CATEGORIZING BIOMEDICAL AND

HEALTHCARE WASTES

Dr. Prashant MehtaAssistant Professor,

National Law University, JodhpurEmail: prashantmehta1@rediffmail.com

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.

Categories of Healthcare Wastes

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.

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.

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.

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.

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.

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.

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).

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.

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.

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

• 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.

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

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.