UNDP GEF Project on Global Healthcare Waste
INSTRUCTOR GUIDE
MODULE 18: MANAGEMENT OF CHEMICAL , CYTOTOXIC , P HARMACEUTICAL AND
RADIOACTIVE WASTES
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UNDP GEF Project on Global Healthcare Waste
MODULE 18: MANAGEMENT OF CHEMICAL, CYTOTOXIC, PHARMACEUTICAL AND RADIOACTIVE
WASTES
Estimated Time
Module Overview
Learning Objectives
Target Audience
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Lecture: 1 hour
Activity: 1 hour
*This activity may also be distributed after Module 20 about mercury, specifically,
depending upon audiences
 Describe sources and types of chemical, cytotoxic, pharmaceutical, and radioactive
wastes in a healthcare setting
 Discuss risks associated with exposure to these specific wastes
 Describe all aspects of management of these specific wastes
 Describe treatment and disposal methods
 Identify hazardous (non-infectious) wastes in a healthcare facility
 Identify key steps in collection, handling, storage, transport, treatment and disposal
of these wastes
Note: If the facility already has an inventory of chemicals used and stored in the facility, the
inventory could be a guide to determine which departments and staff should take this
module.
 HCWM Coordinators
 Facility Managers
 Other management staff
 Healthcare professionals and staff working in chemotherapy, pharmacy, radiology,
radiation therapy and in the laboratories
 Facility engineering, central sterile supply and housekeeping staff dealing with
maintenance waste, disinfectants, and chemicals (Note: Presentation slides should
be adjusted to fit the needs of cleaner and other auxiliary staff.)
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UNDP GEF Project on Global Healthcare Waste
Instructor Preparation
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Materials Needed
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Tailor the module to the specific audience. For example, training of the pharmacy
staff should focus on the slides relevant to pharmaceutical waste.
Make notes pages of PowerPoint slides to hand out to class
Make copies of class exercise for distribution after PowerPoint presentation
Read/review Chapters 2, 7, 8 in Blue Book, and other materials included in the
References
Gather country and region specific data to include in presentation
Make copies of any additional documents/readings that may be handed out to class,
such as those included in the References
Select one or two chemicals to assign to each group. Review the ICSCs and MDSDs
available on the selected chemicals. As much as possible, assign chemicals based on
chemicals that participants have identified as ones that they used in the work. If the
participants’ facilities are not mercury free, assign mercury as one of the chemicals.
Examples of common chemicals are: glutaraldehyde and isopropanol (for nursing
staff), sodium hypochlorite and phenol (for nursing and cleaning staff), xylene or
toluene or methanol (for laboratory staff), ethylene oxide (for central sterile supply
staff), fluoracil or cisplatin or uracil (for chemotherapy staff), nitrous oxide or
enflurante or isoflurane (for surgical staff), hydroquinone or acetic acid (for
radiology staff), trichloroethylene or methylene chloride (for engineering and
maintenance staff), etc.
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
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UNDP GEF Project on Global Healthcare Waste
Student Preparation
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Review Questions
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Blue Book Chapter 2, 7, 8
Think about how your facility manages chemical, cytotoxic, pharmaceutical, and
radioactive wastes
Conduct a survey of your particular department and prepare an inventory of the
chemicals in use, including information on chemical name, CAS #, quantity,
expiration date, storage location, and user. Also make note if the department has an
MSDS or International Chemical Safety Cards or other information on the chemical.
Select two chemicals, preferably the most commonly used chemicals, and research
the physical properties, health effects, symptoms of exposure, recommended
storage requirements, and environmental impacts of the selected chemical. Most of
this information can be found in the MSDS or ICSC.
What are some sources of chemical, cytotoxic, and pharmaceutical wastes in your
facility? What are some examples of these healthcare wastes that may occur both
inside and outside of your facility? What are some major hazards and risks that are
posed by these wastes?
What are some sources of radioactive wastes in your facility? Give some examples,
as well as their hazards and risks.
