste in
health-care establishments, e.g. hospitals
Properties and equipment
Impermeable hard-standing base with good drainage, easy to clean and disinfect and
equipped with water supply;
Readily accessible to staff in charge of handling the waste;
Fitted with a lock, to prevent access by unauthorized persons;
Easily accessible to collection vehicles (carts);
· Inaccessible to animals, insects and birds;
· Good lighting and ventilation;
· Not situated in the proximity of fresh food stores or food preparation areas;
Situated close to the supply of cleaning equipment, protective clothing and waste bags or
containers.
66. Unless a cooled storage room is available the proposed storage periods recommended
by WHO between the generation and treatment of biomedical and health-care waste
are the following:
Temperate climate: maximum 72 hours in winter maximum 48 hours in summer
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Warm climate: maximum 48 hours during the cool seasond maximum 24 hours
during the hot season
67. Anatomical waste should be stored at a temperature of 3° C to 8° C. All infectious
waste must be refrigerated at a temperature of 3° C to 8° C if stored for more than a
week. Health-care facilities should determine the maximum storage time of
refrigerated or frozen biomedical and health-care waste based in the light of their
storage capacity, rate of waste generation and any applicable local regulatory
requirements.
68. Facilities refrigerating or freezing stored waste should use a lockable, closed storage
facility or a lockable domestic-type freezer unit. Either type must be used only for
storing anatomical and infectious waste, must display the biohazard symbol visibly
and must be identified as containing infectious waste. Note that glass or plastic items
containing infectious agents may fracture at lower temperatures.
69. The compacting of untreated infectious waste or waste with a high content of blood or
other body fluids destined for off-site disposal (for which there is a risk of spilling) is
not permitted. Cytotoxic waste should be stored in a specific place, separate from the
storage room devoted to other biomedical and health-care waste.
70. Depending on the local legislation, radioactive waste should be stored in containers
preventing dispersion, behind lead shielding. Waste designated for storage to allow
decay should be labelled with the type of radionuclide, date and required storage
details.
7.4 Special requirements for packaging and labelling for off-site
transport
70. Risks may occur during the storage, handling, transportation and disposal of the
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
infectious waste. For this reason, biomedical and health-care waste generators are
responsible for safe packaging, adequate labelling and authorization of the
destination of the waste to be transported off-site. Hazardous biomedical and health-
care waste should be packaged and labelled to comply with national regulations
regarding the transport of hazardous wastes (dangerous goods), and with
international agreements if they are shipped abroad for treatment. Where there are no
such national regulations, the responsible authorities may refer to the
“Recommendations on the Transport of Dangerous Goods” published by the United
Nations, and specifically section 2.6.3 on infectious substances.
71. The control strategy for hazardous biomedical and health-care waste shall have the
following components:
(a) A consignment note should accompany the waste from production to final
disposal; after the journey, the transporter should complete the part of the
consignment note especially reserved for him and return it to the generator;
(b) The transporting organization should be registered with, or known to, the waste
regulation authority;
(c) Handling and disposal facilities should hold a permit issued by a waste
regulation authority, allowing the facilities to handle and dispose of hazardous
biomedical and health-care waste.
72. The consignment note should be designed taking into account the waste control
system in operation in the State concerned and also taking into account the forms
issued in pursuance of the Basel Convention. 9 Anyone involved in biomedical and
health-care waste generation, handling or disposal should be subject to a general
“duty of care”, i.e. ensure that documentation and transmission of waste comply with
the national regulations.
7.4.1 Packaging requirements
73. In general, the waste should be packaged in resistant and sealed bags or containers to
prevent spilling during handling and transportation. The bags or containers should be
resistant to their content (puncture proof for sharps, resistance to aggressive
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
chemicals) and to normal conditions of handling and transportation such as vibration
and changes in temperature, humidity or pressure (resulting from altitude, for
example)
In general packaging should include the following essential elements:
(a) An inner packaging comprising:
(i) Watertight primary receptacle of metal or plastics with leakproof seal (e.g. a
heat seal, a skirted stopper or a metal crimp seal);
(ii) A watertight secondary packaging;
(iii) Absorbent material in sufficient quantity to absorb the entire contents placed
between the primary receptacle and the secondary packaging; if several
primary receptacles are placed in a single secondary packaging, they shall be
individually wrapped so as to prevent contact between them;
(b) An outer packaging of adequate strength for its capacity, mass and intended use,
and with a minimum external dimension of 100 mm.
7.4.2 Labeling
74. All waste bags or containers should be identified by labels containing basic
information on producer and content. This information may be directly written on
the bag or container or by pre-printed labels. The following major information
should appear on the label:
the type of waste;
the total quantity of waste covered by the description (by mass or volume);
the packaging should be appropriately marked with the month and the year of
manufacture; and
the body authorizing
7.5 Recycling/recovery
75. Recovery and recycling constitute one step in a systematic priority approach for
environmentally sound waste management. Waste segregation at source is the basic
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
requirement for cost-effective normal recycling operations on the non-hazardous
component of biomedical and health-care waste. Some examples for the recycling of
non-hazardous waste components are given in annex II.
76. Opportunities for chemical waste recycling can be described as follows:
(a) Unused or waste chemicals in quantity can often be returned to the supplier
for reprocessing;
(b) Larger health-care facilities should establish internal reuse of chemicals;
(c) Certain material such as mercury from broken thermometers, unused batteries
containing mercury, cadmium, nickel and lead-acid and halogenated or non-
halogenated solvents should be given to specialized recyclers.
7.6 Disposal operation/technologies, accreditation and
environmental impacts
77. Biomedical and health-care waste should, if required, be inactivated or rendered safe
before final disposal or discharge. The decision to treat biomedical and health-care
waste and the choice of treatment method should be determined in accordance with
the following considerations:
(a) The type and nature of the waste material;
(b) The hazard and viability of the organisms in the waste;
(c) The efficiency of the treatment method;
(d) The operating conditions of the treatment method.
Table2 Examples of waste treatment methods related to the type of waste
Type of waste
Treatment
Gas Liquid Solid
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Thermal Possible Recommended Recommended
Chemical Appropriate Appropriate a/
Irradiation b/ b/ b/
Incineration Appropriate c/ Recommended
Filtration Recommended Possible Not applicable
a/ Not possible for mixed wastes.
b/ Only for small amounts of wast
c/ Recommended if the calorific value is high enough to reach a sufficiently high
temperature.
78. The treatment method should be amenable to validation and independent of any
packaging, and should be monitored. Monitoring can involve sampling and analysis
or testing of the effluent for hazardous organisms or the use of suitable physical
engineering or other process controls to demonstrate effective operation within the
prescribed operating criteria.
