UNDP GEF Project on Global Healthcare Waste
INSTRUCTOR GUIDE
MODULE 9: CLASSIFICATION OF HEALTHCARE WASTE
MODULE 10: SEGREGATION OF HEALTHCARE WASTE
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UNDP GEF Project on Global Healthcare Waste
MODULE 9: CLASSIFICATION OF HEALTHCARE WASTE
Estimated Time
Module Overview
Learning Objectives
Target Audience
Instructor Preparation
Materials Needed
Student Preparation
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Lecture: 45 minutes
Activity: 2 hours * to be completed after Module 9 and Module 10
Describe the general classifications of healthcare waste
Present examples of each classification
List the major classifications and typical characteristics of healthcare waste
Recognize the waste classifications that pose the highest risk
Apply basic principles to categorize waste items into their proper classifications
HCWM Coordinators
Healthcare Waste Workers (Note: Presentation slides should be adjusted to fit the
needs of cleaners, waste workers and other auxiliary staff.)
Healthcare professionals
Make notes pages of PowerPoint slides to hand out to class
Read Chapter 2 in Blue Book
Gather country-specific information to fill in appropriate slides on classification
Make copies of any additional documents/readings that may be handed out to class,
such as those included in the References
Prepare any additional notes to be discussed during the presentation
Prepare any additional discussion points or review questions
Projector
Student handouts: slides, exercise, homework
Flip chart and marker pens and/or board and chalk
Any materials on country or local laws related to classification of healthcare wastes.
Blue Book Chapter 2
Think about how healthcare wastes are classified in your facility
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UNDP GEF Project on Global Healthcare Waste
Review Questions (most of
these questions relate to
waste segregation, which is
the related topic of the next
module)
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How does your facility classify healthcare wastes? What are some examples of
sharps waste that pose a major risk in your own facility, or that you would expect to
pose problems in healthcare facilities, in general? What about chemical wastes?
Pharmaceutical wastes? Radioactive wastes?
What are some facility-specific classification and segregation guidelines? Does your
facility use color-coding?
Does your facility have sufficient resources to handle waste properly and
effectively? How can your facility improvise if resources are lacking?
Is the segregation of wastes monitored in your facility? If not, is there any
technique that exists for keeping track of waste segregation?
What works within your facility to improve segregation? What doesn’t work?
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UNDP GEF Project on Global Healthcare Waste
PRESENTATION
Slide Number/Title
Teacher’s Notes
Slide 1: Title Slide
Slide 2: Module Overview
Introduce the outline and major points of the presentation
Slide 3: Learning Objectives
Describe what participants will learn at the end of this module.
Slide 4: Steps in Healthcare
Waste Management
This is the first of a series of modules about specific steps in healthcare waste management.
This module focuses on classification.
Slide 5: General Principles
When properly segregated, the typical breakdown of HCW is about 85% or more of general waste
(similar in risk to domestic waste), while the remaining 15% is usually hazardous waste. The
breakdown may vary by country/region/facility.
Slide 6: General Principles
Sharps wastes pose the highest risk of disease transmission of all waste categories.
Slide 7: Why Segregate
Healthcare Waste?
Describe some major points that answer the question: Why segregate HCW? Ask class for
some ideas.
Note: You may want to skip this slide until the next module about waste segregation
Slide 8: General Principles
HCW classifications are based on: national regulations or international guidelines
Types of risk associated with waste:
-infectious disease transmission
-physical injury
-chemical exposure
Slide 9: General Principles
Classifications are useful for deciding:
-treatment approaches
-waste minimization options
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UNDP GEF Project on Global Healthcare Waste
Slide 10: Country-specific Waste
Classifications
Insert information about country-specific classifications under the existing laws and
regulations. You may add more slides if needed.
Slide 11: Waste Classifications
Go through table of WHO waste classifications
Slide 12: Infectious Wastes
Infectious wastes are healthcare wastes that are suspected to containing pathogenic
organisms in quantities sufficient to cause diseases to an exposed host.
