WASTE MANAGEMENT

Prepared by B. B. Bajgain
Hospital Administrator
Medicare Hospital Pvt.Ltd.,Nepal
Phone:977-9841249899
E-mail:- abajgain@hotmail.com
INTRODUCTION
Hospital waste mean all wastes coming out of hospitals, it may
be biological or non-biological that is discarded, and is not
intended for further use in a hospital. Out of which how
much are “non-hazardous wastes”, how much are “non
infectious but hazardous wastes”, such qualification are
essential for scientific management of hospital wastes.

Hospital wastes include human tissues, organs, body parts and

body fluids that are removed during surgery or autopsy or
other medical procedures and specimens of body fluids and
other containers. They are part of infectious waste as well as
medical waste, bio-medical waste, pathological waste.

B.B.Bajgain 2
Cont..
 Clinical wastes mean any wastes coming out of
medical care provider in hospitals or other medical
care establishments.
 Medical waste is a term used to describe, “any waste
that is generated in the diagnosis, treatment or
immunization of human beings or animals, in research
pertaining there to, or in production or testing of
biological products”.
 Bio-medical waste is described as, “any solid, fluid or
liquid waste, including its container and any
intermediate product, which is generated during the
diagnosis, treatment or immunization of human being
or animals, in research pertaining there to , or in the
production or testing of biological and the animal
waste from slaughter houses or any other like
establishments”.
B.B.Bajgain 3
Objective of hospital waste management

 To support high quality patient care

 To contain the cost of hospital waste management
 To reduce the risk of nosocomial infection
 To comply with regulations and ordinances
 To develop good community relations
 To support the preservation of environmental quality
 To cerate awareness amongst the staff, patient and
community
 To manage the hospital waste properly and
systematically
 Provide a safer working environment
 Protect public health & safety

B.B.Bajgain 4
classification of waste
General waste No risk to human health such as kitchen
wastes, office paper, plastic package materials,
wrappers, papers pieces, general sweeping & so on.
Theses waste can be treated similar to domestic
wastes. It is bulky.

Pathological waste It includes tissues, organs, body

parts, & fluids. This also under the high risk category &
should be autoclaved before leaving the department.

Radioactive waste This includes low level radioactive

waste arising from medical diagnosis, medical
research & disease treatment such as analytic
procedures, diagnostic aids, body organ imaging,
treatment, radiotherapy etc.
B.B.Bajgain 5
Cont..
Infectious waste This waste may transmit viral, bacterial
or parasitic disease to human beings. This category
includes laboratory wastes, wastes from surgery,
cultures & stocks of infectious agents from laboratories
& autopsies, bandages etc.

Chemical waste Such as toxic, corrosive, cyctoxic etc.

and comprises a discarded solid, liquid & chemicals.

Sharps Sharps are items that could cause cuts or

puncture wounds, including needles, scalpel and other
blades, knives, saws, broken glass, and nails.
Whether or not they are infected, such items are
usually considered as highly hazardous hospital
waste.
B.B.Bajgain 6
Cont..
Pharmaceutical waste It includes outdated drugs,
chemicals and other pharmaceutical products.

Pressurized containers These are used for the

instructional purpose, which contains gases or
aerosols which when accidentally punchered or
incinerated could explode.

Genotoxic waste it is highly hazardous & may have

mutagenic, teratogenic or carcinogenic properties. It is
also includes cyctoxic drugs and chemicals.

B.B.Bajgain 7
Generation & Segregation of Waste

Segregation of waste at the point of generation is the

most important activity for an effective hospital waste
management. It is the responsibility of the waste
procedure and should be done at the source of waste
generation.

Segregation various from hospital to hospital depending

on the treatment system and the policies practiced
within the hospital. Most of the hospital segregate
their waste into 3 categories i.e. Hazardous, non-
hazardous and sharps. Suitable containers or bags
are placed in all locations where the waste are
generated.

B.B.Bajgain 8
Cont..
According to WHO, 1999 following guidelines are given to
segregate the hospital waste:

Yellow colored containers Infectious Wastes

Black colored containers Non-infectious waste,

Non-hazardous, and
Communal waste

B.B.Bajgain 9
Collection of Waste
The waste generated should be collected daily within a
certain time interval and should be transferred to the
designated storage site.

For the collection of waste, bags and containers are

used. The waste should be collected not less than 2
times a day or more according to the quantity of waste
generated in the hospital. It should be essential for the
waste handler to were protective clothing and gloves.

B.B.Bajgain 10
Storage of waste
The waste collected from verious collection points should
be stored to a central storage room unit it is
transported for treatment within or outside the hospital
premises. While storing the waste, hazardous and
general waste should be separated. Wastes should be
stored in the areas of generation for a period varying
from 2-6 hours.
The storage room should be located within the hospital
premises but should be well protected from the reach
of outsiders and should be cool, protected from direct
sunlight and should be close to incinerator.

