C

Health Care Waste Management

Plastic Color Liner

  • Determination of Waste Type in Home Healthcare
    • Tablet or Capsule (expired medicine): Black bag, then brown container.
    • Liquid (expired medicine): Remove from bottle (black bag), then place entire bottle in brown container.

Waste Management Hierarchy

  • Most Preferable (Administrative Control Measures):
    • Prevent: Systematize product use; "first in, first out" or "first to expire, first out" for chemicals and pharmaceuticals.
    • Reduce: Eliminate medical supplies/equipment containing hazardous chemicals (e.g., mercury).
    • Reuse: Use less hazardous methods in cleaning (e.g., steam disinfection instead of chemical disinfection).
    • Recycle: Check expiry dates upon delivery and base usage on optimal consumption.
    • Recover: Green Procurement, Resource Development
  • End of Pipe:
    • Treat
    • Dispose

Healthcare Waste Segregation, Collection, Storage, and Transport

  • Segregation: Separating different waste types at the point of generation until final disposal.
  • Responsibility: Correct segregation of HCW is the responsibility of the waste generator, regardless of their position.
  • Enforcement: Segregation at the source is strictly enforced; no re-segregation if mixing occurs due to improper segregation.
  • Risk Reduction: Segregation reduces health risks from potentially infectious fractions (e.g., items contaminated with body fluids, used sharps).
  • Resource Recovery: Proper segregation allows appropriate resource recovery and recycling.
  • Collection and Transport:
    • Auxiliary and outsourced-housekeeping personnel collect waste from bins to the on-site storage area.
    • Collection times are fixed based on waste quantity in each area.
    • Follow established plans for HCW collection and transport.
    • Infectious and general waste should be collected daily (or as required).
    • Waste bags should be no more than three-quarters full, then sealed. Plastic bags should be tied or sealed with a plastic tag – at least 0.07mm thickness.
    • Sharp containers should be collected when three-quarters full.
    • Pharmaceutical and chemical waste collected on demand.
    • Empty vial management based on FDA ruling.
    • Maintain logbook/records of inventory.
    • Radioactive waste collected after procedure finalization.
    • Personnel must ensure waste bags and containers are properly labelled upon collection.
    • Replacement bags/containers should be available at each location.

Waste Types and Color-Coding

  • Sharps: Yellow bins/containers, Yellow liners.
  • Infectious Waste: Yellow liners.
  • Pathological Waste: Brown bins/containers/liners.
  • Anatomical Waste: Orange.
  • Pharmaceutical Waste: Black.
  • Chemical Waste: Black.
  • Radioactive Waste: Black.
  • Non-Biodegradable Hazardous Waste: Green
  • Biodegradable Hazardous Waste: Green

Healthcare Waste Treatment and Disposal

  • Treatment Technology Considerations:
    • Waste characteristics.
    • Technology capabilities and requirements.
    • Environmental and safety factors and cost.
    • Compliance with national standards and international conventions.
    • Type and quantity of waste.
    • Treatment efficiency.
    • Volume and mass reduction.
    • Occupational health and safety.
    • Environmental considerations.
    • Infrastructure and space requirements.
    • Social and political acceptability.
    • Cost of transport and disposal.

Specific Disposal Methods

  • Concrete Vault: Suitable for used sharps and syringes; safety boxes deposited inside.
  • Placenta Pit:
    • Far from public access.
    • Safety distance of at least 1.5 meters from the bottom of the pit to the groundwater level.
    • Not recommended where the water table is near the surface.
  • Steam Treatment Technology:
    • Autoclave
    • Microwave
    • Capable of treating a range of infectious waste, including cultures and stocks, sharps, materials contaminated with blood and limited amounts of fluids, isolation and surgery waste, laboratory waste (except chemical waste).

Basic Treatment Processes

  • Biological:
    • Enzymes for organic waste containing pathogens.
    • Composting and vermiculture (kitchen, organic, and placenta wastes).
    • Burial of pathological wastes.
  • Safe On-site Burial:
    • Located in remote areas.
    • Applicable only to treated infectious waste, sharps waste, pathological, and anatomical waste.
    • Small quantities of encapsulated/inertisized solid chemical and pharmaceutical wastes.
    • Should be considered a transitional or interim solution.
    • Requires 50 cm of Cement on embedded earth mound to keep water out of the pit
    • Bottom clay layer should consider ground water level.
  • Sanitary Landfill:
    • Dedicated cells for treated HCW.
    • Requirements:
      • Waste treatment facility/system passed microbial inactivation standards.
      • Properly treated HCW passed the spore strip test.
      • Valid CPR from DOH-Bureau of Health Devices and Technology (BHDT).
      • EMB-registered TSD facility.
      • Permit to transport.

On-site Treatment Considerations

  • If a healthcare facility operates its own waste treatment:
    • Away from public access and patient rooms.
    • Near storage area or MRF.
    • Near entry/exit of vehicles.
    • Protected from rain, strong winds, floods.
    • Cleaning supplies available.
    • Adequate space for workers to maneuver safely.

Summary Points

  • Waste treatment aims to eliminate hazard/exposure.
  • Infectious waste requires proper treatment and disposal.
  • On-site treatment gives facilities better ownership of wastes.
  • Healthcare facilities should prioritize waste minimization.
  • Encapsulation: Filling containers with waste and immobilizing materials, then sealing.
  • Inertization: Mixing waste (mostly pharmaceutical) with cement before disposal.