Gives basic idea about hospital and biomedical waste

1. CATEGORIZING
BIOMEDICAL AND
HEALTHCARE WASTES
Dr. Prashant Mehta
Assistant Professor,
National Law University, Jodhpur
Email: prashantmehta1@rediffmail.com

2. INTRODUCTION
DEFINITION
• Healthcare waste includes all the waste generated by
healthcare establishments (hospitals and Dispensaries),
Research facilities, and diagnostic laboratories besides
healthcare activities like immunizations, diagnostic
tests, medical treatments procedures, and laboratory
examinations. In addition, it includes the waste
originating from "minor" or "scattered" sources such as
that produced in the course of healthcare undertaken in
the home (dialysis, insulin injections, etc.).
• Between 75% - 80% of the waste produced by
healthcare providers is non-risk or "general" healthcare
waste which is comparable to domestic waste. The
remaining 20% of wastes are considered hazardous
disposed of materials that may be of infectious nature
like organs, toxic materials, or radioactive wastes. The
wastes and by products and are produced cover a
diverse range of materials.

3. Categories of Healthcare Wastes

4. Infectious Wastes
Infectious waste is suspected to contain pathogens (bacteria,
viruses, parasites, or fungi) in sufficient concentration or quantity to
cause disease in susceptible hosts. This category includes:
– Waste suspected to contain pathogens e.g. laboratory cultures;
waste from isolation wards; tissues (swabs), materials, or
equipment that have been in contact with infected patients;
excreta.
– Waste from surgery and autopsies on patients with infectious
diseases (e.g. tissues, and materials or equipment that have
been in contact with blood or other body fluids).
– Waste from infected patients in isolation wards (e.g. excreta,
dressings from infected or surgical wounds, clothes heavily
soiled with human blood or other body fluids).
– Waste that has been in contact with infected patients
undergoing haemodialysis (e.g. dialysis equipment such as
tubing and filters, disposable towels, gowns, aprons, gloves,
and laboratory coats).
– Any other instruments or materials that have been in contact
with infected persons or animals.
– Discarded diagnostic samples etc.

5. Pathological Wastes
• Pathological waste consists of human tissues, organs, body parts, human fetuses,
body fluids. Within this category, recognizable human or animal body parts are
also called anatomical waste. This category should be considered as a subcategory
of infectious waste, even though it may also include healthy body parts.
• Anatomic - recognizable body parts and animal carcasses. Infectious and anatomic
wastes together represent the nearly 15% of the hazardous waste of the total
waste generated from healthcare activities.

6. Sharps
• Sharps are items that could cause cuts or puncture wounds,
including needles, hypodermic needles, scalpel and other blades,
knives, infusion sets, saws, broken glass, and nails. Whether or not
they are infected, such items are usually considered as highly
hazardous healthcare waste.
• Sharps represent about 1% of the total waste from healthcare
activities.
• Throughout the world every year an estimated 2,500 million
injections are administered and all needles and syringes are not
properly disposed of giving an opportunities for reuse, thus it results
in risk for injury and infection like hepatitis B, hepatitis C and HIV
infections. Many of these infections could be avoided if syringes
were disposed of safely.
• In developing countries, additional hazards occur from scavenging
on waste disposal sites and manual sorting of the waste
recuperated at the back doors of healthcare establishments. These
practices are common in many regions of the world. The waste
handlers are at immediate risk of needle-stick injuries and other
exposures to toxic or infectious materials.

7. Geno-Toxic Wastes
• Geno-toxic waste is highly hazardous and may have mutagenic, terato-genic, or carcinogenic
properties. It raises serious safety problems, both inside hospitals and after disposal.
Genotoxic waste may include certain cytostatic drugs used in cancer treatment , vomitus,
urine, or faeces from patients treated with cytostatic drugs, chemicals, and radioactive
material.
• Cyto-toxic (or antineoplastic) drugs are most often used in specialized departments such as
oncology and radiotherapy units to treat cancers. The principal substances in this category,
have the ability to kill or stop the growth of certain living cells and are used in chemotherapy
of cancer. They play an important role in the therapy of various neoplastic conditions but are
also finding wider application as immunosuppressive agents in organ transplantation and in
treating various diseases with an immunological basis.

8. Pharmaceutical Wastes
• Pharmaceuticals – Expired or no longer needed, unused, and contaminated drugs.
The drugs themselves (sometimes toxic and powerful chemicals) or their
metabolites, vaccines and sera. Chemicals and pharmaceuticals amount to about
nearly 03% of waste from healthcare activities.

9. Chemical Wastes
• Chemical waste consists of discarded solid, liquid, and gaseous chemicals, for example from
diagnostic and experimental work and from cleaning, housekeeping, and disinfecting
procedures. Chemical waste from health care may be hazardous or non-hazardous consists of
chemicals with none of the above properties, such as sugars, amino acids, and certain organic
and inorganic salts); in the context of protecting health, it is considered to be hazardous if it has
at least one of the following properties: toxic; corrosive (e.g. acids of pH < 2 and bases of pH >
12); inflammable; reactive (explosive, water- reactive, shock- sensitive); genotoxic (e.g.
cytostatic drugs) used most commonly in maintenance of healthcare centres and hospitals.

