Waste Management I
Waste Management I
Introduction
Health-care medical waste is a by-product of health care that includes sharps,
non-sharps, blood, body parts, chemicals, pharmaceuticals, medical devices, and
radioactive materials. Poor management of health care waste may expose health
care personnel, waste handlers, and the community to infectious agents, to toxic
materials, and to an increased risk of injury. It may also damage the environment
(e.g., contamination of water, air, and food). In addition, if waste is not disposed
of properly, members of the community may have an opportunity to collect
disposable medical equipment (particularly syringes) and to resell these
materials. Medical waste can potentially be reused without sterilization. This
reuse of unsterilized waste material causes a large portion of the diseases that
develop due to poor waste management. 93 An extensive survey of medical
waste generated at a Saudi Arabian hospital found that a comprehensive waste
program was able to reduce the amount of waste being discarded as medical
from 1163 kg/day to 407 kg/day or a 65% reduction. 61 A substantial portion of
items that were being discarded as medical waste were plastics such as IV bags
and tubing, disposable, uncontaminated paper wraps used for instruments which
did not meet this country’s definitions of medical waste.
Magnitude of Medical Waste in Egypt
Although there are no accurate figures on the magnitude of medical waste
generated from health care facilities in Egypt, some limited reports describe the
amount of medical waste generated per bed per day to be on the average of 1
kg. There are approximately 123,000 beds distributed in governmental and
private health care facilities (excluding military and police hospitals). This means
that the total hospital waste is estimated to be on average 123 tons/day. 94
Almost 80% of the total waste generated by health care activities is general
waste (comparable to domestic waste), while the remaining 20% of waste is
considered to be hazardous and may be infectious, toxic, or radioactive. 95 In
other words, Egypt generates an average of 24,600 tons of hazardous or
infectious waste daily.
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Waste Management I
Legislation for Egypt
Law No. 4 for the protection of the environment was issued in 1994. Its
implementation policy was issued by a decree from the board of ministers,
number 338 for year 1995. Law No. 4 is concerned with the protection of the
environment (protection of air, water, and ground) from all aspects of pollution,
including pollution with dangerous waste.
Dangerous waste was defined as all material which harms the health of human
beings or which has a negative impact on the environment as infectious, toxic, or
radioactive material.
Law No. 4 includes 100 elements. Element no. 29 stresses the prevention of
handling of dangerous waste without a license from the responsible
administrative area. Those who do not comply with element no. 29 could be
punished by prison for a period of not less than 5 years and by being fined an
amount of money not less than 20000 L.E.
General Principles of Waste Management

A clear facility policy for waste management should be available for
proper implementation of a waste management system. The policy
should describe in detail the methods of waste segregation, collection,
storage, and disposal, according to the resources available in each
health facility.

Roles and responsibilities of the different team members responsible
for waste management should be clarified. One main person should be
assigned to be responsible for waste management in each facility.

All used sharps must be discarded without re-sheathing in a punctureresistant container that is readily accessible.

All clinical waste, e.g., waste contaminated with blood and/or bloody
fluids, should be discarded into a colored bag (e.g. red or yellow).
Segregation of waste should take place at its source of origin.
The Different Types of Waste
Wastes and by-products cover a diverse range of materials and can be divided
into two categories:
Non-medical waste (or non-hazardous waste)
General or non-medical waste poses no risk of injury or infection to staff, to
patients, to visitors, or to the community at large. It is similar in composition to
household trash.
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Waste Management I
Note:
General waste represents 80% of the total waste from health care activities.
Examples include:
Kitchen waste, paper, boxes, packaging materials, bottles, plastic containers,
hand towels, tissues, food related trash, and similar materials that are not
contaminated with body fluids.76
Medical waste (component of hazardous waste)
Medical waste consists of several different subcategories that should all be dealt
with in the same way:
Infectious waste
Potentially infectious waste includes all waste items that are contaminated
with or suspected of being contaminated with body fluids.
Examples include:
Blood and blood products, used catheters and gloves, cultures and
stocks of infectious agents, waste from dialysis and dentistry units,
wastes from isolation units, wound dressings, nappies, wastes
contaminated with blood and its derivatives, discarded diagnostic
samples, infected animals from laboratories, and contaminated
materials (swabs, bandages, and gauze) and equipment
(disposable medical devices, e.g., IV fluid lines, and disposable
spatulas). 95, 96
Anatomic wastes
Anatomic wastes consist of recognizable body parts and tissues (e.g., placenta),
extracted tumors, waste from microbiology labs, and animal carcasses.
Note:
Infectious and anatomic wastes make up the majority of hazardous waste and
account for up to 20% of the total waste from health care activities.
Sharps waste
Sharps waste consists of used syringes, needles, disposable scalpels and
blades, etc.
Note:
Sharps waste represents about 1% of the total waste from health-care activities.
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Waste Management I
Chemical waste
Waste containing chemical substances e.g., laboratory chemicals, empty bottles
of lab or pharmacy chemicals, disinfectants that have expired or are no longer
needed; solvents, diagnostic kits, poisonous and corrosive materials, and
cleaning agents and others. 95
Pharmaceutical waste
Waste containing pharmaceutical substances.
Examples include:
Expired, unused, and contaminated pharmaceuticals, e.g., expired drugs,
vaccines and sera. 95
Note:
Chemical and pharmaceutical waste account for about 3% of waste from healthcare activities.
Genotoxic waste
Genotoxic waste consists of highly hazardous, mutagenic, teratogenic, or
carcinogenic waste containing substances with genotoxic properties.
Examples include:
Cytotoxic and neoplastic drugs (used in cancer treatment) and their
metabolites and genotoxic chemicals. 95
Radioactive materials
Examples include:
Unused liquids from radiotherapy or laboratory research; contaminated
glassware, packages, or absorbent paper; urine and excreta from patients
treated or tested with unsealed radionucleotides; sealed sources. 95
Heavy metals
Heavy metal waste consists of both materials and equipment with metals and
derivatives.
Examples include:
Batteries, broken mercury thermometers, manometers. 95-96
Note:
Genotoxic waste, radioactive matter and heavy metal content represent about
1% of the total waste from health care activities.
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Waste Management I
Sorting, Handling, Interim Storage, and
Disposal of Medical Waste
Establishing a Medical-Waste Management Plan
Since disposal of medical waste is frequently a problem, it is useful to develop a
medical waste management plan and to designate a staff member to coordinate
the management of medical waste. The management plan should include
training all personnel handling medical waste and orienting the entire staff to the
overall plan. 76
A waste management plan should address four components of waste
management:
Definitions:

