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.