Waste Management Hospital Waste Biomedical Waste Clean Hospital

1. Professor Syed Amin Tabish
FRCP (London), FACP, FRCP (Edin.), FAMS, MD HA
(AIIMS), MBBS, FIMSA, FRIPH
Postdoctoral Fellowship, University of Bristol (UK)

2. Introduction
 What is Biomedical waste?
Biomedical or healthcare waste is a
term used for all waste arising from
health care establishment

3. Risks
 What are the risks of Biomedical
waste if not properly handled?

4. Risks
 Injury by sharps
 Infections (Hep B, C, HIV & Others)
 Radiation

5. Types
 What are the types of wastes generated
from hospitals?
 Risk waste
 Non risk waste

6. Risk Waste
 Infectious waste: contaminated by any
type of bacteria, virus, parasite or fungi
Cultures from lab
Wastes from surgeries or autopsies
Waste from infected patients
Infected animals from laboratories
Any material having being in contact with
infected patients

7. Risk Waste
 Pathological waste
Tissues
Organs
Body parts
Fetuses
Blood and body fluids

8. Risk Waste
 Sharps includes the following whether
infected or not:
Needles
Scalpels
Infusion sets
Saws and knifes
Blades/Scissors
Broken glasses
Any item that can cut or puncture

9. Risk Waste
 Pharmaceutical wastes
Expired or unused pharmaceutical products
Spilled or contaminated pharmaceutical
products
Surplus drugs, vaccines or sera
Discarded items like vials ampoules, gloves
etc

10. Risk Waste
 Genotoxic waste
Cytotoxic drugs
Vomitus, faeces, urine from patients being
treated with cytotoxic drugs
Contaminated materials from preparation and
administration of cytotoxic drugs such as
syringes, vials etc

11. Risk Waste
 Chemical waste
Chemicals from diagnostic and experimental
work
Cleaning material used for procedures
Housekeeping cleaning materials
Mercury waste such as from broken clinical
equipment like thermometer or mercury BP
instrument etc
Cadmium waste from discarded batteries

12. Risk Waste
 Radioactive waste
Liquid, solid or gaseous waste contaminated
by radio nuclides generated from
 in vitro analysis of body tissue or fluid
 in vivo body organ imaging, tumour localization,
investigation and therapeutic procedures

13. Non-risk Waste
 Comparable to domestic waste
Paper and cardboard
Packaging materials
Food waste
Aerosols

14. How to manage hospital waste
 The first step to form a hospital waste
management committee
 The committee forms a team that outlines
the procedures:
From collection from the premises
To disposal outside the premises

15. How is waste managed in the
premises ?
 Waste segregation of
Risk waste & non risk waste
Non risk waste constitute 80% of waste and
usual procedure is adopted as that in any
domestic or other places
Important point here is that
 RISK & NON RISK WASTE should be segregated
at source

16. Waste segregation
 SHARPS should be placed in purpose
built containers which are resistant to
penetration & leakage (made of metals or
high density plastic)
 Containers are designed such that can be
dropped in and be tamper proof to ensure
no items can be removed

17. RISK WASTE:
 All risk waste should be placed in suitable
containers lined with a strong yellow
plastics
 It should be removed and sealed when
they are 3/4th filled
 The sealing should be of plastic sealing
type of self lock
 Bags should never be closed with staple

18. Risk Wastes
 Each bag should be labelled with point of
production (ward & hospital) and content
 The bag should be replaced immediately
with a new type
 NON RISK waste in black plastic bag

19. Waste Storage & Disposal
 Proper site in the hospital
 Adequate space
 Proper flooring
 Near incinerator
 Risk and non-risk waste should be
collected in separate rounds and suitable
trolleys

20. Waste storage & Disposal
 Incinerator
Best method
 Landfill
Make sure it is far away & used only for
biologic toxic material
Make sure it does not contaminate ground
water

21. Managing
Waste in Patient
Care Areas

22. Non infectious waste is the waste which has
not come in contact with any infection
examples are : Papers, tissue, paper towels,
boxes or cartons and disposable packing or
wrappings.

23. Handling
The handling of Non-infectious wastes is
the same in all the wards and units.
They are packed in black or blue bags, filled
to ¾ full with non infectious waste stickers.
They are collected by the cleaners thrice
daily to be disposed off in the nearest
sanitary land fills as approved according to
environmental health and safety

24. INFECTIOUS WASTE
Is waste suspected to contain pathogens
(Bacteria, viruses, parasites or fungi) in
sufficient concentration or quantity to cause
disease in susceptible hosts.
Examples are diapers, under pads, with faeces,
blood and bloody fluids, protective wears such
gloves etc., All IV tubings and IV bottles used
for the patients near the bedside.

