UNDP GEF Project on Global Healthcare Waste
INSTRUCTOR GUIDE
MODULE 17: MANAGEMENT OF SPECIFIC INFECTIOUS WASTES
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UNDP GEF Project on Global Healthcare Waste
MODULE 17: MANAGEMENT OF SPECIFIC INFECTIOUS WASTES
Estimated Time
Module Overview
Learning Objectives
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Target Audience
Instructor Preparation
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Materials Needed
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Lecture: 1 hour
Activity: 1 hour
Describe sources and types of specific infectious waste
Describe all aspects of sharps waste management
Describe procedures for treatment and disposal of specific infectious wastes
Identify specific infectious wastes in a healthcare facility – sharps, bulk blood and
body fluids, cultures and biological stocks, and pathological waste
Identify key steps in the management and disposal of these specific infectious
wastes
HCWM coordinators
Facility managers
Other management and staff interested in participating in HCWM planning
Make notes pages of PowerPoint slides to hand out to class
Make copies of class exercise for distribution after PowerPoint presentation
Read Chapters 3 and 12 in Blue Book, and other materials included in the
References
Prepare for the demonstration of sharps waste management devices as laid out in
the presentation
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
Sharps waste management devices for demonstration
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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 3, 12
Think about sources of infectious waste and sharps waste and the management
techniques used by your facility
How does your facility manage sharps waste? Are needle
cutters/destroyers/melters involved? What are some advantages and
disadvantages of these devices in destroying sharps waste?
How does your facility handle infectious wastes (not including sharps waste)? What
guidelines and procedures are in place for patient and worker safety from infectious
wastes?
What types of personal protective equipment are used in the management of
infectious/sharps waste in your facility? What PPE is available?
What are some regulations for management of sharps and infectious waste present
in your specific country or region?
What are some ways to overcome barriers present in your country/region/facility
for effective management of infectious and sharps waste?
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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.
The trainer will review the major sources of infectious disease transmission from healthcare
waste, with particular emphasis on sharps waste
Slide 3: Learning Objectives
Slide 4: What is Infectious
Waste?
Describe what participants will learn at the end of this module.
Infectious waste includes:
-waste contaminated with blood and other body fluids
-laboratory cultures and microbiological stocks
-excreta and other materials that have been in contact with patients who are ill with highly
infectious diseases in isolation wards
Slide 5: Routes of Disease
Transmission
In addition to information included in slide, introduce the basics of nosocomial infections (as
covered in Blue Book).
Nosocomial infections are infections that are not present at the time of a patient’s admission
to a healthcare facility, but develop during the course of their stay. They are also known as:
 hospital-acquired infections
 hospital-associated infections
 hospital infections
They can occur as a result of medical procedures performed on patients that lead to infections
with the patient’s own (endogenous) flora or as a result of exposure to items contaminated
with infectious agents. Additionally, the risk of acquiring an infection increases for patients
with altered or compromised immunity.
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UNDP GEF Project on Global Healthcare Waste
Slide 6: Sources of Disease
Transmission
Go over the main sources of infectious disease transmission.
In the healthcare setting, the sources of infectious agents may be the personnel, the patients,
or the inanimate environment.
Slide 7: Why are Healthcare
Facilities Ideal for Disease
Transmission?
Slide 8: Chain of Infection
Give some primary reasons for why healthcare facilities are ideal for disease transmission
It is very important to understand the chain of infection so that the most effective measures
can be taken to prevent potential disease transmission.
Ask class if they can provide an example of the chain of infection in their facility.
There are six elements included in the healthcare facility chain of infection:
Infectious agent: a microbial organism that can cause disease
Reservoir: a place where micro-organisms can thrive and reproduce e.g. in humans, animals,
inanimate objects
Portal of exit: a means for a micro-organism to leave the reservoir e.g. respiratory,
genitourinary, and gastrointestinal tracts, skin and mucous membranes and the placenta
Mode of transmission: how the organism moves from one place to another e.g. contact,
droplets, airborne
Portal of entry: an opening allowing the micro-organism to invade a new host; usually the
same as the portal of exit
Susceptible host: a person susceptible to the disease, lacking immunity or physical resistance
to prevent infection
Slide 9: Who is at Risk?
Slide 10: Who is at Risk?
Slide 11: Examples of
Potentially Infectious Wastes
Go over the major groups at risk of infection from healthcare wastes – staff, patients,
community – and give some examples for how they might be exposed.
