Hospital Waste Management/Health Care Waste Management

Introduction

Healthcare waste generated during medical activities poses a significantly higher risk of infection and injury compared to other types of waste. Inadequate and inappropriate handling of such waste can result in severe public health consequences and have a substantial impact on the environment. Therefore, implementing safe and reliable methods for its handling, treatment, and disposal is essential.

Appropriate management of healthcare waste is a crucial component of environmental health protection and should become an integral feature of healthcare services. This ensures not only the safety of individuals and communities but also promotes sustainable environmental practices.

Definition

According to Bio-Medical waste (Management and Handling) Rules, 1998 of India ‘’Bio-medical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of biologicals”.

Purpose

1. To prevent the transmission of diseases between patients, and from patients to healthcare workers and vice versa.
2. To avoid injuries to healthcare workers and support staff during the handling of biomedical waste.
3. To minimize general exposure to the harmful effects of cytotoxic, genotoxic, and chemical waste generated in healthcare facilities.

Classification of health care waste

Waste category	Description and examples
Infectious waste	Waste containing pathogens, often referred to as infectious waste, includes items contaminated with disease-causing microorganisms. Examples include: 1. Laboratory cultures: Cultures, stocks, and specimens from microbiological work that contain infectious agents. 2.Waste from Isolation wards: Materials generated from treating patients in isolation wards, where they are quarantined for contagious diseases. 3.Tissues (swabs): Human or animal tissues, body parts, and swabs collected during diagnostic, surgical, or research activities. 4.Materials or equipment in contact with infected patients: Includes gloves, syringes, gauze, and surgical instruments used in treating infected individuals. 5.Excreta: Feces or urine from patients with infectious diseases that can spread via waste. Such waste requires special handling, treatment, and disposal methods, such as incineration, autoclaving, or chemical disinfection, to prevent the spread of diseases.
Pathological waste	Pathological waste refers to human tissues, organs, and bodily fluids that are removed during medical procedures or laboratory testing. Examples include: Human tissues or body parts: Organs, limbs, and other body parts removed during surgeries, autopsies, or biopsies. Blood and other body fluids: Blood, plasma, serum, and other fluids such as cerebrospinal fluid, peritoneal fluid, or amniotic fluid. Feces: Human excreta, especially when associated with diagnostic testing or disease processes.
Sharps	Sharp waste includes items such as needles, infusion sets, scalpels, knives, blades, and broken glass.
Pharmaceutical waste	Pharmaceutical waste includes expired or unused medications, as well as items contaminated by or containing pharmaceutical residues, such as bottles or packaging materials.
Genotoxic waste	Genotoxic waste includes substances with genotoxic properties, such as cytostatic drugs commonly used in cancer therapy and genotoxic chemicals.
Chemical waste	Chemical waste includes substances such as laboratory reagents, film developers, expired or unused disinfectants, and solvents.
Wastes with high content of heavy metals	Waste containing hazardous materials includes items such as batteries, broken thermometers, and damaged blood pressure gauges.
Pressurized containers	Compressed gas waste includes containers such as gas cylinders and gas cartridges that hold pressurized gases. Examples include oxygen cylinders, nitrous oxide cartridges, and other medical or industrial gas containers.
Radioactive waste	Radioactive waste consists of materials contaminated with radioactive substances, posing potential risks to health and the environment. Examples include unused liquids from radiotherapy or laboratory research, contaminated glassware, packaging or absorbent paper, and bodily waste (urine and excreta) treated or tested with unsealed radionuclides, as well as sealed radioactive sources.

Sources of health care waste

The institutions involved in generation of bio- medical waste are:

• Government hospitals
• Private hospitals
• Nursing homes
• Physician’s office/clinic
• Dentist’s office/clinic
• Dispensaries
• Primary health centers
• Medical research & training establishments
• Mortuaries
• Blood banks and collection centers
• Animal houses
• Slaughter houses
• Laboratories
• Research organizations
• Vaccinating centers
• Bio-technology institutions/Production units

Health hazards of health-care waste

Exposure to hazardous health-care waste can result in disease or injury due to one or more of the following characteristics : (a) it contains infectious agents; (b) it contains toxic or hazardous chemicals or pharmaceuticals; (c) it contains sharps; (d) it is genotoxic; and (e) it is radio-active.

All individuals exposed to such hazardous health-care waste are potentially at risk, including those who generate the waste or those who either handle such waste or are exposed to it as a consequence of careless management. The main groups at risk are :

• medical doctors, nurses, health-care auxilliaries, and hospital maintenance personnel;
• patients in healthcare establishments;
• visitors to health-care establishments;
• workers in support service allied to health-care establishments such as laundries, waste handling and transportation;
• workers in waste disposal facilities such as land-fills or incinerators including scavengers.

1. Hazards from infectious waste and sharps: Pathogens in infectious waste can enter the human body through punctures, abrasions, cuts in the skin, mucous membranes by inhalation, or ingestion. Of particular concern is the transmission of HIV and hepatitis B and C, which have strong evidence of being spread via healthcare waste.