How does your facility segregate chemical and pharmaceutical wastes? What about
specific wastes that have cytotoxic and/or genotoxic properties? What handling
and safety procedures are followed by those who deal directly with the wastes?
How does your facility store chemical, cytotoxic, pharmaceutical, and radioactive
wastes? What treatment and disposal methods does it use or has it used in the past
for each category of waste?
What are country/region-specific policies and guidelines for chemical and
radioactive waste management? What about international guidelines specifically
meant for radioactive wastes? Is your facility able to follow these guidelines?
How does your facility regulate mercury? Are there plans to use alternative sources
in place of mercury and to eventually phase out its use in most medical equipment?
Does your country receive assistance from the Global Healthcare Waste Project?
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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: Sources & Examples of
Hazardous (Non-Infectious) Wastes
Slide 5: Characteristics of Chemical
Waste
Ask class for some examples as you go through the list on this slide
Slide 6: General Types of Chemical
Wastes
Slide 7: Examples of Chemical Waste
Containing Heavy Metals
Slide 8: Health Impacts of Chemical
Exposure
Discarded solid, liquid and gaseous chemicals that are:
-toxic
-corrosive
-flammable
-reactive
-oxidizing
Go through the list of chemical wastes that contain certain heavy metals (mercury,
cadmium, lead)
Describe some of the major health effects of chemical exposure in the next few slides.
Examples of chemicals that produce the health effects listed are given in the
parentheses.
-Effects on the lungs
-Effects on the eyes and mucous membranes
Slide 9: Health Impacts of Chemical
Exposure
-Effects on the skin
-Effects on the nervous system
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UNDP GEF Project on Global Healthcare Waste
Slide 10: Health Impacts of Chemical
Exposure
Examples of chemicals that produce the health effects listed are given under each
health effect.
-Effects on the liver and kidneys
-Effects on the reproductive system
-Cancers
Slide 11: Segregation of Chemical
Waste
Slide 12: Containers and Color
Coding for Chemical Waste
Chemical wastes should be segregated based upon compatibility.
Slide 13: Labeling of Chemical Waste
Go over the elements that should be included in the labeling of chemical waste
containers.
It is important to use proper/consistent color coding procedures for chemical wastes.
Replace slide with the country’s color coding if different.
This slide should be replaced with the country’s specific labeling requirements, if
available.
Slide 14: International Chemical
Waste Symbols
Slide 15: Handling of Chemical Waste
Ensure that proper PPE is worn when handling any hazardous chemicals, with specific
equipment required depending on the characteristics of the chemical.
Slide 16: Handling of Chemical Waste
When handling the waste make sure that:
-appropriate transferring methods are used
-spill kit is available and easily accessible
-secondary containment measures should are in place
Slide 17: On-Site Transport of
Chemical Waste
Describe strict on-site transport specifications for chemical wastes
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UNDP GEF Project on Global Healthcare Waste
Slide 18: Storage of Chemical Waste
Should be in an enclosed area separate from other waste storage areas, with sufficient
lighting and good ventilation. When liquid chemicals are being stored, the area should
be equipped with a liquid and chemical-proof sump. If this is not present, catchcontainers should be placed under the storage containers to catch leaked liquids.
Spillage kits, proper PPE, and first aid equipment should be nearby in the central
storage area.
Slide 19: Storage of Chemical Waste
-No mixing of wastes
-Incompatible wastes stored separately; liquid and solid wastes should be stored
separately
-Temperature-controlled
Slide 20: Sample Sketch of a Chemical Based on Figure 7.12 of the WHO Blue Book
Waste Storage Area
Slide 21: Storage of Chemical Waste
Slide 22: Off-Site Transport
This slide should be replaced with national requirements if available.
Slide 23: Treatment of Chemical
Waste
Treatment categories include:
-chemical and physical treatment
-biological treatment
-thermal treatment
Slide 24: Treatment of Chemical
Waste in Low-Income Countries
Incineration is not an ideal method for treating radioactive wastes. Encapsulation or
inertization are better options if available.
