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<Municipal Solid Waste Management>

Sound Practices
Special wastes

1.7.2 Medical waste

Medical waste is one of the most problematic types of wastes for a solid waste authority. When such wastes enter the MSW stream, pathogens in the wastes pose a great hazard to the environment and to those who come in contact with the wastes.

Waste generated within hospital premises has three main components: common wastes, for example, administrative office waste and kitchen waste; pathogenic or infectious wastes (these also contain sharps); and hazardous wastes (mainly those originating in the laboratories containing toxic substances). The quantity of the first type of waste tends to be much larger than the second and third types.

Ideally, as recommended in the accompanying box, these three types of waste should be separated. However, separation is possible only when there is significant management commitment, in-depth and continuous training of personnel, and permanent supervision to ensure that the prescribed practices are being followed. Otherwise, there is always a risk that infectious and hazardous materials will enter the common waste stream.


Sound practices for managing medical waste

Sound practices for managing medical wastes are characterized by:

  • source separation within the hospital, (a) that isolates infectious and hazardous wastes from non-infectious and non-hazardous ones, through color coding of bags or containers; (b) that source separates and recycles the large quantities of non-infectious cardboard, paper, plastic, and metal; (c) that source separates compostable food and grounds wastes and directs them to a composting facility if available; and (d) that is characterized by thorough management monitoring;
  • take-back systems, where vendors or manufacturers take back unused or out-of-date medications for controlled disposal;
  • tight inventory control over medications, to avoid wastage due to expiration dates (really a form of waste reduction);
  • piggy-back systems for nursing homes, clinics, and doctors' offices, so that they can funnel their wastes through hospital waste systems in the vicinity;
  • treatment of infectious waste through incineration, or by disinfection(including autoclaving, chemical reaction, microwaves, and irradiation). In the case of incineration this may be done within the hospital premises or in a centralized facility. An incinerator is difficult and expensive to maintain, so it should be located in a hospital only when the hospital is large or where it provides services to other nearby hospitals. Otherwise, a centralized incinerator that provides services to hospitals in one region or city is more appropriate. In the case of disinfection, residues from these processes should still be treated as special wastes, unless a detailed bacteriological analysis is carried out.
  • proper disposal of hospital wastes. In many developing countries none of the above treatment systems are widely available, so final disposal of infectious and hazardous components of the wastes is necessary. Since in many developing countries there are no landfills specifically designed to receive special wastes, hospital wastes need to go to the local landfill or dump. In this case, close supervision of the disposal process is critical in order to avoid contact with waste pickers. Final disposal should preferably be done in a specially designated cell, which should be covered with a layer of lime and at least 50 cm of soil. When no other alternative is available for final disposal, hospital wastes may be disposed of jointly with regular wastes. In this case, however, hospital wastes should be covered immediately by a meter thickness of ordinary MSW and always be placed more than two meters from the edge of the deposited waste.


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