Sorting: Sorting is separating
waste by type (e.g., infectious
waste, pharmaceutical waste)
into color coded bags at the
place where it is generated.
Fig. 29: Steps of MedicalWaste Management

Handling: Handling is collecting
and transporting waste within
the facility.

Interim storage: Interim storage
is storing waste within the facility
until it can be transported for
final disposal.

Final disposal: Final disposal is
the elimination of solid medical
waste, liquid medical waste,
sharps, and hazardous chemical
waste from the health facility. 76
Sorting
Only a small percentage of the waste generated by a health care facility is
medical waste that must be specially handled to reduce the risk of infections or of
injury. Therefore, sorting the waste at the point at which it is generated can
greatly reduce the amount that needs special handling. 97
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Waste Management I
Separate containers should be used for disposing of general and medical waste.
The person who generates it should segregate the waste by type.
Colored plastic bags should be used to help distinguish between general- and
medical-waste containers.
A three-bin system for waste sorting should be established as follows:
97

Red bags are used for infectious and pathologic waste that needs to be
incinerated.

Yellow bags are used for radioactive waste that is to be dealt with by
atomic energy institutions.

Black bags are for general waste that is to be disposed with the normal
general waste and is to be transferred by the municipals.
Waste sorting tips
 Sort waste at the point where it is generated;

Always keep separate containers in convenient places wherever both
general and medical waste are generated;

Use colored plastic bags to help distinguish between general and medical
waste containers;

Place sharps containers in convenient places to minimize the distance that
staff need to carry sharps;

Sharps containers should be puncture-resistant and leak proof on three
sides, e.g., tin cans with lids, or plastic bottles;

Medical waste containers should be cleaned with a disinfectant solution at
least once per day. Housekeepers should wear heavy utility gloves and
eye protection during cleaning of the containers. 76
Fig. 30: Waste transportation
Handling
Medical waste should be handled as little as
possible before disposal. Medical waste should
not be collected from patient-care areas by
emptying it into open carts; this may lead to
contamination of the surroundings and to
scavenging of waste as well as to an increase
in the risk of injury to staff, clients and visitors.
76
Bag filling
Waste and sharps containers should be discarded when they become three
quarters full and at least once daily or after each shift. The reason for this is to
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Waste Management I
reduce the risk of plastic bags splitting open and of an injury from a protruding
sharp item in sharps containers. 97
Waste handling tips
 Handle medical waste as little as possible;
 Medical waste and sharps containers should be discarded when they are
three quarters full or at least once per day;
 Never put hands into a container that holds medical waste;
 Do not empty medical waste into open carts because this increases the
risk of injury to staff, patients, and visitors, and may lead to spills and to
environmental contamination. 76
Interim Storage
 Waste should be transported at the end of every shift.
 To reduce the risk of infection and of injury, minimize the amount of time
waste is stored at the health care facility. Waste should be stored in an area
of controlled access that is minimally trafficked by staff, clients, and visitors.
Interim storage time should not exceed two days. 97 It is preferable to have a
room to store waste in on each floor of the facility, but, if this is difficult, one
central storage room should be designated.
 The storage area should be included in a cleaning schedule.
Interim storage tips
Since medical waste poses a serious health threat to the community:
Never store medical waste in open containers
Never throw waste into an open pile.
Waste should be stored in containers with lids to minimize the potential for insect,
rodent, or other animal infestation, and to minimize the smell. 97
Final Disposal of Solid Medical and General Waste
There are two different ways of final disposal at a facility: Burn and non-burn
techniques.
1. Non-burn techniques:

Community waste collecting system.