Encapsulation: Waste-filled containers are tightly sealed after an immobilizing
material is added.
Inertization: Process of mixing waste with cement and other substances before
disposal so as to minimize the risk of toxic substances migrating into surface water or
groundwater.
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UNDP GEF Project on Global Healthcare Waste
Slide 25: Chemical Wastes Containing
Heavy Metals
Slide 26: Chemical Waste
Management
Slide 27: Workers’ Right to Know
Discuss the proper handling, storage, and disposal of chemical wastes containing
heavy metals
Describe major aspects of chemical waste management
More about Principle 10 of the Rio Declaration can be found in:
http://www.unitar.org/egp/sites/unitar.org.egp/files/p10_EN_rio.declaration.pdf
Slide 28: Safety Data Sheets
List of the sections of an SDS
Slide 29: Example of an ICSC
The example only shows the first few sections of an ICSC for glutaraldehyde (50%
solution). ICSCs can be found at the International Labour Organisation website at:
http://www.ilo.org/dyn/icsc/showcard.home
Slide 30: Example of a Safety Data
Sheet
This example only shows the first page of a six-page MSDS for xylene. MSDSs or SDSs
can be found on the Internet or obtained from manufacturers.
Slide 31: Chemical Waste
Minimization
Slide 32: Chemical Waste
Minimization
Slide 33: Chemotherapeutic Waste
Source reduction is the most desirable method for minimizing waste
Slide 34: Examples of Cytotoxic
Waste
Slide 35: Segregation of Cytotoxic
Waste
Give some sources and examples of specific agents of cytotoxic waste
Describe recycling as a waste minimization technique
Introduce different types of chemotherapeutic wastes
Describe chemical degradation, high-temperature incineration with air pollution
control, options for low-income countries
Slide 36: Treatment and Disposal of
Chemotherapeutic Waste
Slide 37: Chemotherapeutic Waste
Minimization
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UNDP GEF Project on Global Healthcare Waste
Slide 38: Characteristics of
Radioactive Wastes
Go over some of the characteristics of radioactive wastes.
Radionuclides used in healthcare activities are generally in unsealed (open) sources or
sealed sources. Unsealed sources are generally liquids applied directly, while sealed
sources are radioactive substances contained in parts of equipment or encapsulated in
unbreakable or impervious objects.
Slide 39: Sources of Radioactive
Wastes in Healthcare
Slide 40: Health Risks of Radioactive
Waste
Slide 41: Containers for Radioactive
Wastes
Slide 42: Segregation of Radioactive
Waste
There are many potential sources of radioactive waste in healthcare activities
The health impacts of radioactive wastes will be determined by the type and extent of
exposure to ionizing radiation.
Segregation of radioactive wastes should be based on:
-half-life
-activity and radionuclide content
-physical and chemical form
-sealed/non-sealed sources
-waste content
Radioactive waste should also be segregated on the basis of the available options for
treatment, conditioning, storage, and disposal.
Slide 43: Labeling of Radioactive
Waste
Slide 44: Storage of Radioactive
Waste
It is essential that radioactive wastes are properly labeled.
Slide 45: Disposal of Radioactive
Waste
Options for the disposal of radioactive waste include: return to supplier, “decay in
storage”, and long-term storage (at an authorized radioactive waste disposal facility).
Many precautions should be taken and steps followed to ensure safety in the storage of
radioactive wastes.
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UNDP GEF Project on Global Healthcare Waste
Slide 46: Radioactive Waste
Minimization
Slide 47: Sources of Pharmaceutical
Waste
Slide 48: Characteristics of
Pharmaceutical Waste
Slide 49: Environmental Impact of
Pharmaceutical Waste
Slide 50: Segregation of
Pharmaceutical Waste
Pharmaceuticals can be:
-acutely hazardous
-toxic
-flammable or ignitable
-corrosive
Pharmaceutical wastes should be segregated from other infectious and radioactive
wastes. National and local regulations must be followed.
