UNDP GEF Project on Global Healthcare Waste
INSTRUCTOR GUIDE
MODULE 11: HEALTHCARE WASTE MINIMIZATION
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UNDP GEF Project on Global Healthcare Waste
MODULE 11: HEALTHCARE WASTE MINIMIZATION
Estimated Time
Module Overview
Learning Objectives
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Target Audience
Instructor Preparation
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Lecture: 1 hour
Activity: 45 minutes
Describe the waste management hierarchy
Describe practices that encourage waste minimization
Describe environmentally preferable purchasing and green procurement methods
Describe safe reuse, recycling, and recovery
Introduce environmental management systems
Understand the reasoning behind the waste management hierarchy
Understand waste minimization and methods and approaches for waste
minimization
Understand practices for reducing waste accumulation and toxic quantities along
the supply chain (EPP, green procurement)
Understand differences between reuse and recycling
Understand key parts of an environmental management system
Administrators
HCWM coordinators
Facility managers
Healthcare professionals
Healthcare waste workers (parts of the module only)
Make notes pages of PowerPoint slides to hand out to class
Read Chapter 6 in Blue Book, and other materials included in the References
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
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UNDP GEF Project on Global Healthcare Waste
Materials Needed
Student Preparation
Review Questions
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Projector
Student handouts: slides, exercise, homework
Flip chart and marker pens and/or board and chalk
Blue Book Chapter 6
Think about any waste minimization techniques that are used at your healthcare
facility
What is the purpose of the waste management hierarchy?
Think of specific ways to apply waste minimization techniques in your facility.
How can EPP and green procurement be implemented in your facility?
Compare reuse vs. recycling and recovery
What are the potential benefits of an EMS?
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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: The Waste Management
Hierarchy
Describe what participants will learn at the end of this module.
Slide 6: The Waste Management
Hierarchy
Slide 7: What is Waste
Minimization
Describe waste minimization using the graphic.
Introduce the waste management hierarchy
‘Desirability’ is defined as the overall benefit from each method in terms of its particular
impacts on the environment, protection of public health, financial affordability, and social
acceptability.
Give general description of waste minimization
Healthcare waste managers may be able to take measures to reduce the production of
waste through adapting their purchasing and stock control strategies.
Ensure staff is properly trained in waste minimization
Slide 8: Benefits of Waste
Minimization
-Reduces cost of waste disposal and environmental impacts
-Enhances public health and worker safety
-Improves public image
Slide 9: Waste Minimization
Opportunity Assessment
The usefulness of a waste minimization opportunity assessment or waste minimization
audit method will have to be determined based upon each facility’s circumstances. The
method was developed by the US Environmental Protection Agency.
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UNDP GEF Project on Global Healthcare Waste
Reference:
US Environmental Protection Agency (June 1990). Guides to Pollution Prevention: Selected
Hospital Waste Streams.
Slide 10: Stages in the Waste
Minimization Process
Slide 11: Planning and
Organization
Slide 12: Assessment Phase
Go through the stages of the waste minimization process based on the WMOA.
Reference:
US Environmental Protection Agency (June 1990). Guides to Pollution Prevention: Selected
Hospital Waste Streams
Describe the planning and organization stage in the waste minimization process
Go over the assessment phase of the process
Slide 13: Assessment Phase
Slide 14: Waste Minimization
Techniques
Go through the diagram of waste minimization techniques.
Can you think of an example from your country or the facility to share with the class?
Slide 15: Specific Examples of
Waste Minimization in Health
Facilities
Slide 16: Environmentally
Preferable Purchasing (EPP)
Specific examples of waste minimization include the categories: source reduction, recovery
and reuse, recycling, and composting
EPP: purchase of the least damaging products and services, in terms of environmental
impact.
‘Life-cycle thinking’ is an assessment of the environmental impact of equipment from
manufacture to final disposal.
Healthcare facilities using an EPP policy may be limited to buying from suppliers that have
an Environmental Management System (discussed later) in place
Facilities will have less of a negative environmental impact by switching to less hazardous
materials; examples include mercury-free thermometers and other products that don’t
contain polyvinyl chloride (PVC), organophosphate fertilizers, and plasticizers that may be
linked to birth defects.
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UNDP GEF Project on Global Healthcare Waste
It is easier to dispose of small amounts of chemical and pharmaceutical wastes, rather than
having to rely on more costly methods for greater quantities of waste.
Reference:
Best Environmental Practices and Alternative Technologies for Medical Waste
Management, 8th International Waste Management Congress and Exhibition, 2007
Slide 17: Life Cycle Approach
Slide 18: Life Cycle Approach
For purchasing departments that do not have the resources to conduct a life-cycle analysis
of products, ecolabels could be a guide to purchasing. It is important to note, however, that
some ecolabels have been developed by industries or manufacturing associations which
have been accused of using labels to “greenwash” their products. When using ecolabels to
guide procurement, be aware of the authority or organization that awarded the ecolabel
and the criteria used. Some labels require an independent evaluation by an authorized
third party or government agency based on multiple environmental criteria, while others
are based on self-declarations by the manufacturer.
