How to Safely Manage Medical Waste

How to Safely Manage Medical Waste

According to the World Health Organization (WHO), healthcare activities generate non-hazardous wastes, which account for about 85% of all healthcare waste. Similarly, it generates hazardous waste that accounts for 15% of the total wastes. These hazardous wastes are toxic, infectious, or radioactive. Some of the wastes generated include used needles, dressings materials, syringes, diagnostic samples, body parts, radioactive materials, medical devices, pharmaceuticals, chemicals, and blood.

Poor management of waste can have adverse effects on workers, patients, waste handlers, the larger community, and the whole environment. They can significantly pollute the environment, cause infections and injuries. It is paramount for all medical wastes to be segregated immediately and handled for proper disposal. 

Each year approximately 16 billion injections are administered worldwide, and not all syringes and needles are appropriately disposed of after use. Health facilities produce tons of waste daily. For instance, in the United States, the health care sector generates over 7000 tons of medical waste daily. One patient may produce up to 25 pounds of waste.

Different Type Of Medical Wastes

Medical wastes refer to any waste that is a by-product of healthcare activity. These include surgeries, dentist service providers, laboratories, and hospitals. These wastes include material or substances that may come into contact with the body during research, diagnosis, treatment, and drug administration.

There are different types of medical wastes and can be grouped depending on materials and waste disposal methods. Generally, there are four broad categories of medical wastes: general waste, infectious wastes, hazardous wastes, and radioactive wastes.  

General medical wastes include sharps, and they are objects such as blades, razors, needles. Depending on how they have been used, they can vary on how they will be categorized, and sometimes they can be in the infectious group.

Infectious wastes include human body parts and body fluids or tissues, cultures, and swabs. Sometimes they are known as anatomical or biohazard wastes.

A large proportion of the medicines are categorized as pharmaceutical or hazardous waste unless they’re cytostatic or cytotoxic waste.

It is important to understand different types of medical wastes so that they can be separated accordingly to protect others and dispose of them safely. 

Various wastes require unique ways of disposing so that any infectious material may not spread or contaminate others. Some medical wastes may be disposed of in landfills. However, some required specialized treatment, such as an incinerator. Incineration ensures all traces of infections or pathogens are entirely killed.

Other Classification of Wastes

 

  1. Safe or typical waste: This category comprises the primary type of waste generated in different health facilities. They are easy to dispose.
  2. Waste from piercing objects: These are all waste items or objects used in the dressing, cutting, or tearing. These objects include forceps, surgery knives, razors, scissors, needles, and syringes.
  3.  Infectious waste: These are wastes generated from materials stained with blood and different fluids. Similarly, they are referred to as bio-hazardous elements. Such wastes consist of used surgical knives and razors, gauzes, Elastoplast, swabs, clinical cotton, and laboratory infectious agents, and many others.
  4. Waste from tissue operation processes: These types of medical waste is generated from medical body operation processes that call for the extraction of body organs from both persons or animal bodies and corpses.
  5. Waste in the form of chemicals: this category comprises risky forms of wastes generated from laboratories’ solvents and reagents. It comprises disinfectants, sterilizing agents, and medical device metals.
  6. Pharmaceutical waste: These wastes comprise pharmacy waste, for example; out of date and unfit drugs and vaccines.
  7. Cytotoxic medical waste: These are wastes such as drug residues that have mutagenic, teratogenic, and carcinogenic components. This class is hazardous because it contains waste harmful to the body cells. Additionally, it has elements that have been contaminated by the same drugs. 

Waste from emitted rays: in the field of health and treatment, this type of waste is traceable in radiotherapy and x-ray centers. When a radionuclide comes into contact with the rays, radioactive waste is generated.

What Are the Sources of Medical Waste?

Medical waste is not only a product of hospitals. There are other sources of medical wastes, and they include the following:

  • Infirmaries and health facilities
  • Laboratories and healthcare research centers
  • Morgues and  autopsy centers
  • Blood banks and transfusion centers
  • Nursing and care homes  for the elderly
  • farm pet research and examination facilities

Consequences of Improper Management of Medical Wastes

  • They can result in injuries from needles and other sharp objects. For example, over three hundred thousand sharp objects-related cases are registered yearly. 
  • Infections from contaminated items. Globally, medical centers report over 1.7 million infections of hepatitis B. These infections are transmitted through contact with unsterilized clinical needles.
  • Lethal and toxic exposure to dangerous pharmacological substances such as cytotoxic drugs, dioxin, and heavy metals likes mercury.
  • TOxic chemical effluents into the environment while disposing of the used substances. 
  • Pollution of the air by the solid or liquid products when burning medical trash.
  • Radiations

Risks Posed by Medical Wastes

All medical wastes pose a serious health risk to all people. Some wastes create an opportunity for reuse leading to infections. In 2010, there were 33,800 new infections of HIV as a result of unsafe injections and thousands of other infections such as hepatitis. 