79. Treatment of the waste should be validated with regard to the inactivation of the
organisms and of any residual contamination of the packaging or containers. The
process should not significantly increase the risk of exposure of laboratory staff or
other waste handlers to the hazard itself or to other risks from the concomitant
hazardous agents, equipment and substances which are employed in the treatment.
Outlines of the main advantages and drawbacks of the treatment and disposal options
addressed in these guidelines are shown in table 3.
7.6.1 Methods of treatment or disposal
80. The validated chemical and physical methods for the treatment or inactivation of
waste include: steam sterilization, chemical disinfection/sterilization, dry heat
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
sterilization and other methods.
81. The relative effectiveness of these and other treatment methods depends on a number
of factors including the volume, concentration, type and hazard caused by the
organisms and the physiological state, the diffusion resistance of the material to be
disinfected and the operating parameters and conditions of the treatment method. In
general, steam sterilization should preferably be used in the treatment of infectious
waste. Thermal methods are generally easier to validate and monitor than chemical
treatment and are less damaging to the environment.
82. Methods other than steam sterilization should be selected only if this is impracticable
or inappropriate. For example, effluent from veterinary research, contaminated
laboratory equipment, fixtures and furniture which cannot readily be removed may
be effectively treated using a gaseous fumigant such as formaldehyde. These
methods of treatment can be used alone or in combination, depending on the risk
assessment requirements and/or discharge consent standards, to enable the waste to
be inactivated and safely discharged.
Table 3: Summary of the main advantages and drawbacks of treatment and
disposal options
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Treatment/disposal
methods
Advantages Drawbacks
Pyrolytic incineration/two-
stage incineration with
efficient gas cleaning
Very high disinfection
efficiency; adequate for all
infectious waste and most
pharmaceutical and
chemical waste.
Incineration temperature above
800°C, destruction of cytotoxics;
relatively high costs of investment
and ope-ration. Care has to be taken
on the management of the
incineration residues (e.g. bottom
ashes, fly ashes) because they can ex-
hibit hazard characteristics.
Single chamber
incineration with dust
reduction
Good disinfection
efficiency; Drastic
reduction of the weight
and volume of waste; the
residues may be disposed
of in a
Generation of significant emissions
of atmospheric pollutants and
periodic slag and soot removal; with
temperature below 800°C, inefficient
in destruction of
landfill; no need for highly
qualified operators;
relatively low investment
and operation
thermally resistant chemicals and
drugs such as cytotoxics.
costs.
Drum or brick incinerator Reduction of the weight
and volume of the waste;
the residues may be
disposed of in a landfill;
no need for highly
qualified operators; very
low investment and
operating costs.
Only 99 per cent destruction of
microorganisms; no complete
destruction of many chemicals and
pharmaceuticals; massive emission of
black smoke, fly ash and toxic flue
gas. Exception only for disposal of
infectious waste under certain
circumstances outside urban areas
(e.g., no other treatment method
available during an emergency
situation like acute outbreak of
communicable) diseases).
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Table 3 cont…
Treatment/disposal
methods
Advantages Drawbacks
Chemical disinfection Efficient disinfection
under good operating
conditions with special
waste; costly if the
chemical disinfectants are
expensive.
Requirement of highly qualified
technicians for operation of the
process; use of hazardous substances
which require comprehensive safety
measures; inadequate for
pharmaceutical, chemical and most
types of infectious waste (mixed
solid waste).
Autoclave wet-thermal
treatment
Environmentally sound;
relatively low investment
and operation costs. Good
for infec-
Shredders are subjected to many
breakdowns and bad functioning;
operation requires qualified
technicians; inadequate
tious and microbiological
wastes.
for pharmaceutical and chemical
waste or waste which is not easily
penetrable
by steam; without shredding or other
methods of destruction although
inad
equate for anatomic waste.
Microwave irradiation Good disinfection
efficiency under
appropriate operational
conditions;
environmentally sound.
High investment and operation costs;
potential operation and maintenance
problems; only for wet infectious
waste or for infectious waste with a
high water con
tent.
Encapsulation(e.g. with Simple and safe; low costs. Only for sharps.
concrete or gypsum)
Special engineered landfill Safe if access is restricted
and where natural
infiltration is limited.
Safe if access to site is limited and
there is no risk of water
contamination.
7.6.1.1 Steam sterilization
83. Steam sterilizing or autoclaving is the exposure of waste to saturated steam under
pressure in a pressure vessel or autoclave. Autoclaves should meet the requirements
of internationally agreed standards. Autoclavable waste containers should be of a
design and material, which allows steam to penetrate the load. They should have
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
sufficient stability and resistance to the maximum operating temperature and
pressure.
84. In addition to any devices such as gauges or indicators which measure and record the
basic operating criteria (e. g. temperature, vacuum, pressure), a biological or chemical
indicator should be placed in the waste load for validation to indicate that the
necessary sterilization conditions have been achieved. The operational parameters, e.
g. time, pressure and temperature, should be maintained and checked during the
sterilization cycle.
85. While the temperature and time depend upon the total volume of the material to be
treated, the number and type of organisms and their resistance against steam, it is
necessary first to remove all the air from the autoclave, the waste and the waste
containers to ensure that the required sterilization temperature will be maintained. In
the case of closed containers included in waste material, the validation (with
biological indicators) should take place within the material being sterilized.
Sterilization should commence only when the air has been removed from the
autoclave and the operating temperature has been reached.
86. The potential of complete air removal is affected by factors such as the type of waste,
the amount of waste, the packaging, the water content of the waste and the form and
material of the container. The whole treatment process, including loading, the load,
the suitability of the packaging or the container, air removal and filtration of the
removing gas and liquid effluent discharge should be validated.
87. A record should be retained of all monitoring, maintenance and performance tests
carried out on the autoclave together with a logbook or similar record of all routine
disposals including the temperature charts and details of the load. When appropriate,
air removed from the autoclave should be discharged into the environment after
passing through a microbiologically validated filter.
88. Details of sterilization procedures, including the operational parameters and
conditions, should be written down as a standard operating procedure document or
operating manual which is to be used by all waste handlers. The document should be
kept under review. A suitable biological indicator for steam sterilization is the spores
of Bacillus stearothermophilus. Autoclaving may not change the visible appearance
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
of the waste and it may be necessary to distinguish treated from untreated waste by
careful removal or obliteration of biohazard warning labels from treated containers
or by labeling such containers as “autoclaved” or “sterilized”.
89. Alternatively, chemical indicators may be added to the load to indicate that the load
has been autoclaved. Aesthetic concerns may require that the autoclaved waste is
further treated to render it acceptable for final disposal, e.g. if the waste contains
human or animal material or tissue. Autoclaving may not remove or reduce the non-
biological hazards arising from the presence of chemical or physical agents or other
materials in the waste.