Disposal of general or non-hazardous waste. 97

Burying solid medical waste.
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Waste Management I
To use the burial method of waste disposal there must be enough space
available to dig a burial pit and to enclose it in a fence or a wall. 97
Fig. 31: Burial pit
When burying solid medical waste, adhere to the following guidelines:

Burial should be at least 50 meters from the nearest water source,
located downhill from any wells, free of standing water, and in an area
that does not flood.

Burial pit should be 1-2 meters wide and 2-5 meters deep. The bottom
of the pit should be at least 1.8 meters above the water table.

Erect a fence or a wall around the site to keep out animals.

Every time solid medical waste is added to the pit, cover it with 10-30
cm of dirt.

When the level of waste reaches to within 30-50 cm of ground level, fill
the pit with dirt, seal it with concrete, and dig a new pit. 97
In order to bury medical waste in Egypt, a facility must apply for a license.
Transporting solid medical waste
Transporting solid medical waste is an option for final disposal if a facility is
unable to use burn or non-burn techniques. It is the least desirable option for
disposal because it is likely that non-medical personnel will put themselves at risk
by being involved in the disposal process. If this option is used, facility staff must
educate the waste transport and disposal personnel to the risks involved in the
disposal process and must teach them how to dispose of solid medical waste
safely. 76
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Waste Management I
2. Burn technique
Incineration of solid medical waste
Incinerating is the best option for solid waste
disposal, since the high temperature (1300 ˚C)
destroys microorganisms and reduces the
amount of waste. Burning in an incinerator or
oil drum is recommended. 97
Facilities that generate low levels of solid
medical waste should use an incinerator
appropriately sized for the facility’s demands.
Fig. 32: Incinerator
Facilities that generate low levels of solid
medical waste can use a small drum
incinerator. A drum incinerator can be made
from a 200 liter or 55 gallon oil drum. 97
Using a drum incinerator:

The drum incinerator should be sited downwind from the facility.

Put a fence around the incinerator or never leave the fire unattended in
order to ensure the safety of staff, patients, visitors, and the community
at large.

Place the incinerator on hard earth to prevent grass or vegetation from
catching fire.

The drum incinerator should have sufficient air inlet to allow for efficient
and complete burning of medical waste.

Burn only medical waste to minimize the amount of waste to be
burned.

Use kerosene as an accelerant. To avoid an explosion add kerosene
before ignition.

Treat ash from incineration as general waste and dispose of it properly.
97
Tips for disposal of solid medical waste
Always wear heavy utility gloves and shoes when handling
solid medical waste.
The disposal site for solid medical waste should be on the
grounds of the medical facility. This allows staff who are
knowledgeable about the risks of medical waste to
supervise the disposal process.
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Waste Management I
Final Disposal of Liquid Medical Waste
Liquid medical waste can be poured down a sink, drain, and flushable toilet. If
none of these are available, liquid medical waste should be buried in a pit. Points
to remember when disposing of liquid medical waste:

Always wear heavy utility gloves and shoes when handling or
transporting liquid medical waste. Afterwards, wash both gloves and
shoes.

Consider where the sink, drain or toilet empties. It is hazardous to have
medical waste flowing through open gutters or emptying onto the
grounds of the facility.

When carrying or disposing of liquid medical waste, avoid splashing
the waste on yourself, on others or on surfaces.

After disposal rinse the sink, drain, or toilet to remove residual waste,
being careful to avoid splashing. Clean the fixture with a disinfectant
solution at the end of each day or more often if heavily soiled.

Decontaminate the container that held the liquid medical waste by
filling it with a 0.5% chlorine solution and letting it sit for 10 minutes
before washing. 76
Final Disposal of Hazardous Chemical Waste

Always wear heavy utility gloves and shoes when handling or
transporting hazardous chemical waste. Afterwards, wash both gloves
and shoes if they become contaminated.

Cleaning solutions and disinfectants should be handled as liquid
medical waste.

After disposal, rinse containers thoroughly with water, wash glass
containers with detergent and water. Do not reuse plastic containers.
Disposing of cytotoxic and radioactive waste should be done in accordance with
all local and national laws and regulations. 76
Note:
Final waste disposal should follow the Egyptian regulations published in “The
guidelines of final medical waste disposal” (MOHP and the WHO,1998).
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