Slide 13: Subcategories of
Infectious Wastes
Slide 14: Waste Contaminated
with Blood/Body Fluids
Slide 15: Cultures and Stocks
Give some examples of waste contaminated with blood or body fluids
Provide some examples of cultures and stocks
Slide 16: Isolation Ward Waste
Slide 17: Sharps Waste
Sharps waste includes any items that could cause cuts or puncture wounds, whether
infected or not
Slide 18: Review of Infectious
Wastes
Slide 19: Chemical Wastes
Refer to table
Slide 20: Chemical Wastes
Hazardous chemical wastes are chemicals with at least of the following properties:
-Toxic
-Corrosive
-Flammable
-Reactive
-Oxidizing
Chemical wastes are discarded solid, liquid, and gaseous chemicals from diagnostic and
experimental work and from cleaning and disinfection
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UNDP GEF Project on Global Healthcare Waste
Slide 21: Chemical Wastes
Provide some examples of hazardous and non-hazardous chemical wastes.
Slide 22: Pharmaceutical Wastes
Slide 23: Radioactive Wastes
Solid, liquid and gaseous materials contaminated with radionuclides; this category of waste
may not exist in primary healthcare facilities that do not deal with radiation therapy
Slide 24: Non-hazardous General
Waste
Non-hazardous general wastes are those that have not been in contact with infectious
agents, hazardous chemicals, or radioactive substances, and that does not pose a sharps
hazard.
Slide 25: Examples of NonHazardous General Wastes
Give some examples of non-hazardous general wastes.
plastics, and cardboard.
The majority includes paper,
Slide 26: General Wastes
Slide 27: Typical Waste
Characteristics
Give some ballpark figures statistics for typical waste generation rates. These estimates
vary by country, region, and facility type.
Slide 28: Discussion
Go through discussion questions with class.
Note: Please wait to complete modules 9 and 10 before going over the discussion
questions.
What is recyclable?
Common accidents?
References (in order as they
appear in slides)
Blue Book Chapter 2
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UNDP GEF Project on Global Healthcare Waste
MODULE 10: SEGREGATION OF HEALTHCARE WASTE
Estimated Time (*subject to
change)
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Module Overview
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
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Learning Objectives
Target Audience
Instructor Preparation
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Materials Needed
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Lecture: 1 hour and 15 minutes
Activity: 2 hours * to be completed after Module 9 and Module 10. You may choose
one or all of the activities based on how much time you have.
Review waste classifications
Describe why waste segregation is important
Describe color-coding and waste containers
Demonstrate segregation of healthcare waste
Explain why segregation is important
Demonstrate segregation of healthcare waste
Discuss acceptable options for commercial color-coded bags and sharps containers
Create informational posters and signs specific to waste segregation
HCWM Coordinators
Healthcare Waste Workers
Healthcare professionals
Make notes pages of PowerPoint slides to hand out to class
Make copies of class exercises for distribution after PowerPoint presentation
Read Chapter 7 in Blue Book
Gather country-specific information to fill in appropriate (segregation, posters
about segregation) and find additional photos showing problems with segregation.
Make copies of any additional documents/readings that may be handed out to class,
such as those included in the References
Prepare any additional notes to be discussed during the presentation
Prepare any additional discussion points or review questions
Projector
Student handouts: slides, exercise, homework
Flip chart and marker pens and/or board and chalk
Any materials on country or local laws related to segregation of healthcare wastes.
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UNDP GEF Project on Global Healthcare Waste
Student Preparation
Review Questions (same set of
questions included in Module
9, as segregation is related to
classification)
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Blue Book Chapter 7
Think about how healthcare wastes are segregated in your facility
How does your facility classify healthcare wastes? What are some examples of
sharps waste that pose a major risk in your own facility, or that you would expect to
pose problems in healthcare facilities, in general? What about chemical wastes?
Pharmaceutical wastes? Radioactive wastes?
What are some facility-specific classification and segregation guidelines? Does your
facility use color-coding?
Does your facility have sufficient resources to handle waste properly and
effectively? How can your facility improvise if resources are lacking?
Is the segregation of wastes monitored in your facility? If not, is there any
technique that exists for keeping track of waste segregation?
What works within your facility to improve segregation? What doesn’t work?
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UNDP GEF Project on Global Healthcare Waste
PRESENTATION
Slide Number/Title
Teacher’s Notes
Slide 1: Title Slide
Slide 2: Module Overview
Introduce the outline and major points of the presentation
Slide 3: Learning Objectives
Slide 4: Steps in Healthcare
Waste Management
Slide 5: General Principles
Describe what participants will learn at the end of this module.