Slide 51: Treatment and Disposal of
Pharmaceutical Waste
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Slide 52: Disposal of Pharmaceutical
Waste in Low-Income Countries
Options for the disposal of pharmaceutical wastes in low-income countries include:
-reverse distribution (returning to supplier)
-safe burial on hospital premises
-encapsulation of inertization
-landfill disposal
-discharge to a sewer
Sources:
Waste disposal
http://www.healthcarewaste.org/fileadmin/user_upload/resources/WDU_guidelines
2_en.pdf
Waste reduction
http://www.healthcarewaste.org/fileadmin/user_upload/resources/10_Steps_to_Impl
ementing_a_Regulated_Medical_Waste_Reduction_Plan.pdf
http://archive.basel.int/pub/techguid/tech-biomedical.pdf
http://www.healthcarewaste.org/fileadmin/user_upload/resources/who_first_do_no_
harm_2002.pdf
Slide 53: Pharmaceutical Waste
Minimization
Keys strategies for minimizing pharmaceutical wastes are: good inventory control,
avoidance of unnecessary prescriptions, and the reformulation of drugs
Slide 54-55: Discussion
Generate a discussion of the review questions.
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UNDP GEF Project on Global Healthcare Waste
References (in order as they appear
in slides)
Blue Book, Chapter 2, 7, 8
UNDP, GEF: Global Healthcare Waste Project. www.gefmedwaste.org
World Health Organization. Managing Health Care Waste Disposal: Guidelines on to
Construct, Use, and Maintain a Waste Disposal Unit. September, 2004
http://www.healthcarewaste.org/fileadmin/user_upload/resources/WDU_guidelines
2_en.pdf
Hospitals for a Healthy Environment. Regulated Medical Waste Reduction: 10 Steps to
Implementing a Regulated Medical Waste Reduction Plan.
http://www.healthcarewaste.org/fileadmin/user_upload/resources/10_Steps_to_Impl
ementing_a
_Regulated_Medical_Waste_Reduction_Plan.pdf
UNEP, Basel Convention. Technical Guidelines on the Environmentally Sound
Management of Biomedical and Healthcare Wastes. September, 2003
http://archive.basel.int/pub/techguid/tech-biomedical.pdf
WHO, Department of Protection of the Human Environment, Department of Vaccines
and Biologicals. First Do No Harm: Introducing Auto-Disable Syringes and Ensuring
Injection Safety in Immunization Systems of Developing Countries.
http://www.healthcarewaste.org/fileadmin/user_upload/resources/who_first_do_no_
harm_2002.pdf
WHO, Department of the Protection of the Environment, Water, Sanitation, and Health.
Mercury in Health Care: Policy Paper.
http://www.healthcarewaste.org/fileadmin/user_upload/resources/WHO-mercuryin-HC-policy-paper-2005.pdf
WHO, UNDP, Global Healthcare Waste Project: Mercury.
http://gefmedwaste.org/section.php?id=31
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UNDP GEF Project on Global Healthcare Waste
ACTIVITY: MODULE 18: EXERCISE (1 HOUR)
Knowledge and understanding of toxicity, risk of exposure, and health impact of a chemical is very important for the safe use
and disposal of chemicals in a healthcare facility. The purpose of this exercise is to learn how to find qualitative information on
chemical exposure from the label, materials safety data sheets (MSDSs) and the ILO International Occupational Safety and
Health Information Centre (CIS). Use other accompanying documents about phasing out mercury in health care and the health
effects of mercury.
MSDSs are prepared by a chemical manufacturer and provide basic information on the chemical, physical properties, and
related health effects. The MSDSs gives guidance on using, storing and handling substances safely on the job and in
emergencies such as fires and spills. However, information on MSDSs may be incomplete or inaccurate. MSDSs are another
piece of information that can help to better understand workplace exposures. The CIS forms contain information on types of
hazard/exposure, acute symptoms, prevention and first aid/fire fighting.