Top row of ecolabels: China, Germany, USA, Australia, Japan
Middle row of ecolabels: Netherlands, South Korea, European Union, India, Canada
Bottom row of ecolabels: Austria, Spain, France, Taiwan, Africa
Slide 19: Packaging and Green
Purchasing
Slide 20: Inventory Control
Slide 21: Basic Inventory Control
Concepts
Introduce inventory control
The ABC classification system is also known as Selective Inventory Control. The inventory
is grouped into three categories (A, B, and C) in order of their estimated importance. “A”
items are costly, “B” item are less costly, and “C” items are the least costly. Under the ABC
classification system, “A” items require very tight control and accurate records to avoid
excess inventory, “B” items require less tight control and good records, while “C” items use
the simplest controls possible and minimal records.
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UNDP GEF Project on Global Healthcare Waste
Slide 22: Basic Inventory Control
Concepts
Slide 23: Basic Inventory Control
Concepts
Slide 24: Some Approaches to
Inventory Control
Go over the basics of VED analysis
Describe the ABC-VED matrix
FIFO is an inventory control method wherein the first items purchased are the first items
to be used or consumed.
Just-in-Time inventory refers to receiving items just when they are needed. It requires that
inventory managers are able to accurately forecast the demand for the item. The inventory
manager must carefully monitor the consumption of AV items (expensive and vitally
critical items) and adjust procurement schedules as the demand changes.
Slide 25: Other Source Reduction
Practices
Products with short expiration dates should be refused from the supplier
Slide 26: Plastics and Green
Purchasing
Through the procurement of certain plastics and materials, the toxicity in the waste stream
may be reduced considerably.
The suppliers of chemicals and pharmaceuticals can become responsible partners in waste
minimization programs, which healthcare facilities can support by ordering only from
suppliers who provide rapid delivery of small orders, who accept the return of unopened
stock, and who offer off-site waste management facilities for hazardous wastes.
Latex or nitrile gloves may replace the use of PVC gloves.
Polycarbonate is made from bisphenol A, an endocrine disruptor, and should also be
avoided where possible.
Slide 27: Recycling Symbols for
Plastics
International classification system for identifying and recycling plastics.
In cases where plastics are not labeled, procurement staff should contact the manufacturer
for further information.
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UNDP GEF Project on Global Healthcare Waste
Slide 28: Safe Reuse of Materials
When considering reuse, different products should be distinguished:
1) non-medical supplies, disposable items (which should be avoided)
2) medical devices that pose no cross-infection risk
3) medical devices specifically designed for reuse
It is important to properly recycle/dispose of single-use equipment after sterilization
Slide 29: Examples of Single-Use
vs. Reusable Products
Go through the list of reusable products that can replace single-use items. Ask participants
for some ideas about reusable items that might be used in their facility.
Slide 30: Solvent Recovery and
Reuse
Slide 31: Examples of Solvent
Recovery Units for Dialysis,
Histology and Pathology Labs
Slide 32: X-ray Film and Silver
Recovery
Slide 33: Recovery and Recycling
Describe aspects of solvent recovery and provide some examples
Slide 34: Examples of Recyclable
Materials
Slide 35: Typical Hospital Waste
Composition
Slide 36: Sources and Types of
Common Recyclable Waste in a
Hospital
Talk about x-ray film and silver recovery
Recycling is increasingly popular in some healthcare facilities as a way to deal with nonhazardous wastes, reducing costs considerably. When determining the economic
feasibility of recycling and recovery, it is important to consider the costs of alternative
options that may exist, as well as the value of reclaimed materials.
A large hospital can produce as much waste as a small town
Source:
Saskatchewan Waste Reduction Council
http://www.saskwastereduction.ca/resources/ICI/hospital-waste.html
Use the table to give some sources and types of recyclable waste in a hospital
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UNDP GEF Project on Global Healthcare Waste
Source: An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities, C.L.
Bisson, G. McRae, and H.G. Shaner, American Society for Healthcare Environmental Services
(American Hospital Association), Chicago, Illinois, 1993.]
Slide 37: Segregation of
Recyclable Materials
Slide 38: Storage and
Compaction of Recyclables
Slide 39: Composting of Kitchen
and Yard Waste
Slide 40: Key Factors in
Composting
Describe composting and its benefits, and give some examples of waste that may be ideal
for it
Go over some key factors in composting:
 carbon/nitrogen ratio
 presence of microorganisms
 moisture level
 oxygen level
 particle size
Aerobic means that the process takes place in an oxygen-rich environment. Aerobic
bacteria require oxygen to decompose the waste.
Slide 41: Examples of Compost
Bins and Tumblers
Slide 42: Composting of Kitchen
and Yard Waste
Vermi-culture is also known as worm composting. Kitchen waste such as fruit scraps,
vegetables, tea bags, coffee grounds, grains, egg shells, etc. are mixed with some soil, sand,
sawdust and water in a bin with worms (usually red worms). Waste is added once a week
to allow enough time for the worms to eat the waste and avoid odors. Every few months,
the brown earth, with rich worm castings, are moved to one side while new and partially
composted scraps are moved to the other. In about a week or two, the worms move to the
side with the new food and the dark soil is ready to be used as a soil conditioner or
fertilizer.