This module focuses on segregation.
Slide 6: Why Segregate
Healthcare Waste?
Describe some major points that answer the question: Why segregate HCW? Ask class for
some ideas.
Slide 7: Country-specific Waste
Segregation Requirements
Slide 8: Review of Waste
Classifications
Slide 9: Waste Segregation
Add your own country/region/facility segregation requirements
Slide 10: WHO-Recommended
Segregation Scheme
Slide 11: Example of a More
Complex Segregation Scheme
Slide 12: Minimum Level of
Segregation Recommended by
WHO
Slide 13: Specifications and
Alternatives for Low-Resource
Settings
Use the given table to describe the WHO-recommended segregation scheme
When properly segregated, the typical breakdown of HCW is about 85% or more of general waste
(similar in risk to domestic waste), while the remaining 15% is usually hazardous waste. The
breakdown may vary by country/region/facility.
Review waste classification with WHO slide from previous presentation
Ask participants what they do in their own facility?
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UNDP GEF Project on Global Healthcare Waste
Slide 14: Container Photos
Slide 15: Containers for Waste
Collection
Some alternatives for sharps containers
Waste containers:
• Come in many shapes and sizes. In all cases, they should be sturdy and leak-proof,
and (except for sharps containers) lined with a sturdy plastic bag.
• Preferably chlorine-free.
• Should have well-fitting lids, either removable by hand or a foot pedal.
Example of color coding:
Yellow Bin - Waste for Incineration/ Secured Landfill Disposal
Human anatomical waste, microbiological, pathological, cytotoxic and discarded medicines
Red Bin - Waste for Non-incineration Treatment Disposal
Infected plastics, syringes, tubings, catheter, gloves, blood bags, urine bags, cotton
dressings, etc.
White Bin - Waste Requiring no Treatment
Paper, packaging material, cardboard, general waste, etc.
Green Bin - Waste Requiring no Treatment
Vegetables, fruit peels, leftover food, leaves and garden wastes, etc.
Blue Bin - All sharps in puncture-proof containers
Slide 16: Color Coding for Bags
and Containers
Discuss acceptable options for commercial color-coded bags and sharps containers.
Slide 17: Bags for Waste
Collection (use this slide if red is
used for infectious waste)
-Bins should have the same colored bags/liners, preferably be 70 µm in thickness.
-Bags and containers for infectious waste should be marked with the international
infectious substance symbol
-The color of containers/plastic bags used for collection of segregated biomedical waste
should be prominent and easily identifiable.
For example,
Noninfectious - black
Infectious - yellow
Highly infectious - red
Sharps waste - yellow safety boxes
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UNDP GEF Project on Global Healthcare Waste
Slide 18: Bags for Waste
Collection (use this slide if
yellow is used for infectious
waste)
Slide 19: Safety Boxes
-Bins should have the same colored bags/liners, preferably be 70 µm in thickness.
-Bags and containers for infectious waste should be marked with the international
infectious substance symbol
-The color of containers/plastic bags used for collection of segregated biomedical waste
should be prominent and easily identifiable.
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Sharps should all be collected together, regardless of whether or not they are
contaminated.
Containers should be puncture-proof (usually made of metal or high-density plastic)
and fitted with covers. They should be rigid and impermeable so that they safely
retain not only the sharps, but also any residual liquids from syringes.
To discourage abuse, containers should be tamper-proof (difficult to open or break)
and needles and syringes should be rendered unusable.
Where plastic or metal containers are unavailable or too costly, containers made of
dense cardboard are recommended (WHO, 1997); these fold for ease of transport
and may be supplied with a plastic lining.
Slide 20: Class Discussion: What
Goes Where?
Slide 21: Class Discussion: What
Goes Where?
Slide 22: Class Discussion: What
goes where?
Generate discussion with class participants
Slide 23: Where Do You Place
Bins?
Go through a list of where bins should be properly placed for specific scenarios
Non-hazardous general wastes are those that have not been in contact with infectious
agents, hazardous chemicals, or radioactive substances, and that does not pose a sharps
hazard. Is the child sick because of a bone fracture or a brain concussion, or due to an
infection? If the child has a fracture, will the lollipop or spoon be contagious? If the child
has an infection, how is the infectious agent transmitted – through contact with infected
skin, contact with infected stool, contact with mucous membranes, contact with wound
drainage, exposure to respiratory secretions, exposure to infected droplets from coughing
or sneezing, exposure to pathogenic airborne particles, etc.? How can transmission-based
precautions be used to determine where the waste item goes?