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 record their answers. Instructor
should record participant/group responses on a wipe board, flip chart, or transparency, categorize their responses. Instructor
may provide the resources and other reading material as homework, so students have the time to be familiar with the
materials before the activity. Instructor may also choose to use the common websites listed to identify any other chemical
used at the facility. Instructor will go over the responses, once again, during the de-brief.
Resources for Mercury:
http://www.cdc.gov/niosh/ipcsneng/neng0056.html
http://www.sciencelab.com/msds.php?msdsId=9927224
http://www.cdc.gov/niosh/npg/npgd0383.html
http://www.cdc.gov/niosh/npg/npgd0384.html
http://gefmedwaste.org/downloads/WHO%20Policy%20Paper:%20Mercury%20in%20Health%20Care.pdf
http://gefmedwaste.org/section.php?id=31
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UNDP GEF Project on Global Healthcare Waste
http://gefmedwaste.org/downloads/NOTES%20on%20Selecting%20Mercury%20Reduction%20Activities.pdf
http://gefmedwaste.org/downloads/Mercury%20Elimination%20Guide%20for%20Hospitals%20.pdf
Mercury in healthcare policy paper:
http://www.who.int/water_sanitation_health/medicalwaste/mercurypolpap230506.pdf
Resources for other chemicals:
ICSCs:
http://www.ilo.org/dyn/icsc/showcard.home
http://www.cdc.gov/niosh/ipcs/icstart.html (different languages)
http://www.inchem.org/pages/icsc.html
MSDSs:
http://msds.ohsah.bc.ca/
http://www.ilpi.com/msds/index.html
http://hazard.com/msds/index.php
http://www.msdsxchange.com/english/index.cfm
http://www.msdsprovider.com/
http://www.msdshazcom.com/
http://www.chemexper.com/
http://www.ilpi.com/msds/index.html#Manufacturers (links to manufacturers’ MSDS websites)
http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/index-eng.php (specific to pathogens)
http://www.cdms.net/LabelsMsds/LMDefault.aspx?t= (specific to pesticides)
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UNDP GEF Project on Global Healthcare Waste
General information on chemicals:
http://www.atsdr.cdc.gov/toxfaqs/index.asp
http://www.chemspider.com/SimpleSearch.aspx
http://www.ncbi.nlm.nih.gov/
http://scorecard.goodguide.com/chemical-profiles/
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MODULE 18: EXERCISE:
Select one or more chemicals for each group to focus on based on the chemicals researched by the participants during their preparation. If
mercury is used in the facility, assign mercury to one of the groups. Participants will be asked to answer the following questions.
a. Describe the potential health effects from exposure to this chemical?
Does this chemical cause cancer? What other health effects does this chemical cause?
What are the ways this chemical can get into the body?
What are the symptoms from exposure to this chemical?
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UNDP GEF Project on Global Healthcare Waste
What does this chemical look like?
How should this chemical be stored?
What are the recommendations for limiting exposure when using this chemical?
Does this chemical cause environmental harm?
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UNDP GEF Project on Global Healthcare Waste
Now think about your facility and answer these questions
1. LOCATION OF USE AND STORAGE (FOR EXAMPLE, IS IT STORED IN A LOCKED CABINET, WITH WHAT OTHER CHEMICALS IS IT STORED?)
2. Is there a standard operating procedure on how this chemical is stored, used and disposed?
3. HOW MANY PEOPLE HAVE ACCESS OR HOW MANY STAFF USE THIS CHEMICAL?
4. DO THEY RECEIVE ANY TRAINING ON HOW TO SAFELY USE THIS CHEMICAL?
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5. Describe common causes of exposure?
6. What protective equipment is used while handling this chemical?
7. What happens if there is a spill or accident? Describe key steps in your protocol.
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DE-BRIEF
Instructor will discuss responses to questions by group and also provide resources (MSDS websites) where participants
can find out about other chemicals used in their facility. If you have access to the internet then you can give them a
demonstration of how to find MSDSs.
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