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UNDP GEF Project on Global Healthcare Waste
Slide 43: Biodigestion of
Healthcare Waste
Anaerobic means the process takes place in an environment that has little or no oxygen.
Anaerobic digestion takes place in the four following steps: (1) Hydrolysis, in which
complex organic matter is decomposed into simple soluble organic molecules using water
to split the chemical bonds between the substances; (2) Fermentation or Acidogenesis,
involving the chemical decomposition of carbohydrates by enzymes, bacteria, yeasts, or
molds in the absence of oxygen; (3) Acetogenesis, in which the products of fermentation
are converted into acetate, hydrogen and carbon dioxide by acetogenic bacteria; and (4)
Methanogenesis, wherein acetate and hydrogen/carbon dioxide are transformed by
methanogenic bacteria into methane and carbon dioxide. The conditions for anaerobic
decomposition are very different from those for aerobic decomposition (composting).
Slide 44: Biodigestion at a
Nepalese Hospital
Biodigester project at Bir Hospital in Kathmandu, Nepal. The left photo shows the twentyfive cubic meter anaerobic digestion system under construction. The right photo shows the
garden under which is the biodigester. The main feedstock of the biodigester is 75 kg of
kitchen and food waste that the four hundred and sixty bed hospital produces every day.
The bacteria inside the biodigester convert the waste to biogas--a renewable fuel mainly
composed of methane and carbon dioxide, and a slurry that is discharged directly into the
sewer. Initial estimates indicate that the biodigester could produce the equivalent of a
thousand dollars' worth of cooking gas each year. The project was a partnership involving
Health Care Without Harm, HealthCare Foundation Nepal (HECAF), and WHO. Source:
HECAF and Ruth Stringer, HCWH.
Slide 45: Re-Melting of Sterilized
Waste
Photos from left to right: coat hanger, flower pot, electrical distribution cap
Photo bottom right: slippers
Slide 46: Environmental
Management System (EMS)
Formal approach in countries with strict environmental laws to manage an organization’s
impact on the environment. You may want to do some research regarding whether any
organizations within your country have the system in place.
Go through the list of possible benefits
Slide 47: Environmental
Management System (EMS)
Describe the key elements of an EMS
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UNDP GEF Project on Global Healthcare Waste
Slide 48: Examples of Waste
Minimization Around the Globe
Slide 49: Minimal Approach to
Waste Minimization
Slide 50: Discussion
Some examples from the Blue Book about waste minimization around the world
References (in order as they
appear in slides)
Blue Book Chapter 6
Describe the elements of a minimal approach to waste minimization.
Involve class in a discussion about these points.
US Environmental Protection Agency (June 1990). Guides to Pollution Prevention: Selected
Hospital Waste Streams.
http://www.wmrc.uiuc.edu/info/library_docs/other_pubs/p2_guide_hospital_waste_strea
ms.pdf
Healthcare Waste Minimisation: A Compendium of Good Practice.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/
digitalasset/dh_4119678.pdf
Emanuel, Jorge, United Nations Development Programme, GEF Project on Healthcare
Waste. Eighth International Waste Management and Congress Exhibition (2007): Best
Environmental Practices and Alternative Technologies for Medical Waste Management.
http://www.noharm.org/lib/downloads/waste/MedWaste_Mgmt_Developing_World.pdf
Saskatchewan Waste Reduction Council: “Wasting Away” in Healthcare Facilities.
http://www.saskwastereduction.ca/resources/ICI/hospital-waste.html
An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities, C.L. Bisson, G.
McRae, and H.G. Shaner, American Society for Healthcare Environmental Services
(American
Hospital
Association),
Chicago,
Illinois,
1993.]
http://infohouse.p2ric.org/ref/39/38597.pdf
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UNDP GEF Project on Global Healthcare Waste
ACTIVITY: MODULE 11: EXERCISE (45 MINUTES)
The purpose of this exercise is to have participants discuss waste minimization opportunities and barriers in their facility.
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 will go over the responses, once again, during the de-brief.
MODULE 11 EXERCISE: WASTE MINIMIZATION OPPORTUNITIES AND BARRIERS
Instructor should describe the module overview and objectives and then ask participants to:
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Does your healthcare facility practice any waste minimization techniques? What are some examples, whether used
within you facility or not?
What are some reusable items that may replace single-use products and help to minimize unnecessary amounts of
wastes? Does your facility promote reusable products?
What are some examples of recycling and/or recovery of wastes that are used in your facility? How effective are these
processes at reducing waste? Does your facility use the universal plastics labeling system?
What are some examples, within the healthcare facility and beyond, of environmentally preferable purchasing of
products?
What are some of the barriers to promoting waste minimization in your facility? How can you promote EPP?
What changes would you like to see in your facility?
De-brief
Instructor will discuss advantages of waste minimization and how we can overcome barriers to responsible waste
management.
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