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UNDP GEF Project on Global Healthcare Waste
Slide 24: Where Do You Place
Bins?
Slide 25: Which Bins Would You
Place In…?
Slide 26: Which Bins Would You
Place In…?
Slide 27: Problems of
Segregation
Get class involved in the next bunch of slides
For example: Think about wastes as sharps, (depending on system, may also have
infectious and sharps), infectious, recyclable, non –recyclable, chemical,
sharps, infectious, pathological, general, pharmaceutical, possibly infectious depending on
procedures performed.
Ask class what is wrong with the picture.
Photo shows sterile packaging in infectious (red) bag. It also includes sharps which should
be in sharps containers.
Slide 28: Problems of
Segregation
Slide 29: What is Wrong With
This Picture?
Photo shows sharps in infectious (yellow) bag. Sharps should be in sharps containers.
Slide 30: What is Wrong With
This Picture?
Black bag wrongly used for general waste (empty water bottle, packaging, discarded cloth)
and also for infectious waste (bloody bandages, contaminated gloves).
Slide 31: What is Wrong With
This Picture?
Black bag wrongly used for infectious waste (bloody bandages), sharps waste (syringes,
presumably the needle from the intravenous (IV) set), and general waste (empty sterile
solution bottles, empty IV tubing without visible blood, food waste such as banana and
lemon peels, empty food containers, sterile packaging).
Slide 32: What is Wrong With
This Picture?
General waste (sterile packaging) discarded in the infectious waste bag. Sharps discarded
in the infectious waste bag.
Black bag wrongly used for general waste (drinking cups, food scraps, discarded food
packaging, paper, empty blister pack, empty food wrapper) and for sharps waste
(syringes).
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UNDP GEF Project on Global Healthcare Waste
Slide 33: What is Wrong With
This Picture?
Slide 34: Problem of Overfilling
and Mixing Colors
Clean packaging was discarded in an infectious waste bag.
Slide 35: What is Wrong With
This Picture?
Slide 36: Problems of
Segregation
You may add pictures with examples from your country or the facility.
Slide 37: Dealing With
Segregation Errors
Talk about what to do (and what not to do) if errors are made during segregation.
Slide 38: Sample of an
Educational Segregation Poster
Slide 39: Sample of an
Educational Segregation Poster
Slide 40: Sample of an
Educational Segregation Poster
Slide 41: Sample of an
Educational Segregation Poster
Slide 42: Samples of Educational
Segregation Posters
Slide 43: Example of a
Segregation Poster for Infectious
Waste Placed Above a Yellow
Container
Slide 44: Example of Segregation
Posters Placed Above
Corresponding Bins for
Example is from Tanzania
Red bag is overfilled. It is placed inside a black bag (probably because of leaks). Leaking
infectious waste bags should be put in bags with the infectious waste color.
Batteries should not be discarded as regular waste.
Ask class: What would you do with a broken thermometer?
Is there monitoring?
The poster is from the UNDP GEF Project in Senegal
The poster is from a hospital in Brazil
Poster is from SS Medical Systems in India
Poster from Indonesia (Source: ETLog Health, GmbH; published in the WHO Blue Book)
Poster from the UNDP GEF Project in Senegal
From the UNDP GEF Project in the Philippines
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UNDP GEF Project on Global Healthcare Waste
Infectious, General and
Recyclable Wastes
Slide 45: Example of Segregation
Posters Placed Above
Corresponding Bins for
Infectious, General and
Recyclable Wastes
Slide 46: Example of Segregation
Bins for Regular Waste
Slide 47: (Additional Slide for
Country-Specific Segregation
Posters)
Slide 48: Discussion
References (in order as they
appear in slides)
From a low-resource hospital in India
From a hospital in Brazil
You may include posters from your own country or facility here and in any additional
slides needed
Go through discussion questions with class. Combine discussion for modules 9 and 10.
Blue Book Chapter 7
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UNDP GEF Project on Global Healthcare Waste
ACTIVITY: MODULE 9 AND 10: EXERCISES
Note: You should wait until after Module 9 and Module 10 are presented to have participants do exercise.