25. The drainage bags, drains and tubings disposable
secretion catheters, E.T tubes and wound drains
contaminated tissue, paper towels and cotton wool
and pads.
Waste from blood gas machines, soiled wound
dressing and sponges, leftover food from isolation
rooms.

26. Handling
In ICU infectious wastes are dropped
in yellow waste bins with lid bearing
biohazradous seal on these yellow bags.
They should only be ¾ full with
infectious waste sticker. They are
stored and collected from the sluice
room thrice daily.

27. SHARPS :
Put them in Puncture Proof Boxes
& SEAL Them.

28. HANDLING:
In ICU these are dropped in yellow impenetrable
containers which are also filled 3/4, while the lid is
closed tightly. These should not remain more than 1
week in the unit. Used syringes with needles are never
recapped and should be dropped off into the sharp
containers but where only syringe is used with 3 way
for medication without the needle then the syringe
should be put in the yellow bag.
Bottles are potential sharps because they are capable
of inflicting injuries when they are broken. They are
packed in cartons which are put in yellow bags.

29. To facilitate the possibility of the objective ICU Sluice
room is situated at the beginning of the unit with 2
doors, one leading into the unit, the other on to the
corridor. The staff go in and out of the sluice through
the link door and the 2 doors should be kept closed at
all times. The corridor door is meant for the waste
collector who does not come into the unit at all; while
the link door remains shut.
This minimizes spread of nosocomial infection to
health workers, patients and the community

30. IN NICU : The peculiarity is in the isolation
room with capacity of 4 cots. These are the
neonates admitted from other hospitals, home and
other wards.
All Items from this room such as green gowns,
masks, suction bottles, tubes, patients linen, shoe
cover and visitors gowns are considered
infectious. Visitors are limited to mothers and
fathers of the babies only. The nurse from this
room is not allowed to go to any other room nor
touch any other baby.
All items are put in yellow bags and labeled i.e.,
infectious linens, infected papers, and of course
sharps in sharp containers. The room is given
terminal disinfection when empty.

31. IN LABOUR AND DELIVERY
ROOM : The peculiar wastes from this
unit are pathological ones which are human
body parts and tissues removed after delivery.
These are placenta membranes and umbilical
cord which are collected in yellow bags tied
in knots kept on trays in a refrigerator to
avoid dripping of blood.
Every morning, the yellow bags are all put in
bigger red bags, tied and labeled as placenta
on an infections waste sticker and sent to be
buried.

32. IN OPERATING THEATRE :
Pathological wastes include excised tissues
and amputated body parts such as fingers,
toes, arms and legs these are packed in red
bags with bioharzardous waste seal and
must be labeled indicating which body part
it contains . It is sent to the mortuary in
accordance to ISLAMIC FATWA No 8099
dated 21st SAFAR 1405 H.

33. This applies to LR & DR and OT

34. SUCTIONED HUMAN BODY
FLUIDS WASTES: These are regulated
body fluids sucked by a suction machine
during surgical operation which are
intended to be discarded. These include
blood, cerebro spinal fluids, synovial fluids,
pleural fluids, peritoneal fluids, pericardial
fluids etc.,
All these fluids are carefully poured and
flushed in the sanitary sewer that will go to
the water treatment facility of the hospital.

35. DENTAL WASTES: Consist of hand gloves,
blood soaked gauze, extracted teeth which are treated
as infectious wastes and packed away in yellow bags,
¾ full with appropriate labels just as other units.
All sharps such as needles, orthodontics wires, blades
and medication vials are treated as sharps just as
other units.
The reusable instruments such as dental drills and
other instruments are washed with gloved hands in
disinfectants before being sent to the central
sterilizing supply department for sterilization in
between patients.
Continued…

36. The saliva and the blood in the cuspidor end
up in the hospital sewer, in the water
treatment facility of the hospital.
The uniqueness is in the X-ray films which
are wrapped in gloves while in the patients’
mouths to prevent them being infected by
the patients body fluid
The impression materials are soaked in
cidex 2% for 30mins for cleansing as they are
re-used for other patients.

37. THANK
THANK