Handling or touching hazardous materials can affect one’s health. Those who handle waste are at higher risks of needle injuries and other toxic materials. In 2015, WHO and UNICEF found that half of the sampled health facilities in 24 countries worldwide, only about 58% had enough capacity for safe disposal of health care wastes.

Effects on Environment

Disposal and treatment of healthcare waste can potentially pose a health risk if they release pollutants and pathogens into the environment.

  • Untreated wastes in landfills can contaminate surface and groundwater and pollute drinking water.
  • Disinfectants used in treating medical wastes can potentially release harmful chemical substances to the environment if they are not handled and disposed of in the proper manner.
  • Incineration is one of the efficient ways that has been used for a long time. However, incineration of unsuitable materials or improper incineration can generate more pollutants into the environment. For instance, materials having chlorine can release carcinogenic substances such as furans and dioxins if they are incinerated. Similarly, materials containing heavy metals like cadmium, mercury, and lead can adversely affect the environment.

Managing Medical Waste

The different medical wastes generated from various sources require different disposal and management methods. Some health centers prefer assigning contracts to organizations or firms with reputable waste management expertise.

  1. Follow the waste disposal regulations: There are laid down regulations established by WHO or Environment Protection Agency (EPA) and other federal and state guidelines. There is a need to separate waste at the source for easier handling and disposal. For example, solid non-risky shredded paper should not be disposed of at the same point with used needles or expired pills.
  2. Staff workshops: Even though waste disposal regulations are vital, they might not take the facility to the required levels to handle the waste. It’s essential to invest in employees to learn the latest waste handling requirement. Seminars can keep workers updated on the new trends, and therefore they should be emphasized from time to time. 
  3. Observe your state’s medical waste management rules: different States have different waste management regulations. For example, in some states, there are no restrictions on the period you can keep in the facilities the unwanted medical products before disposal. In others, there are well-laid procedures on time and waste disposal. Always check and get updated with your state's requirements.
  4. Introduce color-coded containers to encourage waste sorting: Understanding the types of waste will help sort and dispose of them properly. The most effective time to sort your waste is at the disposal stage. Anything done after disposal would only increase the chances of contamination, wrong treatment, and control. Color-coding is a wise idea because it will ease the sorting process. By mastering the colors, the personnel involved can determine what waste belongs and identify the most effective treatment method.

Therefore, the generated waste will determine how it will be sorted, disposed of, and treated. For instance, plastic bags are sufficient for most wastes, while radioactive-related waste must always be stored with lead containers due to their reactive nature.

  1. Use recyclable products instead of expendable alternatives: it’s estimated that 33% of waste generated from a typical hospital is plastic residue. The majority of these containers are single-time use and disposed of. While it’s expensive to purchase them, the cost of disposal is also not very friendly. When you can, it’s important you consider the harmless and recyclable alternatives. Additionally, some disposal boxes and medical accessories can also be sterilized and reused without risking the health of your staff.
  2. Employ signage to direct what goes where: you have color-coded your containers, but still, some people, especially the sick and aged, may not properly identify what type of waste should go to what container. Employing visually based reminders and hints around the medical waste boxes can serve a great deal to help them operate within your facilities’ set policies. You can also place signs on the containers and help reduce the chances of dispose-errors.
  3. Strategic positioning of the waste bins: Naturally, human beings would drop waste at convenience. Make sure that you take note while placing and positioning your collection bins. Portable or small waste bins can be placed near the patient’s bed. The proximity would motivate both the sick and staff to dispose of medical litter quickly. Larger waste bins encourage staff and clients to utilize them as normal trash containers for regular public waste. It’s advisable that the accessibility to medical waste bins be limited to staff only.
  4. Manage pharmaceuticals and chemotherapy drugs attentively: wastes in this class are primarily toxic. Disposing of such waste demands the presence of an authorized medical waste conveyor to ferry and dispose of. The waste also requires to be categorized in diverse and separate bins from other sorts of waste. This category comprises IV bags, gowns, tubing, and hand gloves that are likely to have had risky contamination from chemotherapy. Traditionally, yellow is the primary color for boxes used before elimination. If you handle such waste in your facility, you must familiarize your workers with such contamination, how to sort and dispose of it. Slight mistakes can lead to dire consequences.
  5. Conduct timely waste audits: Having a practical working system is an excellent step. But periodically checking its effectiveness is worth everything. Plan impromptu inspection on the healthcare waste disposal operations and ensure compliance. If you identify blind spots or areas that need stepping up, communicate with your staff and put the process in order. If retraining is required, don’t hesitate to organize a refresher class. Are your employees performing as expected? It goes without saying: cheer them up with an appreciation.

Prudent management of waste is essential for each healthcare facility. When rightly put in place, the waste management plan can significantly lower the environmentally caused effects, expenses on disposal, and the facility’s operating costs. Ensure your Firm goes beyond the compliance regulations and be at peace. Finally, the facility, employees, and patients are the first beneficiaries of proper waste management.

Incineration of Medical Waste

Incineration transforms waste into organic matter and reduces its weight and volume, besides rendering them harmless. It is a thermal process, and the primary aim is to eliminate pathogens.