The purpose of this activity is to educate participants about classification and segregation of wastes (how to select the right
containers)
Instructor: Break class into groups of three or more, and distribute exercise at beginning of class. You may group participants
by facility, department, or job type. Participants will complete the activity in groups and then present their answers.
Instructor should record participant/group responses on a wipe board, flip chart, or transparency, categorize their responses.
In the de-brief following the presentation, you will go over the activity once again.
MODULE 9 AND 10, EXERCISE 1: CLASSIFICATION MATRIX (30 MINUTES)
Instruct should ask participants how they would classify the following items and record responses by group.
o
o
o
o
o
o
o
#
1
2
3
4
5
Sharps
Infectious
Pathological
Pharmaceutical
Chemical
Radioactive
General (non-hazardous)
Item
Bandage saturated with blood
Empty IV bag
IV bag containing fluid blood
Broken thermometer
Unused (clean) hypodermic syringe
Sharp Infect Patho Pharm Chem Radio General
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UNDP GEF Project on Global Healthcare Waste
6
7
8
9
10
11
12
13
14
15
Soiled disposable diaper
Dirty glove
Cotton swab with little dried blood
Clean broken glassware
Used disinfectant solution
Empty juice bottle used by patient
Cotton swab with little alcohol (ethanol)
Expired antibiotics
Eye wash
Old fluorescent lamp
Answer Key:
1 – infectious
2 – depends on whether there is a needle attached; the needle would be sharps waste, empty IV bag would be general waste
3 – with needle – sharps; without needle – infectious
4 - chemical
5 – sharps
6 – general waste unless the diaper comes from an infected patient in an isolation ward
7 – if dirt is due to blood or body fluids – infectious, otherwise general
8 – in countries where there is good waste handling and sanitary landfills – general waste, otherwise infectious waste
9 – sharps
10 – chemical or general waste depending on the type of disinfectant and the country’s laws and regulations
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UNDP GEF Project on Global Healthcare Waste
11 – general, unless patient in is isolation ward with potential for contact transmission
12 – general waste
13 – pharmaceutical
14 – general, possibly pharmaceutical depending on the type of solution and the country’s laws and regulations
15 – chemical
MODULE 9 AND 10 EXERCISE 2: SEGREGATION ACTIVITIES (45 MINUTES)
1. Each group will be given surrogate waste items (such as sharps, anatomical wastes, paper, gloves, needles, diapers,
bottles, etc) and color-coded containers (based on what is available by country laws). Note: Do not use real infectious
waste items for this exercise! For example, for contaminated bandages, use new bandages smeared with red paint or
tomato sauce. For contaminated gloves, use new gloves covered with tomato sauce or mineral oil to represent body
fluids. For syringes, use unused syringes. For chemical waste, use water or juice in a container with a fake chemical
label. For anatomical waste, use uncooked meat or other suitable surrogate. Select waste items that the participants
would normally deal with in their specific job functions. The participants should be told that these are surrogate items
(fake replacements to represent waste items) but the participants should use the correct PPE and place the surrogate
items in containers that are appropriate as if those items are real.
2. Each person takes a turn taking a waste item and placing it in the proper container.
3. With each turn, the group checks if everyone agrees with the placement.
4. If not, each participant explains why he or she disagrees with the placement until consensus is reached.
5. If no consensus is reached, the group brings the waste item to the attention of the whole class.
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UNDP GEF Project on Global Healthcare Waste
6. Responses will be recorded in the following table.
[Note to instructor: replace the color codes and containers below with the required color codes and containers
used in the country.]
Waste type
Yellow
bins
Red bins
Blue Bins
Puncture Proof
Container
General Waste
MODULE 9 AND 10 EXERCISE 3: SEGREGATION POSTERS (45 MINUTES)
The purpose of this activity is for the participants to learn to design simple but effective posters related to segregation.
Instructor may ask each group to:
•
•
•
•
Select an area of the facility
Identify the hazards, and/or a particular group of employees they want to educate. (For example, do you want to create
a poster or sign in your local language to help the waste handlers in the wards)
Create an informational posters, or signage, specific to waste segregation.
Each group presents their hand-drawn poster to the class for discussion.
De-brief
Instructor will discuss the correct responses after each activity.
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