Best Practices in
Biomedical Waste Management
Deepinder Singh, Head – Quality Improvement
KIMS Group of Hospitals
Oman I UAE I KSA I Bahrain I Qatar I India
PROBLEMS
Definition
Biomedical waste
Any waste which is generated during the
diagnosis, treatment or immunization of
human beings or animals or in research
activities
SOURCES
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Major Sources
Hospitals
Medical Centers
Related laboratories and research
centres
Biotechnology institutions
Mortuary and autopsy centres
Animal research and testing
Blood banks and blood collection
services
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Minor Sources
Physicians/ dentists’ clinics
Animal houses/slaughter houses.
Blood donation camps.
Vaccination centers.
Funeral services.
CLASSIFICATION
The World Health Organization, 2014 (WHO)
TYPICAL WASTE COMPOSITIONS IN HEALTH-CARE FACILITIES
World Health Organization states that 85% of hospital wastes are
actually non-hazardous, whereas 10% are infectious and 5% are
noninfectious but they are included in hazardous wastes.
About 15% to 35% of Hospital waste is regulated as infectious waste.
Safe management of wastes from health-care activities (WHO), 2014
WASTE GENERATION IN DEVELOPING COUNTRIES
WASTE GENERATION IN A DEVELOPED COUNTRY
CHARACTERISTICS OF HAZARDS
The hazardous nature of health-care waste is due to one or more of the following characteristics:
 • Presence of infectious agents
 • A genotoxic or cytotoxic chemical composition
 • Presence of toxic or hazardous chemicals or biologically aggressive pharmaceuticals
 • Presence of radioactivity
 • Presence of used sharps
PROBLEMS WITH IMPROPER BIOMEDICAL WASTE DISPOSAL
 Injuries from sharps leading to infection to all categories of hospital personnel and
waste handler.
 Nosocomial infections in patients from poor infection control practices and poor
waste management.
 Risk of infection outside hospital for waste handlers and scavengers and at time
general public living in the vicinity of hospitals.
 Risk associated with hazardous chemicals, drugs to persons handling wastes at all
levels.
 “Disposable” being repacked and sold by unscrupulous elements without even
being washed.
 Drugs which have been disposed of, being repacked and sold off to unsuspecting
buyers.
 Risk of air, water and soil pollution directly due to waste, or due to defective
incineration emissions and ash
HAZARDS FROM INFECTIOUS WASTE AND SHARPS
WHO IS AT RISK ?
 Medical doctors, nurses, health-care auxiliaries and hospital
maintenance personnel
 Patients in health-care facilities or receiving home care
 Visitors to health-care facilities
 Workers in support services, such as cleaners, people who work in
laundries, porters
 Workers transporting waste to a treatment or disposal facility
 Workers in waste-management facilities (such as landfills or
treatment plants), as well as informal recyclers
The general public could also be at risk whenever hazardous healthcare waste is abandoned or disposed of improperly.
SOLUTIONS
BIOMEDICAL WASTE DISPOSAL
Segregation
Containment
Labelling
Collection
Handling
Thermal
Processes
Chemical
Processes
Irradiation
technologies
Transport
Storage
Disposal
Records
Biological
processes
Mechanical
processes
THE WASTE-MANAGEMENT HIERARCHY
RECYCLING AND RECOVERY
Recycling is increasingly popular in some health-care facilities, especially for
the large, non-hazardous portion of waste. It can reduce costs considerably,
either through reduced disposal costs or through payments made by a
recycling company for the recovered materials
National Health Service (NHS)
Foundation Trust facility in the
United Kingdom generates the
annual waste equivalent of
5500 households. The trust
invested in balers and
compactors to facilitate waste
recycling, particularly paper
and cardboard
Health Care Foundation – Nepal recycles bloodcontaminated plastics after autoclaving. The foundation
also recycles paper, plastic and glass, and estimates that
40% of waste-handling costs are covered by recycling.
SAFE REUSE
The use of non-disposable items for medical
procedures should be encouraged where their reuse
after cleaning can be demonstrated to minimize
infection transmission to acceptably low probabilities
• Endoscopes
• Surgical instruments
WASTE MINIMIZATION
The most preferable approach, if locally achievable,
is to avoid producing waste as far as possible and
thus minimize the quantity entering the waste
stream.