Certain medical wastes such as chemical wastes and pharmaceuticals require higher temperatures than ordinary incinerators to destroy wastes. The most reliable technology is pyrolytic incineration with gas cleaning equipment. It's a double chamber consisting of a post-combustion chamber and a pyrolytic chamber.   In the pyrolytic chamber, the wastes are exposed to a combustion process with deficient oxygen and medium temperatures of between 800-900oC to produce gases and solid ashes.

In the post-combustion chamber, the produced gases and ashes are exposed to higher temperatures between 900-1200oC, where fuel and excess air are used.

Other Alternatives of Medical Waste Disposal

Besides incineration, medical wastes can be disposed of using the following processes.

  • Autoclaving is a form of steam sterilization
  • Microwaving thermal treatment
  • Chemical mechanical treatment systems
  • Electrolysis

State Policies and Regulation on Medical Waste Disposal

Each state in the country has rules and regulations for medical wastes and may vary from one state to another. However, in some states, the Environmental Protection Agency (EPA) is responsible for developing and enforcing medical waste disposal and management regulations. The health department in some states plays a crucial role and serves as the regulatory agency. In cases where the two agencies are involved, ordinarily, the department of health would be responsible for on-site management, and EPA would be responsible for transporting and disposing of medical waste. Other aspects of medical wastes that could vary with states include

  • Covering and packaging
  • Storage
  • Transportation
  • Registration of the facility
  • Obtaining permits

 

State regulation may also cover on-site treatment, contingency plans, training, reporting, recordkeeping, and waste tracking. 

California

In California, medical waste is handled following the Medical Waste Management Act (MWMA). A medical waste generator refers to any facility that generates or stores medical waste on-site. They could either be large quantity generators (LQG) generating more than 200 pounds per month or small quantity generators (SQG) generating less than 200 pounds per month.

All medical waste generators, whether small or large, in California, must register by filing the generation registration application form.

Generators with on-site treatment must obtain an on-site treatment permit  

Under the Medical Waste Management Act (MWMA), it's a requirement that:

  • All medical wastes should be segregated and stored. Sharps should be stored in biohazard bags or containers with biohazard bags
  • Medical waste generators are expected to maintain tracking documents of all medical waste removed for disposal or treatment for three years.

Texas

In Texas, handling medical waste must follow the Texas Administrative Code (TAC) as given by the Texas Commission on Environment Quality (TCEQ). Any facility generating more than 50 pounds of medical waste in a month is regarded as a large quantity generator (LQG). On the other hand, any that generate less than 50 pounds of medical waste is categorized as a small quantity generator (SQG).

All generators have to maintain records and documents of all medical waste. They have to obtain a signed shipping receipt from a registered transporter to provide untreated medical waste shipped off-site. These records have to be retained for three years and made available for TCEQ inspectors. 

Any medical waste transported off-site for treatment is expected to be packaged and labeled as specified in TAC.

References

CDC. (2003). Medical Waste | Background | Environmental Guidelines | Guidelines Library | Infection Control | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/medical-waste.html

Department of Toxic Substances (DTSC). (n.d.). Managing Hazardous Waste. DTSC. Retrieved April 5, 2021, from https://dtsc.ca.gov/generators/

Environmental Compliance Assistance Platform (EnvCAP). (n.d.). Regulated Medical Waste. Environmental Compliance Assistance Platform. Retrieved April 6, 2021, from https://www.envcap.org/srl/rmw/ca-rmw.html

Environmental Health and Safety. (n.d.). Medical Waste | Environmental Health & Safety. Retrieved April 6, 2021, from https://www.ehs.ucsb.edu/biosafety/medical-waste

EPA. (n.d.). Model Guidelines for State Medical Waste Management. Retrieved April 5, 2021, from https://www.epa.gov/sites/production/files/2016-02/documents/model_guidelines_for_state_medical_waste_management.pdf

EPA. (2021a, February 5). Links to Hazardous Waste Programs and U.S. State Environmental Agencies. US EPA. https://www.epa.gov/hwgenerators/links-hazardous-waste-programs-and-us-state-environmental-agencies

EPA. (2021b, March 29). Medical Waste. US EPA. https://www.epa.gov/rcra/medical-waste

Padmanabhan, K., & Barik, D. (2018, November 9). Health Hazards of Medical Waste and its Disposal. PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152398/

TCEQ. (2016, August). Texas Regulations on Medical Waste. Texas Regulations on Medical Waste.
https://www.tceq.texas.gov/assets/public/comm_exec/pubs/rg/rg-001.pdf/

Thomson Reuters. (n.d.). California Code of Regulations. Thomson Reuters Westlaw. Retrieved April 5, 2021, from https://govt.westlaw.com/calregs/Document/I1E6300709C2211DF9483EFDBF75312D5?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

WHO. (n.d.). Handling, storage, and transportation of health-care waste. World Health Organization. Retrieved April 6, 2021, from https://www.who.int/water_sanitation_health/medicalwaste/061to076.pdf/

WHO. (2018, February 8). Health-care waste. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/health-care-waste