2. Hazards from chemical and pharmaceutical waste: Many chemicals and pharmaceuticals used in healthcare establishments are toxic, genotoxic, corrosive, flammable, reactive, explosive, or shock-sensitive. Although present in small quantities, they can cause intoxication through acute or chronic exposure and result in injuries, including burns. Disinfectants, in particular, are significant members of this group. They are used in large quantities and are often corrosive; reactive chemicals can form highly toxic secondary compounds.

3. Hazards from genotoxic waste: The severity of hazards for healthcare workers responsible for handling or disposing of genotoxic waste is determined by a combination of the substance’s toxicity and the extent and duration of exposure. Exposure may also occur during the preparation or administration of specific drugs or chemicals. The main pathways of exposure include inhalation of dust or aerosols, absorption through the skin, and ingestion of food accidentally contaminated with cytotoxic drugs, chemicals, or wastes.

4. Hazards for radioactive waste: The type of disease caused by radioactive waste depends on the type and extent of exposure. It can range from headaches, dizziness, and vomiting to more severe health problems. Because radioactive waste is genotoxic, it may also affect genetic material.

5. Public sensitivity: In addition to health hazards, the general public is highly sensitive to the visual impact of healthcare waste, particularly anatomical waste.

Hospital Waste categories and Disposal

Option	Waste Category	Treatment & Disposal
Category 1	Human anatomical waste	Incineration /deep burial
Category 2	Animal waste	Incineration /deep burial
Category 3	Microbiology and biotechnology waste	Incineration /deep burial
Category 4	Sharps	Incineration / disinfection /chemical treatment /mutilation
Category 5	Medicines and cytotoxic drugs	Incineration / destruction and disposal in secured landfill
Category 6	Solid waste (Blood & Body fluids)	Autoclave/chemical treatment/burial
Category 7	Solid waste (disposable items)	Autoclave/chemical treatment/burial
Category 8	Liquid waste ( blood & body fluids)	Disinfection by chemicals/discharge into drains
Category 9	Incineration Ash	Disposal in municipal landfill
Category 10	Chemical waste	Chemical treatment/ secure landfill

Treatment and disposal technologies for health care waste

1. Incineration: Incineration is a high-temperature dry oxidation process that reduces organic and combustible matter, resulting in a significant reduction in waste volume and weight. This process is typically used to treat wastes that cannot be recycled, reused, or disposed of in a landfill. Incineration requires no pretreatment, provided that certain waste types are not included in the matter to be incinerated. Characteristics of the waste suitable for incineration are: (a) low heating volume- above 2000 kcal/kg for single- chamber incinerations and above 3500 kcal/kg for pyrolytic double-chamber incinerators (b) content of combustible matter above 60% (c) content of noncombustible solids below 20% and (d) content of noncombustible fines below 20% and (e) moisture content below 30%.
2. Chemical disinfection: –Chemical is added to waste to kill or inactive the pathogens it contains, this treatment usually results in disinfection rather than sterilization. Chemical disinfection is most suitable for treating liquid waste such as blood, urine, stools or hospital sewage. However, solid wastes including microbiological cultures, sharps etc. may also be disinfected chemically with certain limitations.
3. Wet and dry thermal treatment: –Wet thermal treatment or steam disinfection is based on exposure of shredded infectious waste to high temperature, high pressure steam and is similar to the autoclave sterilization process. The process is inappropriate for the treatment of anatomical waste and animal carcasses and will not efficiently treat chemical and pharmaceutical waste.
4. . Microwave irradiation: –Most microorganisms are destroyed by the action of microwave of a frequency of about 2450 MHz . The water contained within the waste is rapidly heated by the microwaves and the infectious components are destroyed by heat conduction. The efficiency of the microwave disinfection should be checked routinely through bacteriological and virological tests.
5. Land disposal: –Municipal disposal sites: If a municipality or medical authority genuinely lacks the means to treat waste before disposal, the use of a land fill has to be regarded as an acceptable disposal route. There are two types of disposal- land open dumps & sanitary landfills. Health care waste should not be deposited on or around open dumps.The risk of either people or animals coming into contact with infectious pathogens is obvious. Sanitary landfills are designated to have at least four advantages over open dumps; geological isolation of waste from the environment, appropriate engineering preparation before the site is ready to accept waste, staff present on site to control operations, and organized deposit and daily coverage of waste.
6. Inertization:-The process of “inertization” involves mixing waste with cement and other substances before disposal in order to minimize the risk of toxic substances contained in the wastes migrating into the surface water or ground water. A typical proportion of the mixture is 65% pharmaceutical waste 15% cement and 5% water. A homogeneous mass is formed and cubes or pellets are produced on site and transported to suitable storage sites.

Sources: https://www.who.int/news-room/fact-sheets/detail/health-care-waste

Park, K. (2021). Park’s textbook of Preventive and Social Medicine (26th ed.). Bhanot Publishers.