Where practicable, recovering waste items for
secondary use is the next most preferable method.
Waste that cannot be recovered must then be dealt
with by the least preferable options, such as
treatment or land disposal, to reduce its health and
environmental impacts.
WASTE MINIMIZATION
Source reduction
• Purchasing reductions: selecting supplies that are less wasteful where smaller quantities can be used,
or that produce a less hazardous waste product.
• Use of physical rather than chemical cleaning methods (e.g. steam disinfection instead of chemical
disinfection).
• Prevention of wastage of products (e.g. in nursing and cleaning activities).
Management and control measures at hospital level
• Centralized purchasing of hazardous chemicals.
• Monitoring of chemical use within the health center from delivery to disposal as hazardous wastes.
Stock management of chemical and pharmaceutical products
• More frequent ordering of relatively small quantities rather than large amounts at one time, to reduce
the quantities used (applicable in particular to unstable products).
• Use of the oldest batch of a product first.
• Use of all the contents of each container.
• Checking of the expiry date of all products at the time of delivery, and refusal to accept short-dated
items from a supplier.
ENVIRONMENTALLY PREFERABLE PURCHASING (EPP)
Purchase of the least damaging products and services, in
terms of environmental impact
 Conserve energy and water
 Increase the use of recycled and reused materials
 Reduce hazardous substances, especially persistent, bioaccumulative and
toxic chemicals
 Decrease greenhouse gas emissions
 Improve indoor air quality
 Promote end-of-life management
 Reduce waste
http://www.nyc.gov/html/mocs/html/programs/epp.shtml
GREEN PROCUREMENT
• Reducing the toxicity of waste is also beneficial, by reducing
the problems associated with its treatment or disposal
• Globally, the most easily recyclable plastics are
polyethylene, polypropylene and polyethylene
terephthalate (PET). Conversely, polyvinyl chloride (PVC) is
the most difficult, partly because its products come in a
variety of forms containing different additives.
• Packaging of mixed materials, such as paper or card
covered in plastic or aluminum foil, is rarely recyclable.
• Ethylene oxide is used to sterilize medical devices, but it is
carcinogenic and so should be avoided where alternatives
exist.
ENVIRONMENTAL MANAGEMENT SYSTEMS
• An environmental management system (EMS) is a formal approach
in countries with strict environmental laws to manage an
organization’s impact on the environment.
• Hospitals and health centres of any size should derive a benefit
from introducing and implementing an EMS. These benefits include
cost reductions through
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Reduced energy consumption
Reduced quantities of waste
Increased recycling
Minimized negative impacts on the environment from waste
handling and treatment
– An improved public image.
• An environmental procurement policy in a Hospital under NHS, UK,
reduced health-care waste quantities by 4.1% (78 tonnes), energy
consumption by 3.6% and water usage by 9.6%
LEGISLATIVE, REGULATORY AND POLICY ASPECTS OF
HEALTH-CARE WASTE
Guiding principles
1.
2.
3.
4.
5.
The “polluter pays” principle
The “precautionary” principle
The “duty of care” principle
The “proximity” principle
The “prior informed consent” principle
INTERNATIONAL AGREEMENTS AND CONVENTIONS
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The Basel Convention
The Bamako Convention
The Stockholm Convention
The environment and sustainable development conferences
United Nations Committee of Experts on the Transport of
Dangerous Goods
• United Nations Economic Commission for Europe
• Aarhus Convention of the United Nations Economic
Commission for Europe
SHORT-TERM STRATEGIES
1.
2.
3.
4.
5.
Production of all syringe components using the same plastic to facilitate
recycling.
Selection of polyvinyl chloride–free medical devices.
Identification and development of recycling options wherever possible
(e.g. for plastic, glass).
Research into, and promotion of, new technology or alternative to smallscale incineration.