7.6.1.2 Dry heat sterilization
90. Dry heat sterilization is the exposure of the waste to heat at a temperature and for a
time sufficient to ensure sterilization of the entire waste load. The sterilization
process should be monitored by the addition of a suitable indicator or measuring
device to the waste load, and where appropriate by monitoring the organism(s)
present in the waste. The sterilizing unit or equipment should incorporate a suitable
thermal cut-out device which is independent of the device used for indicating or
monitoring.
7.6.1.3 Chemical disinfections/sterilization
91. This method involves the exposure of waste to chemical agents which possess
antimicrobial activity. General disinfectants may not inactivate organisms such as
spores, some fungi and viruses and should not be used as the principal treatment
methods unless thermal procedures are inappropriate because of the nature of waste
or contaminated material. Thermal sterilization should be given preference over
chemical disinfections for reasons of efficiency and environmental considerations.
92. The choice of an appropriate chemical agent and conditions of use should be
determined by the risk assessment, taking into account the identity of the
organism(s) to be treated, the nature of the waste and the presence of organic, protein
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
or particulate matter, and the nature of the surfaces, items or equipment which will
be exposed to the chemical disinfectant.
93. Chemical agents should be used at the manufacturers’ recommended concentrations
and exposure times according to the requirements and conditions of use. The
chemical agent selected should be compatible with other substances or material that
may be present in the waste load so that its efficiency is not reduced, and also to
ensure that toxic or hazardous products are not thereby formed or released. The
efficiency of any chemical agent against a particular organism or type of organism
may be confirmed by reference and adherence to manufacturers’ data and
instructions. Ethylene oxide, formaldehyde (alone or with low-temperature steam)
and certain other agents may be used as gaseous fumigants, particularly for
equipment and items that should be treated in situ. This method can also be used for
the disinfection of body fluids and excreta before being released to the sewer system
if no thermal treatment is available.
7.6.1.4 Other treatment/disposal methods
94. The options available for the treatment/disposal of waste and waste effluent which
cannot be recycled or reused are incineration and landfill.
95 Other waste treatment methods are available but are not yet validated for general use
and have only limited application. These include irradiation (e. g. with microwave,
gamma and ultraviolet radiation) and other treatment methods (e. g. encapsulation
and filtration). If such methods are used, validation and monitoring procedures should
be performed.
96 The selection of an appropriate option should be based on a number of considerations,
including:
(a) The nature of the waste and its intrinsic hazard;
(b) Whether the waste has been inactivated by a reliable and validated method;
(c) The aesthetic acceptability of the discharged waste;
(d) The potential deleterious effect of the discharged waste on the environment;
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(e) The ease and reliability of the disposal method;
(f) The disposal and other costs;
(g) The general occupational hazards and risks to waste producers, handlers and
operators;
(h) The overall impact of the disposal or discharge plant or equipment on the local
and general environment.
7.6.1.5 Incineration
97. Incineration can be used as one important method for the treatment and
decontamination of biomedical and health-care waste. Oxidation at high temperature
converts the organic compounds into their gaseous oxides, mainly carbon dioxide
and water. Inorganic components are mineralized and converted into ash, unless they
pass into the flue gas.
98. Depending on the type of incinerator, the following objectives can be achieved:
(a) Destruction of pathogens;
(b) Reduction of the hazard and pollution potentials as far as possible;
(c) Reduction of volume and quantity;
(d) Conversion of remaining residues into a form which is utilizable or suitable
for landfill;
(e) Use of the released heat.
99. For reasons of emission control and operational safety and reliability, it is desirable to
incinerate the biomedical and health-care waste from as many hospitals as possible in
one central unit. In specific cases, even smaller separate incinerators may be justified.
With a view to minimizing the environmental impact of incineration plants, emissions
in the air, water and soil shall be reduced by the use of effective and advanced
incineration and emission control techniques under technically and economically
viable conditions, taking into account the location of the plant.
100. Incineration leads to a significant reduction of the volume and quantity of the treated
waste. Waste which has not been previously treated to inactivate it or to render it
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
safe should be incinerated in a plant suitably designed and operated for the
destruction of biomedical and health-care waste or other hazardous waste. If
biomedical and health-care waste can be incinerated only in inadequate conditions
(low temperature, inadequate emission control system), waste fractions like
cytotoxic drugs, chemicals, halogenated materials or waste with a high content of
heavy metals (batteries, broken mercury thermometers, etc.) should not be consigned
to such an incinerator.
7.6.1.6 Landfill
101. To date, there is no adequate risk assessment of the use of landfills for untreated
biomedical and health-care waste which may contain infectious organisms and
hazardous chemicals. Best practice would require that any landfill used for
biomedical and health-care wastes be engineered and secured (specially engineered
landfill).
102. There are ongoing health and safety issues (and hence legal implications) associated
with disposal of untreated biomedical and health-care wastes. With the availability
of suitable landfill sites being reduced, the physical problem of disposing of large
volumes of waste must be considered.
103. Disposing of infectious wastes into a landfill greatly increases the risks to human
health and the environment of exposure to infection from this source. If the waste is
disturbed by any means, or not properly covered, further risks will arise. It is
therefore not good practice to dispose of infectious waste directly into a landfill. To
guard against these risks, where landfill is the only available option, infectious
wastes should be treated in order to destroy/remove their infectivity, preferably at
the site of generation of the waste. This can be done by using known effective
techniques such as autoclaving, microwave treatment, dry heat sterilization or
chemical disinfection.
104. The following is a description of the features of a “specially engineered landfill”
which are necessary for the safe and environmentally acceptable disposal of
biomedical and health-care wastes:
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
(a) Impermeable clay and/or synthetic liner to minimize groundwater pollution;
(b) Collection, treatment and environmentally acceptable disposal of leachate;
(c) Monitoring systems for groundwater surrounding the site to check integrity of
leachate contamination protection;
(d) Daily and final covers to restrict the potential for disease vectors, reduce
odours and reduce water infiltration;
(e) Monitoring for gas migration in the unsaturated zone surrounding the site,
together with control measures if necessary.
105. It is generally accepted that untreated biomedical and infectious health-care waste
disposal into landfills is not “best practice”. Where health-care wastes are disposed
of at a specially engineered landfill site, the following should apply:
(a) Biomedical and infectious health-care wastes should be deposited at the lowest
edge of the working face of the landfill or in an excavation;
(b) An operator or representative should supervise immediate cover with solid
waste or cover soil to a depth of at least 1 metre;
(c) Any compacting should be only on the cover material;
0 (d) Biomedical and health-care disposal areas should be at least 3 metres from
the proposed
1 edge of the landfill;
(e) No access of unauthorized persons to the site of the landfill;
(f) Any biomedical and health-care waste should be at least 2 metres below the
final surface of the landfill i.e. not in the final lift.