B.B.Bajgain 11
Transport of waste

The waste generated from different places

should be transported. The waste may be
transported within the hospital or from the
hospital to the treatment place. For onsite
transportation, the waste is collected using the
trolley and for off-site transportation, a vehicle
is used. The transportation system depends
on the amount of the waste generated,
existing management techniques, operations
and maintenance cost.

B.B.Bajgain 12
Treatment & Disposal of Waste
Treatment is any method, technique or process designed
to change the biological character or composition of
the medical waste to reduce or eliminate pathogens so
that the waste no longer hazardous to persons who
may be exposed to it. Several methods are used for
hospital waste treatment, depending on the types of
waste.
These treatment methods include incineration,
disinfection, using autoclaves, hydroclaves,
microwaves or landfill etc. all the treatment technique
depends on the types of infected or non-infected
waste.

B.B.Bajgain 13
1. Incineration
Incineration functions under the high temperature dry oxidation
process, which is a combination of controlled heat and air.
Incineration can range from extremely sophisticated, high
temperature operating plants to very basic combustion units that
operate at much lower temperature.
If incinerations are properly designed, maintained & operated, they
are effective in killing organisms present in infectious waste &
also help to reduce the volume of waste.

There are three basic kinds of incineration technologies:

Double-chamber pyrolytic incinerator which may be especially
designed to burn infectious hospital waste
Single chamber furnaces with static grate, which should be used
only if pyrolytic incinerator is not affordable.
Rotary kilns operating at high temperature, capable of causing
decomposition of substances and heat-resistant chemicals

B.B.Bajgain 14
2. Chemical Treatment

Chemical disinfections are the preferred

treatment for liquid infectious wastes, but it
can also be used in treating solid infectious
waste. Chemical treatment is used according
to the type of microorganism, degree of
contamination, type of disinfectant, contact
time and other relevant factors such as
temperature, the biology of the microorganism
etc.

B.B.Bajgain 15
3. Autoclave

Bio-hazard wastes (except human body parts) in

designed bags are exposed to steam at high
temperature (134d C) & pressure (35psi) for at
least 30 minutes. Autoclaving is an effective
wet thermal disinfection process. Typically,
autoclaves are used in hospitals for the
sterilization of reusable medical equipment. It
is recommended that all general hospital, even
those with limited resources, be equipped with
autoclave.

B.B.Bajgain 16
4. Hydroclave

It supplies steam (which is stored in a double

wall/jacket) as an indirect heat source,
allowing total dehydration of the waste at 132d
c and 36 psi. the waste is also internally
agitated & fragmented to attain a high
sterilization level of all components & particles-
sharps, pathological waste etc.

B.B.Bajgain 17
5. Microwave
Microwave uses electromagnetic wave that enter
into or penetrate materials. Most
microorganisms are destroyed by the action of
microwaves of a frequency of about 2450 MHz
and a wavelength of 12.24cm. The microwave
rapidly heat the water contained within the
waste and the infectious components are
destroy by heat conduction. The efficiency of
microwave disinfection should be checked
routinely through bacteriological and
virological tests.

B.B.Bajgain 18
6. Burial Pit

A special type small pit (1-2m depth) could be

prepared to receive medical waste only and
filled to a depth of 1-1.5cm. After each waste
load, the waste should be covered with soil
layer 10-15 cm deep. If soil is not available,
line may be deposited over the waste.
Hazardous waste can be buried in a special
pit.

B.B.Bajgain 19
Steps in hospital waste management

 Create awareness amongst the hospital staff

members and population

 Assign the specific responsibility to the hospital staff

 Training to the hospital staff

 Waste segregation, classification and assess waste

management

 Ensure safe storage

 Identify reuse options

B.B.Bajgain 20
Cont..
 Ensure safe transportation of wastes Ensure staff and
workers safety

 Return outdated drugs or chemicals to the supplier

 Adequate treatment and disposal of waste water and

other wastes

 Improve stock management of chemical and

pharmaceutical

 General waste treatment

B.B.Bajgain 21
Waste management policy
 Each health care institution should develop a waste
management policy, outlining the accountabilities and
responsibilities of managers, employees and staff. It is
the responsibility of health care institution to comply
with guidelines, to ensure proper classification,
segregation, containment, treatment and disposal of
waste.

 Each health care institution establishes “waste

management committee”, which will have function of
implementing waste management policy.

B.B.Bajgain 22
Policy of biomedical waste management

 Waste minimization
 Segregation at source
 Identification (color coding)
 Collection
 Storage
 Transport
 Measurement
 Treatment
 Disposal
 Worker training
 Worker health and safety

B.B.Bajgain 23
Composition of waste management committee

 The hospital superintendent, chairman

 The heads of all hospital departments/units
 The chief pharmacist
 The radiology officer
 The matron
 The head of administration
 Hospital engineer (if any)
 The housekeeper
 Representative from support staff

B.B.Bajgain 24
B.B.Bajgain 25