Until countries in transition and developing countries have access to
health-care waste-management options that are safer for the
environment and health, incineration may be an acceptable response
when used appropriately. Key elements of appropriate operation of
incinerators include effective waste reduction and waste segregation,
placing incinerators away from populated areas, satisfactory engineered
design, construction following appropriate dimensional plans, proper
operation, periodic maintenance, and staff training and management.
MEDIUM-TERM STRATEGIES
1. Further efforts to reduce the number of unnecessary
injections, to reduce the amount of hazardous healthcare
waste that needs to be treated.
2. Research into the health effects of chronic exposure to low
levels of dioxin and furan.
3. Risk assessment to compare the health risks associated with
(a) incineration, and (b) exposure to health-care waste.
LONG-TERM STRATEGIES
1.
2.
3.
4.
5.
Effective, scaled-up promotion of non-incineration technologies
for the final disposal of health-care waste to prevent the disease
burden from (a) unsafe health-care waste management, and (b)
exposure to dioxins and furans.
Support to countries in developing a national guidance manual for
sound management of health-care waste.
Support to countries in developing and implementing a national
plan, policies and legislation on health-care waste.
Promotion of the principles of environmentally sound
management of health-care waste as set out in the Basel
Convention.
Support to allocate human and financial resources to safely
manage health-care waste in countries.
Collaboration
RESPONSIBILITIES : GOVERNMENTS
• Allocate a budget to cover the costs of establishment and
maintenance of sound health-care waste management
systems
• Request donors, partners and other sources of external
financing to include an adequate contribution towards the
management of waste associated with their interventions;
• Implement and monitor sound health-care waste
management systems, support capacity building, and ensure
worker and community health.
RESPONSIBILITIES OF OTHERS
NGOs should
• Include the promotion of sound health-care waste management in their advocacy
• Undertake programs and activities that contribute to sound health-care waste
management.
The private sector should
• Take responsibility for the sound management of health-care waste associated
with the products and services it provides, including the design of products and
packaging.
All concerned institutions and organizations should
• Promote sound health-care waste management
• Develop innovative solutions to reduce the volume and toxicity of the waste they
produce and that is associated with their products
• Ensure that global health strategies and programs take into account health-care
waste management.
NATIONAL LEGISLATION : ELEMENTS TO BE CONSIDERED
 A clear definition of hazardous health-care waste and its various
categories
 A precise indication of the legal obligations of the health-care waste
producer regarding safe handling and disposal
 Specifications for record keeping and reporting
 Establishment of permit or licensing procedures for systems of treatment
and waste handling
 Specifications for an inspection system and regular audit procedures to
ensure enforcement of the law and for penalties to be imposed for
contravention
 Designation of courts responsible for handling disputes arising from
enforcement of, or non-compliance with, the law
MINIMUM APPROACH TO DEVELOPING HEALTH-CARE
WASTE-MANAGEMENT POLICY
Where there is no national policy, legislation or guidelines, this should not prevent a hospital or
health-care facility from commencing a modest program of health-care waste management.
A short document could be prepared that states the problems, sets out simple actions, identifies the
stakeholders, and mobilizes them to carry out the actions.
The following two example publications can be downloaded from the internet:
1. Starting health care waste management in medical institutions (WHO, 2000), available at
http://www.healthcarewaste.org/fileadmin/user_upload/resources/HCW_practicalInfo1.pdf
2. Preparation of national health care waste management plans in sub-Saharan countries: guidance
manual (WHO, 2005), available at
http://www.who.int/water_sanitation_health/medicalwaste/guidmanual/en/
The success of a practical health-care waste-management plan in one hospital will often
influence other hospitals.
It may also encourage national governments subsequently to devise the necessary
national policy and framework.
CONCLUSIONS
Actions involved in implementing effective health-care waste
management programs require multisectoral cooperation and
interaction at all levels.
Establishment of a national policy and a legal framework, training of
personnel, and raising public awareness are essential elements of
successful health-care waste management.
Improved public awareness of the problem is vital in encouraging
community participation in generating and implementing policies and
programs.
Hospitals are meant only to
cure diseases.
Deepinder Singh
Head – Quality Improvement
KIMS Group of Hospitals
Oman I UAE I KSA I Bahrain I Qatar I India
[email protected]