106. The following biomedical and hazardous health-care wastes are generally
considered unsuitable for disposal at a landfill site:
(a) Identifiable body tissue;
(b) Cytotoxic wastes;
(c) Pharmaceutical, laboratory or domestic chemicals;
(d) Radioactive wastes;
(i) Infectious wastes.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
107. Landfill is recognized as the terminal site for all wastes including ash from
incineration and residues from other processes. Some residues of the treatment
process residues may contain chemicals that could interact with other materials in a
landfill. Consideration needs to be given to the stability and nature of such process
residues and any potential impacts prior to disposal into a landfill. Some of the
treatment processes may also contribute excess water to the landfill. Resultant
leachate considerations require that engineered landfills should be used to ensure
maximum environmental protection.
108. The application of treatment and disposal methods to biomedical and hazardous
health-care waste categories is shown in table 4. It provides a broad overview of
suitable treatment and disposal methods for the different health-care waste
categories.
BIOMEDICAL WAST FOOD SECURITY GUIDELINE, FEPA, 2004
Table 4 Overview of disposal and treatment methods suitable for hazardous health-care waste categories
Method
Waste types
Pyrolytic
incineration/two-stage
incineration (with after
burning zone, e.g.
rotary kiln)
Single-chamber
incineration or
municipal
waste
incineration
Chemical
disinfection
Autoclavewet-
thermal
treatment
Microwave
irradiation
Encapsulation
(e.g. with con-
crete,
gypsum, etc.
only minimal
programmes)
Specially
engineered
landfill
Infectious
waste
Yes Yes (special
requirements,
like direct
Small
quantities
Yes Yes (wet
waste)
No Yes b/
Anatomic Yes Yes b/ No c/ c/ No Yes b/
Sharps Yes Yes b/ Yes Yes No Yes Yes b/
Pharmaceut
ical waste
Small quantities or (at
high temperature >850
°C)
Yes b/ No No No Yes Small
quantities
Cytotoxic
waste
At high temperature
>850 °C
No No No No No In excep-
tional cases
if special
requirements
Chemical
waste
Small quantities c/ No No No No In excep-
tional cases
if special
requirements
are met
Radioactive
waste d/
Low-level infectious
waste
Low-level infec-
tious waste
No No No No No
b/ Not the preferred method.
c/ Uncertainty still prevails as to the unsuitability of the disposal operation. There could be cases where the disposal option could be used, provided a number
of safeguards are in place. d/ Only if the clearance levels set by IAEA are met. Note: Entries in bold indicate preferred methods.
7.7 Responsibility (including emergency response and
contingency plan)
7.7.1 Assignment of responsibilities
109. The proper management of biomedical and health-care waste is largely dependent
on good administration and organization. These should be supported by adequate
legislation and financing as well as active participation of trained and informed
staff.
110. The head of the hospital /clinic should establish a waste management team to
develop a waste management plan. The head of the establishment should formally
appoint the members of the waste management team in writing, informing each of
them of their duties and responsibilities as outlined below.
111. In institutions where no direct patient care service is available, such as medical
research institutions, the head of the establishment should use his discretion to
appoint members of the waste management team. Depending on the availability of
relevant staff, the post of waste management officer may be assigned to the hospital
engineer, the hospital manager, or any other appropriate staff member, at the
discretion of the head of the hospital.
7.7.1.1 Duties of the head of the hospital
112 The head of the health-care establishment is responsible for the following tasks:
(a) Formation of a waste management team to formulate a written waste
management plan for the hospital; within this plan, the duties and
responsibilities of all members of staff, both clinical and non-clinical, shall
be clearly defined in respect of the handing of health-care waste. A clear line
of accountability shall be indicated in both the clinical and non-clinical
management structures;
(b) Designation of the waste management officer (WMO) to supervise and
coordinate the waste management plan; such an appointment shall not relieve
him of his overall responsibilities in ensuring that biomedical and health-care
and other waste are disposed of in accordance with the national guidelines;
(c) Keeping the management plan up to date;
(d) Allocation of sufficient financial and manpower resources to ensure efficient
operation of the plan for example, he has to ensure that adequate manpower
is assigned to the WMO to ensure efficient operation of the waste
management plan;
(e) Ensuring that monitoring procedures are incorporated to assess the
efficiency and effectiveness of the disposal system and to effect the
continuous improvement and updating of the system where appropriate;
(f) Appointing a successor immediately in the event of personnel leaving key
positions in the waste management team, or assigning temporary
responsibility until a successor is appointed;
(g) Ensuring adequate training for key staff members; he shall designate staff
responsible for coordinating and implementing training courses;
(h) Ensuring adequate emergency response planning.
7.7.1.2 Duties of the waste management officer (WMO)
113. The WMO is responsible for the day-to-day operation and monitoring of the waste
management system. He shall have direct access to all members of hospital staff to
facilitate his control function. The WMO will be directly responsible to the head of
the hospital. He shall liaise with the infection control officer, the pharmaceutical
officer and the radiation protection officer to familiarize himself with the correct
procedures for handling and disposing of pathological, pharmaceutical, chemical
and radiological wastes.
114. Concerning waste collection, the WMO should undertake the following tasks:
(a) Controlling internal collection of waste containers and their transport to the
central waste storage facility of the hospital, on a day-to-day basis;
(b) Ensuring the supply of items required for waste collection and handling; he
should liaise with the supplies department to ensure that an appropriate and
acceptable range of health-care waste bags and containers, protective
clothing and collection trolleys are available at all times;
(c) Ensuring that hospital attendants and ancillary staff immediately replace used
bags and con tainers with the correct new bag or container as appropriate;
(d) Directly supervising hospital attendants and ancillary workers assigned to
collect and trans port health-care waste.
115. Concerning waste storage, the WMO should:
(a) Ensure the correct use of the central storage facility for health-care waste at
the health-care establishment, which shall be fenced with a lock on the
entrance; hospital attendants and ancillary staff should always have
immediate access to the storage area;
(b) Prevent unsupervised dumping of waste containers on the hospital grounds,
even for short periods of time.
116. To supervise evacuation or disposal of the waste, the WMO should:
(a) Coordinate and monitor all waste disposal operations;
(b) Monitor methods of transportation of wastes on-site and off-site and ensure
that wastes collected from the hospital are transported by an appropriate
vehicle to the designated incinerator;
(c) Ensure that waste is not stored on the hospital grounds for periods longer
than specified in the guidelines and that the required frequency of collection
is maintained; he should therefore liaise with the transport organization,
which may be the local authority or a private contractor.