10. Chemical Waste
• Formaldehyde - Formaldehyde is a significant source of chemical waste in hospitals. It is used
to clean and disinfect equipment (e.g. haemodialysis or surgical equipment), preserve
specimens, disinfect liquid infectious waste, used in pathology, autopsy, dialysis, embalming,
and nursing units.
• Photographic Chemicals - Photographic fixing and developing solutions are used in X-ray
departments. The fixer usually contains 5-10% hydroquinone, 1-5% potassium hydroxide, and
less than 1% silver. The developer contains approximately 45% glutaraldehyde. Acetic acid is
used in both stop baths and fixer solutions.
• Solvents - Wastes containing solvents are generated in various departments of a hospital,
including pathology and histology laboratories and engineering departments. Solvents used in
hospitals include halogenated compounds, such as methylene chloride, chloroform,
trichloroethylene, and refrigerants, and non-halogenated compounds such as xylene,
methanol, acetone, isopropanol, toluene, ethyl acetate, and acetonitrile.
• Organic Chemicals Waste generated in HealthCare Facilities Include: disinfecting, cleaning
solutions such as phenol-based chemicals used for scrubbing floors, perchlorethylene used in
workshops and laundries; oils such as vacuum-pump oils, used engine oil from vehicles
(particularly if there is a vehicle service station on the hospital premises); insecticides,
rodenticides.
• Inorganic Chemicals - Waste inorganic chemicals consist mainly of acids and alkalis (e.g.
sulfuric, hydrochloric, nitric, and chromic acids, sodium hydroxide and ammonia solutions).
They also include oxidants, such as potassium permanganate (KMnO4 ) and potassium
dichromate (K 2Cr2O7), and reducing agents, such as sodium bisulfite (NaHSO3) and sodium
sulfite (Na2SO3).

11. Heavy Metal Waste
• Wastes with a high heavy-metal content represent a subcategory of
hazardous chemical waste, and are usually highly toxic.
• Mercury wastes are typically generated by spillage from broken clinical
equipment but their volume is decreasing with the substitution of
solid-state electronic sensing instruments (thermometers, blood-
pressure gauges, etc.). Residues from dentistry have a high mercury
content.
• Cadmium waste comes mainly from discarded batteries.
• Lead Waste comes from certain "reinforced wood panels“ are still
used in radiation proofing of X-ray and diagnostic departments.
• Arsenic Waste - A number of drugs contain arsenic, but these are
treated here as pharmaceutical waste.
• Healthcare waste is a reservoir of potentially harmful micro-organisms
which can infect hospital patients, healthcare workers and the general
public. Wastes and by-products can also cause injuries, for example
radiation burns or sharps-inflicted injuries; poisoning and pollution,
whether through the release of pharmaceutical products, in particular,
antibiotics and cytotoxic drugs, through the waste water or by toxic
elements or compounds such as mercury or dioxins.

12. Pressurized Containers
• Many types of gas are used in health care, and are often stored in
pressurized cylinders, cartridges, and aerosol cans. Whether inert or
potentially harmful, gases in pressurized containers should always be
handled with care; containers may explode if incinerated or accidentally
punctured. The main types of gases used in hospitals are:
• Anaesthetic gases: nitrous oxide, volatile halogenated hydrocarbons (such
as halothane, isoflurane, and enflurane), which have largely replaced ether
and chloroform. These are used in hospital operating theatres, during
childbirth in maternity hospitals, in ambulances, in general hospital wards
during painful procedures, in dentistry, for sedation, etc.
• Ethylene oxide - Applications - for sterilization of surgical equipment and
medical devices, in central supply areas, and, at times, in operating rooms.
• Oxygen - Stored in bulk tank or cylinders, in gaseous or liquid form, or
supplied by central piping. Application - inhalation supply for patients.
• Compressed air - Applications - in laboratory work, inhalation therapy
equipment, maintenance equipment, and environmental control systems.

13. Radioactive Wastes
• The use of radiation sources in medical and other applications is widespread throughout the
world. Occasionally, the public is exposed to radioactive waste, usually originating from
radiotherapy treatments, that has not been properly disposed of. With new methods of
treatment the threat to such wastes will grow exponentially

14. • Immunisation is vital to prevent disease and save lives. However, large scale vaccination
programs can create enormous amounts of waste. Often, waste is open burned or donors
build cheap small scale incinerators which are used to burn syringes from the vaccination
program and other medical waste after the vaccination program is over, perpetuating the
problem of dioxin pollution. In June 2000, six children were diagnosed with a mild form of
smallpox (vaccinia virus) after having played with glass ampoules containing expired smallpox
vaccine at a garbage dump in Vladivostok (Russia). Although the infections were not life-
threatening, the vaccine ampoules should have been treated before being discarded.

15. Components of Bio-Medical Wastes
• Human Anatomical Waste (tissues, organs, body parts etc.)
• Animal Waste (as above, generated during
research/experimentation, from veterinary hospitals etc.)
• Microbiology and biotechnology waste, such as, laboratory
cultures, micro-organisms, human and animal cell cultures, toxins
etc.
• Waste sharps, such as, hypodermic needles, syringes, scalpels,
broken glass etc.
• Discarded medicines and cyto-toxic drugs
• Soiled waste, such as dressing, bandages, plaster casts, material
contaminated with blood etc.
• Solid waste (disposable items like tubes, catheters etc. excluding
sharps)
• Liquid waste generated from any of the infected areas
• Incineration Ash
• Chemical Waste

17. Environmental Concerns
• Spread of infection and disease through
vectors (fly, mosquito, insects etc.) which
affect the in-house as well as surrounding
population.
• Spread of infection through contact / injury
among medical/non-medical personnel and
sweepers / rag pickers, especially from the
sharps (needles, blades etc).
• Spread of infection through unauthorised
recycling of disposable items such as
hypodermic needles, tubes, blades, bottles etc.
• Reaction due to use of discarded medicines.
• Toxic emissions from defective / inefficient
incinerators.
• Indiscriminate disposal of incinerator
ash / residues.