117. For staff training and information, the WMO should:
(a) Liaise with the matron and the hospital supervisor to ensure that the nursing
staff and medical assistants are familiar with their responsibilities for
segregation and storage of waste and of the limited responsibilities of hospital
attendants and ancillary staff in the handling and trans port of sealed waste
bags and containers;
(b) Liaise with departmental heads to ensure that all doctors and other qualified
clinical staff are aware of their responsibilities regarding segregation and
storage of waste and of the limited responsibilities of hospital attendants and
ancillary staff in the handling and transport of sealed bags and containers;
(c) Ensure that hospital attendants and ancillary staff are not involved in waste
segregation and that they handle only waste bags and containers sealed in the
correct manner.
118.For incident management and control, the WMO should:
(a) Ensure that emergency procedures are available and in place at all times and
that personnel are aware of the appropriate action to be taken;
(b) Investigate or review incidents reported during the handling of health-care
waste.
7.7.2 Emergency response
119. For health-care establishments, spills of infectious or other hazardous material or
waste are probably the most common emergencies related to hazardous material.
Basically, the same response procedures are applied, regardless of whether the
spills are from material or waste. The response to emergencies should ensure the
following:
(a) The waste management plan should be respected;
(b) Contaminated areas should be cleared and, if necessary, disinfected;
(c) The exposure of workers should be limited as much as possible during the
operation;
(d) The impact on the environment should be limited to the extent possible.
120. The staff should be well prepared for emergency response, and the required
equipment should be easily available at all points in time and within reasonable
distance to ensure that an adequate response can be made safely and routinely. The
procedures for the different types of emergencies should be written down. For
dangerous spills, clean-up should be carried out by designated, specifically trained
personnel.
7.7.2.1 Response to injuries
121. A response programme should be established for immediate reaction to injuries or
exposure to a hazardous substance. All staff handling biomedical and health-care
waste should be trained in dealing with injuries. Such a programme should include
the following elements:
(a) Immediate first aid measures, such as cleansing of wounds and skin and
splashing of eyes;
(b) Immediate reporting to a responsible designated person;
(c) Retention, if possible, of the item and details of its source for identification
of possible infection;
(d) Additional medical care from an accident, emergency or occupational health
department as soon as possible;
(e) Medical surveillance;
(f) Blood or other tests if indicated;
(g) Recording of the incident;
(h) Investigation, determination and implementation of remedial action.
7.7.2.2 Dealing with spills
122. Spills usually require only clean-up of the contaminated area. In spills of infectious
agents, it is important to determine the type of infectious agent, as some may
require immediate evacuation of the area, whereas others require fewer precautions.
The more hazardous spills usually occur in laboratories rather than in health-care
departments.
123. Spill-cleaning procedures should specify safe handling operations and appropriate
protective clothing. An example of such a procedure is provided in box 2.
Appropriate equipment for collecting the waste and placing it in new containers,
and for disinfection, should be provided. Table 6 provides an example of the
required items.
Box 2 Example of general procedure for spill-cleaning
(a) Evacuate the contaminated area;
(b) Eye and skin decontamination (disinfection) of exposed personnel should take place
immediately;
(c) Inform the designated person (usually the waste management officer);
(d) Determine the nature of the spill;
(e) Evacuate all the people not involved in cleaning up if agent is particularly hazardous;
(f) Provide first aid and medical care to injured persons (see response to injuries);
(g) Secure the area to prevent additional exposure of persons;
(h) Provide adequate clothing to personnel involved in cleaning up;
(i) Limit the spread of the spill;
(j) Neutralize or disinfect the spill or contaminated material if indicated;
(k) Collect the spill and the contaminated material; Sharps should never be picked up by hand, but
with tools, e.g. pans or brushes. Spilled material and contaminated items used for cleaning
should be placed into the appropriate bags or containers;
(l) Decontaminate or disinfect the area, and absorb; (m)Rinse the area, and absorb;
(n) Decontaminate or disinfect the used tools;
(o) Take off protective clothing and decontaminate or disinfect it if necessary;
(p) Seek medical care if exposure to hazardous material has occurred during the operation.
Table 5 Example of a list of items for spillage-cleaning
Action Tools or items
Approaching the spillage Protective equipment
Containing the spillage
Neutralizing or disinfecting the
spillage (if necessary)
Absorbent material (e.g. absorbent paper, towels, gauze pads) For
infectious material: disinfectant a/
For acids: sodium or calcium carbonate or other base
For cytotoxic material: special chemical degradation substances
For bases: citric acid powder or other acid
Collecting the spillage
For liquids: absorbent paper, gauze pads, wood shavings, calcium
bentonite, diatomaceous earth
For solids: forceps, broom, dust pan or shovel
Containment for disposal Mercury: mercury sponge or vacuum pump
Plastic bag (red, yellow or brown, as appropriate), sharps container
Decontamination or For infectious material: disinfectants a/
disinfection of the area For hazardous chemicals: suitable solvent or water
Source: WHO.
a/ Such as bleaching powder, which is a mixture of calcium hydroxide, calcium chloride
and sodium hypochlorite, used in the powder form or in solution of varying dilutions (1:1
to 1:100), depending on the nature of the spilled material.
7.7.2.3 Reporting accidents and incidents
124. All waste management staff should be trained in emergency response and made
aware of the correct procedure for prompt reporting of accidents and incidents.
Accidents or incidents, including near-misses, spillages, damaged containers,
inappropriate segregation or any incidents involving sharps should be reported by
the WMO if waste is involved, or otherwise to another designated person. The
report should include:
(a) The nature of the accident or incident;
(b) Where and when it occurred;
(c) Which staff were directly involved;
(d) Other relevant circumstances.
125. The incident should be investigated by the responsible officer (WMO in cases of
waste) to establish its causes and if possible action taken to prevent recurrence.
Records should be kept.
8. Waste management auditing
126. The purpose of a waste audit is to help a hospital to determine which initiatives will
be most beneficial. It does this by developing a detailed picture of the current status
of waste generation and disposal for the hospital. It then identifies potential areas
for improvement and develops action plans for each area. The ultimate impact of
environmental action is judged in terms of a positive impact on the environment and
cost savings for the institution.
127. There are three major steps involved in the waste audit. They include information
gathering, waste stream analysis and the development of action plans. First, a waste
audit must collect information on the following:
(a) The total volume of each type of waste generated by the entire hospital;
(b) The volume of each type of waste generated by each specific area in the
hospital;
(c) The current costs associated with the disposal of each type of waste;
(d) The waste management initiatives currently in place. Typically, these include
reuse, reduction, recycling and recovery programmes.
128. Much of the information can be found in purchase records and requisitions,
estimates made by the facility, and a search of the literature, and from interviews
with staff concerning their experience in handling waste in the facility.
129. The next step in the waste audit is to proceed with the sorting and weighing of the
components of the waste stream or to conduct a waste stream analysis. This second
task will be referred to as the comprehensive study of general waste. This task is
usually accomplished by personnel from the housekeeping staff over a period of
two weeks. For safety reasons, no types of waste that could threaten the staff in any
way are sorted - that is, biomedical waste, sharps, chemicals and so on are weighed
only.
130. The third stage of a waste audit is to develop action plans for reuse, reduction,
recycling and recovery initiatives. This involves analysing the data collected and, in
the first part of the audit, identifying potential areas of opportunity. Each of these
areas is then investigated to identify potential benefits associated with realistic
initiatives.
131. For each area where benefits can be achieved, an action plan is developed to
implement the initiative. The plan identifies where existing systems and work habits
can be modified and where new systems could be introduced to achieve the desired
results. While the action plan covers the entire hospital, the recommendations for
action may focus on specific areas within the hospital where the most benefit can be
gained.
132. Hospital managers or personnel making decisions need specific information about
which types of waste are being generated, the volumes of these wastes and the
locations of their generation. This information allows initiatives to be targeted to the
specific hospital locations and/or types of waste for which the most significant
benefits can be obtained. For example, waste recycling is most effective when the
segregation of recyclables from non-recyclables occurs at the point where the waste
is generated. By the time waste has reached the disposal hopper or compactor, it is
too late to consider waste reduction, reuse or recycling options. Knowing the
specific locations where most of the recyclable waste is generated permits
assessment of the recycling opportunity and the development of appropriate plans.
9. Capacity-building
133. The objectives of a comprehensive capacity-building strategy could include the
following:
(a) To provide a basic legal, technical and logistical framework;
(b) To introduce options for the sound management of biomedical and health-care
wastes;
(c) To develop a logical framework for the completion of national biomedical and
health-care waste profiles and the preparation of national health-care waste
plans.
134. The elements of a comprehensive capacity-building programme are:
(a) Establishment of a committee for the environmentally sound
management of bio medical and health-care wastes; Completion of
national (local) health-care waste profiles;
(b) Development of a national (local) health-care waste management
programme, including a technical and financial plan;
(c) Preparation of national regulations on the environmentally sound
management of biomedical and health-care wastes;
(d) Undertaking of training programmes for health-care personnel, waste
disposers, enforcement institutions, etc., including development of
decision-supportive tools for policy makers and waste handlers.
9.1 Education and training of personnel of health-care
establishments
135. A biomedical and health-care waste management policy is not effective unless it is
applied daily by all involved staff in a consistent and accurate way. Training
employees in implementing the policy is a critical step for a successful biomedical
and health-care waste management programme. The overall aim of the training is to
develop in the participants awareness of health, safety and environmental protection
issues relating to biomedical and health-care waste and how these can affect them in
their daily work. It should highlight the responsibilities and role of the employees in
the overall management programme. Health and safety at the workplace and
environmental awareness are the responsibility of everyone.
136. All hospital personnel, including senior medical doctors, should be educated with a
view to convincing them of the importance of the comprehensive health-care waste
management policy of the hospital and of its value for the health and safety of
everyone. This is the best way to obtain their collaboration in the implementation of
this policy.
137. Training activities should be designed for and targeted at four main categories of
personnel: managers and regulatory staff, e.g. safety advisers; medical doctors;
nurses and assistant nurses; and hospital cleaners, waste handlers and drivers.
138. Medical doctors may be educated through high-level workshops chaired by the head
of the hospital, while general hospital staff may be educated through formal
seminars. The training of waste managers and/or regulators does not usually take
place in the hospitals but in public health schools or university departments of
hospital engineering.
139. Education programmes should include: information on each aspect of the health-care
waste policy and its justification; informing each hospital staff member of his or her
responsibilities and role in implementing this policy; and technical instructions on
the application of the practices relevant to the target group.
140. As the best way of learning is probably through practice, hands-on training in small
groups should be considered where relevant. Testing the participants at the end of
the course, by simple true/false or multiple-choice questions, often provides an
incentive for learning and gives the course organizers an idea of the actual
knowledge acquired by the participants. The more detailed course contents are
presented below.
141. The instructors should have experience in teaching and training, be familiar with the
hazards and practices of biomedical and health-care waste management and, ideally,
have experience in waste handling.
142. Periodic repetition of courses will refresh the acquired knowledge, provide
orientation for new employees and for existing employees with new responsibilities,
and provide continuous updating on policy changes. Follow-up training will provide
data about the retention of information and the need for refresher courses.
9.1.1 Responsibility for training
143. The head of the health-care establishment should appoint a responsible person such
as the infection control officer, the doctor for hygiene or the WMO for all training
related to segregation, collection, storage and disposal of health-care waste. He
should ensure that staff at all levels are aware of the hospital waste management
plan and policy and of their responsibilities and obligations within the framework of
this plan and policy. A record of all training sessions should be kept. The content
of the training programmes should be periodically reviewed and updated where
necessary. For smaller sources of biomedical and health-care waste, a central
training function could be established at the regional health authority.
9.1.2 The training package
144. A training package could be developed by the national government agency
responsible for the disposal of biomedical and health-care wastes.
145. The training package on biomedical and health-care waste should be suitable for
various types of health-care establishment, including government hospitals,
teaching hospitals, dental hospitals, polyclinics, health centres, health-care research
institutions, clinical laboratories and other establishments where health-care wastes
are generated. Such a training package would also be useful for educational
establishments and the sectors providing services for biomedical and health-care
waste disposal. The package should contain numerous illustrations, such as
drawings, figures, photographs, slides or overhead transparencies.
9.1.3 Selection of participants
146. The ideal number of participants for a training course is 20 to 30 because larger
groups may render discussions and exercises difficult. Training courses should be
organized and targeted for all personnel categories. The discussions may, however,
be easier if the group is composed of personnel from various disciplines (e.g.
supervisors, medical and nursing staff, laboratory staff, engineers, ancillary staff) or
if the group is laced with one or two medical assistants and nurses.
147. It may be beneficial to include senior administration staff and heads of department
in certain training groups to demonstrate their commitment to the policy to other
staff members and to show that the policy is the responsibility of all personnel of
health-care establishments. Line managers may find it worthwhile to run the
training sessions themselves, with their own personnel attending.
9.1.4 Training recommendations
9.1.4.1 Training recommendations for personnel providing health-care
148. As mentioned above, the content of the training course should provide an overview
of the waste management policy and its inherent rationale and provide information
on relevant practices for the targeted group. For example, personnel providing
health-care will mainly be informed that with respect to waste segregation practices:
(a) Care should be taken while removing needles from syringes during operations
which require this;
(b) In no event should the staff correct segregation mistakes by removing items
from a bag or container once disposed of, or by placing a bag into a bag of
another colour;
(c) Hazardous and general waste should not be mixed. However, where this has
occurred, the mixture should be treated as health-care risk waste;
(d) Nursing and clinical staff should ensure that adequate numbers of bag holders
and health-care waste containers are provided for the collection and on-site
storage of medical waste in the wards, clinics, operating theatres and other
sources of waste generation. These on-site receptacles should be located close
to the source of waste generation.
149. Upon completion of the training course, the members of staff should be aware of
their responsibilities.
9.1.4.2 Training recommendations for waste-handling staff
150. Relevant training chapters may constitute a basis for the training course. Topics
covered may include the waste management policy, health hazards, on-site
transportation, storage, safety practices and emergency response. The attention of
members of staff who routinely handle biomedical and health-care waste may
decrease with time, which will increase the risk of injury. Periodic training is
therefore recommended.
9.1.4.3 Training of health-care waste management operators
151. The minimal training requirements for waste management operators should
include the following:
(a) Information on the risks associated with the handling of biomedical and
health-care waste;
(b) Training on the procedures for dealing with spillages and accidents;
(c) Instructions on the use of protective clothing.
152. The training needs will depend on the type of operations the staff perform.
Depending on the duties, training on specific areas (e.g. operation of incinerators,
waste transportation) will be required.
9.1.4.4 Training for members of staff who transport waste
153. The health-care establishment may either transport the waste itself or contract an
authorized waste transporter. Drivers and waste handlers should be specifically
trained and be aware of the nature and risks of the waste being transported. In
particular, transport staff should be trained in the following issues, and be able to
carry out the procedures and respect the instructions without any help from others:
(a) Correct procedures for handling, loading and unloading waste bags and
containers;
(b) Procedures for dealing with spillages or accidents; for these procedures, written
instructions should be available in the vehicle;
(c) Protective clothing and footwear should be worn at all times.
154. The vehicles dedicated to waste collection should at all times carry a supply of
plastic bags, protective clothing, cleaning tools and disinfectants to clean and
disinfect any spillage which may occur during loading, transport or unloading.
Documentation and recording of health-care waste, e.g. by using a consignment
note system, are necessary because they make it possible to trace the waste from the
point of collection to the final disposal facility. The head of the health-care
establishment should liaise with the transport contractor to ensure that the waste
collection crew is well trained. Untrained personnel should never be allowed to
handle biomedical and hazardous health-care waste.
9.1.4.5 Training of incinerator operators
155. Operation of incinerators requires qualified incinerator operators. It should be
remembered that the availability of such operators in certain regions should be
verified before purchasing high-technology incinerators. If qualified operators are
not available, health-care establishments should either resort to alternative health-
care waste disinfection technologies or contract the incineration out through a
regional facility.
156. Incinerator operators should have received at least secondary technical education.
They should be specifically trained in the following subjects:
(a) Overall functioning of the incineration facility, including heat recovery and
flue-gas cleaning technologies, if they exist;
(b) Health, safety and environmental implications of their operations;
(c) Technical procedures for the operation of the plant;
(d) Emergency response, e.g. in case of equipment failures, alarms;
(e) Maintenance of the plant;
(f) Surveillance of ash quality and emissions according to the specifications.
9.1.4.6 Training of operators of specially engineered landfill sites
157. The training of landfill operators is important for limiting subsequent risks presented
by buried biomedical and health-care waste, both in relation to preventing
scavenging and to protecting the quality of water. Operators should be trained in the
following areas:
(a) Health risks related to biomedical and hazardous health-care waste;
(b) Hazards related to sorting of this type of waste, which should in no event be
practised by the landfill operators or other people;
(c) Handling of biomedical and health-care waste by drivers or site operators,
which should be limited to a minimum;
(d) Use of protective equipment and personal hygiene;
(e) Application of safe procedures to dispose the wastes into a landfill;
(f) Procedures for emergency response.
Annex I: Glossary/terminology
Activity Disintegration of an amount of a radionuclide in a particular
energy state at a given time per time interval at a given moment.
Air pollution The presence of a material or substance in the air which may be
harmful to either the natural or human environment, which
includes any material present in sufficient concentrations for a
sufficient time, and under certain circumstances, to interfere
significantly with the comfort, health or welfare of persons or with
the full use and enjoyment of property.
Air quality standards The level of pollutants that cannot by law be exceeded during a
specified time in a defined area.
Solid or liquid waste arising from health-care (medical) activities
such as diagnosis, monitoring, treatment, prevention of disease or
alleviation of handicap in humans or animals, including related
research, performed under the supervision of a medical practitioner
or veterinary surgeon or another person authorized by virtue of his
professional qualifications.
Bottom ash The non-airborne combustion residue from burning fuel and other
materials in an incinerator. The material falls to the bottom of the
incinerator and is removed mechanically.
Capacity The quantity of solid waste that can be processed in a given time
under certain specified conditions, usually expressed in terms of
mass per 24 hours.
Chemical waste Wastes generated from the use of chemicals in medical, veterinary
and laboratory procedures, during sterilization processes and
research.
Collection The act of removing accumulated containerized solid waste from
the generating source. Private collection of solid and liquid waste
by individuals or companies from residential, commercial, health
facility or industrial premises; the arrangements for the service are
made directly between the owner or occupier of the premises and
the collector.
Cytotoxic waste Material which is visibly contaminated with a cytotoxic drug
during the preparation, transport or administration of cytotoxic
therapy.
Decontamination The process of reducing or eliminating the presence of harmful
substances such as infectious agents so as to reduce the likelihood
of disease transmission from those substances.
Disinfection Process of reducing the viability of micro-organisms by various physical and chemical methods.
Emergency A situation created by an accidental release or spill of hazardous chemicals
or infectious material which poses a threat to the safety of workers,
residents, the environment or property.
Exposure
The amount of radiation or pollutant present in a particular environment
(i.e. human, natural) which represents a potential health threat to the living
organisms in that envi ronment.
Fly ash
The finely divided particles of ash entrained in the flue gases arising from
com bustion. The particles of ash may contain incompletely burned material.
The par ticles are frequently glassy spheres but may also be crystalline or
even fibrous in structure.
Health-care waste See biomedical and health-care waste.
Human tissue
The tissue, organs, limbs, blood, and other body fluids that are removed
during surgery and autopsy.
Incineration
The controlled burning of solid, liquid or gaseous combustible wastes to
produce gases and residues containing little or no combustible material.
Irradiation Exposure to radiation of wavelengths shorter than those of visible light
(gamma, x-ray or ultraviolet) for medical purposes, the destruction of
bacteria in milk or other foodstuffs or initiation of polymerization of
monomers or vulcanization of rubber.
Liquid wastes Any waste material that is determined to contain “free liquids” - liquids
which readily separate from the solid portion of waste under ambient
temperature and pressure.
Monitoring
Periodic or continuous surveillance or testing to determine the level of
compliance with statutory requirements and/or pollutant levels in various
media or in humans, animals and other living things.
Off-site facility
A clinical and related waste treatment, storage or disposal facility that is
located away from the generating site.
On-site facility
A clinical and related waste treatment, storage or disposal facility that is
located on the generating site.
Pharmaceutical
waste
Wastes from the production, preparation and use of pharmaceutical
products.
Pyrolysis
The decomposition of organic material by heat in the absence of or with a
limited supply of oxygen.
Radioactive waste Material contaminated with a radioisotope which arises from the medical or
research useof radionuclides. It is produced, for example, during nuclear
medicine, radio immunoassay and bacteriological procedures, and may be
in a solid, liquid or gaseous form.
Residual wastes Those materials (solid or liquid) which still require disposal after the
completion of
a treatment or resource recovery activity, e.g., slag and liquid effluents
following a
pyrolysis operation and the discards from front-end separation systems.
Sanitation
The control of all the factors in the physical environment that exercise or can
exercise
a deleterious effect on human physical development, health, and survival.
Sharps
All objects and materials which are closely linked with health-care activities
and
pose a potential risk of injury and/or infection.
Sterilization A process used to reach a state free of viable micro-organisms. Note that in a
sterilization process, the nature of microbiological death or reduction is
described
by an experimental function. Therefore, the number of micro-organisms that
survive
a sterilization process can be expressed in terms of probability. While the
probability
may be reduced to a very low number, it can never be reduced to zero.
Waste
minimization
The application of activities such as waste reduction, reuse and recycling to
minimize
the amount of waste that requires disposal.
Waste
segregation
The process of keeping source-separated wastes apart during handling,
accumula
tion (interim storage), storage and transport to assist resource recovery and to en
sure that appropriate designated treatment and/or disposal methods are utilized.
Waste segregation should be practised by both generators and waste-handling com
panies for efficient waste management.
Annex II: Examples of specific waste reduction, reuse and recycling
activities
Purchasing practices
· Purchase recycled content material where appropriate (e.g. office paper, envelopes,
toilet tissue, paper towels) and look for environmental labels. Work with purchasing
committees to determine which products may be suitable
· Work with suppliers to have oversized packaging materials returned or recycled
·
Use building construction products with recycled content materials (e.g. drywall,
asphalt)
· Use environmentally responsible vehicles and maintenance products (e.g. propane as
fuels, re-refined oils, retreated tyres, recycled antifreeze).
Reduction
Use two-sided photocopying
Use electronic mail (i.e. personal computers or phone messages)
Buy in bulk (e.g. food and drink containers in the cafeteria and soaps and detergents
in house keeping)
Avoid products with excess packaging and work with suppliers to reduce it
Reroute publications such as magazines, newspapers and journals
Circulate memos or documents
Use bulletin boards for posting announcements
Single-space texts
Use two-way envelopes for billing
Make sure staff understand how to use equipment to reduce wastage
Use the reduction feature on your copier to fit more than one paper per page
Use permanent tape dispensers, not disposable ones
Use refillable pens instead of disposable ones
Purchase durable equipment, furnishings and supplies
Install energy-efficient appliances (e.g. lighting)
Use water-saving devices
Turn off lights and office equipment when not in use
Use incinerators that meet the new discharge guidelines and have an energy
recovery system
Use computer fax software to send facsimiles without making hard copies
Use non-solvent liquid scintillation cocktails in laboratories
Use less hazardous radioactive materials where appropriate
Develop microtesting procedures to reduce chemical usage
Make sure biomedical waste is properly segregated from general waste to reduce dis-
posal costs and increase materials for recycling
Explore opportunities to reduce formalin usage in sample analysis by replacing with
cold, physiological saline solutions where appropriate
Replace formalin solutions with commercially available, less toxic cleaning solutions
in dialysis machines.
Recycling
· Newspapers and telephone books can be given to farmers or
charitable organizations as bedding
· Give used towels and rags to rag recyclers · Use plain-paper
fax machines; the paper is recyclable and the messages
will not fade
· Recycle juice bottles or baby formula; juice and food material
containers; newspapers; and plastic containers (e.g.
polyethylene containers or other types where
appropriate)
· Recycle cardboard with a commercial recycler or through your
supplier · Recycle pallets with a commercial recycler or
through your supplier · Include pick-up of containers as
part of the supplier’s role in your contracts
· Work with suppliers to help them design workable packages
that are recyclable
· Pool local businesses that recycle material and contract for the
services of the same recycler t o reduce pick-up costs
· When purchasing products, ensure that all packages can be
returned to the supplier or recycled at your facility
· Use a distribution network to recycle materials back to a
central location for better marketing of material
· Explore waste-recycling options for food waste either as
human food, as animal feed either directly or through a
commercial processor - or as composting or for
vermiculture, and use compost at your facility in
landscaping
· Contract a shredding company that recycles your shredded
paper
· Involve ambulatory patients in waste minimization
programmes (e.g. psychiatric and geriatric patients in
composting projects)
· For large waste generators, explore processing equipment such
as balers or compactors for recyclable materials
· Locate markets for recyclable materials which are generated in sufficient quantities,
such as office paper, cardboard, plastics, solvents (xylenes, toluenes, CFCs),
oils (vegetable and hydraulic) and construction and demolition materials such
as drywalls, asphalt, concrete, wood Install silver recovery units for photo
processing waste waters
· Evaluate opportunities for anaesthetic gas recycling.
Reuse
· Donate used publications to doctors’ surgeries, nursing homes or the local library.
· Reuse worn cloth nappies and towels as rags.
· Reuse scrap paper for notepads and draft copies.
· Reuse old envelopes by applying labels (with non-solvent glues) on top of old
addresses.
· Use reusable nappies, incontinence pads and underpads where appropriate.
· Use reusable urine trays.
· Use reusable drapes and gowns where appropriate.
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Biomedical
and health
care waste
ZOrHearP ORF OED
risk waste waste
Use 7
Treatment/
reprocessing
a
Risk + Non- Reuse - recycling of
a Possible action points a
Classification/ Transport/
Definition > 4 Risk ) < Treatment > Disposal
Non-risk waste < > >
Municipal
[Neutralization fwaste
INFECTIOUS —p i for landfill or, A disposal
Infectious lif necessary for
incineration
SHARPS -—> Physical Incineration
BIOLOGICAL - . UB
fe Ethical religious
ANATOMICAL Seperate
specific
DRUGS F disposal
REAGENTS P Toxic options
RADIOACTIVE 2 J
COMPOUNDS i> Radioactive
Law clause
- section 1
- section 2.6.
- section 6.1,
- section 6.1,
Law code
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