Table with categories of infectious waste and examples.
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UNDP GEF Project on Global Healthcare Waste
Slide 12: Where is Potentially
Infectious Waste Found?
Discuss where sharps waste, bulk blood and body fluids, cultures and biological stocks, and
pathological waste might be found in a healthcare facility.
Ask participants where they would expect to find infectious wastes within the healthcare
facility.
Personnel managing potentially infectious waste streams need to be vigilant. The waste
stream should be addressed as if they were treating a patient.
Containers and sacks used to transport waste can become visibly contaminated with blood
and body fluids. Therefore, in addition to wearing personal protective equipment, the staff
needs to understand how they may become exposed to infectious agents and how they can
eliminate the potential for exposure.
Slide 13: Sharps Waste
Management
Describe all the major aspects of sharps waste management in the next batch of slides.
There are many items that can be classified as sharps waste, but hypodermic needles make up
the majority of it.
Sharps not only cause cuts and punctures, but may also infect these wounds if they are
contaminated with pathogens. Because of this double risk – injury and disease transmission –
sharps are considered as a very hazardous waste class.
Slide 14: Sharps Waste
Management
Slide 15: Sharps Waste
Management
Go through some key recommendations for minimizing and preventing needle-stick injuries.
Sharps waste should be placed directly in a sharps container, except for syringes, which may
need to have their needles removed/destroyed before being placed in an infectious waste bin.
Since sharps can cause injuries that leave people vulnerable to infection at a later date, both
contaminated and uncontaminated sharps should be collected in a puncture-proof and
impermeable container, which is difficult to break or open after closure, and clearly labelled.
Sharps containers may be disposable or designed for disinfection and reuse.
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UNDP GEF Project on Global Healthcare Waste
If low-cost options are used, the original labels should be removed or defaced and the
containers should be clearly labelled as sharps containers.
Slide 16: Sharps Waste
Management
Go through the recommendations for handling sharps. There may be others that you are
aware of.
Slide 17: Sharps Waste
Management
It is important for sharps containers to be readily accessible in areas where sharps are used.
The containers should be filled only ¾ full.
Go through the points for proper handling of sharps containers.
Slide 18: Options for Sharps
Waste Treatment
Slide 19: Example of
Autoclaving and Shredding of
Sharps Waste in Tanzania
Source: UNDP GEF Project, Health Care Without Harm, AGENDA, John Snow, Inc.
Top photos: Autoclave (left) and shredder (right) from India
Bottom: Treatment of sharps boxes, right photos show the sharps waste after sterilization and
shredding
Slide 20: Example of
Autoclaves and Re-melting
Sharps waste from the hospital and HIHT’s health outreach is collected in autoclavable metal
containers and brought back to the hospital where the waste is autoclaved. The sterilized
sharps waste is then crushed in a locally built shredder. A bin full of water is used to separate
the plastics (which float) and the metals (which sink). The plastics are re-melted to produce
other plastic products. (It is possible for sterilized glass to be re-melted into new glass
products and metals to be re-melted in a foundry.)
Slide 21: Options for Sharps
Waste Management
Due to the hazards associated with sharps, all infectious or non-infectious sharps should be
mutilated and disinfected before their final disposal. There are different devices available for
mutilation of sharps at the point of generation. Needle melters and needle cutters are two
such devices.
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UNDP GEF Project on Global Healthcare Waste
Slide 22: Needle
Cutters/Destroyers
Discuss some advantages and disadvantages of needle cutters/destroyers.
Advantages and disadvantages of needle cutters/destroyers
Advantages
-Prevents reuse of syringe either inadvertently or illegally
-Reduces volume of sharps wastes
-Potential for recycling syringe barrels after disinfection
-Removes inclination of staff to recap used needles
-Reduces risk of injury from improperly disposed syringes
Disadvantages
-Cost: one will be needed wherever injections are given and will require maintenance. Sharps
containers may still be needed for lancets and other sharps waste
-Some models collect the sharps in containers that need to be capped after filling; potential for
spilling of needles and/or NSI during container exchange
-Potential splash of blood during operation
-Busy staff may leave syringes to be cut later, increasing chances of NSI and infection from
discarded syringes
-Some needle destroyers are electrically operated and so not appropriate where power
outages are common
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Slide 23: Example of
Autoclaves and Re-melting
The Swiss Red Cross piloted a project at a hospital in Kyrgyzstan. Hub cutters were used to
separate the needles from the plastic barrel immediately after giving an injection. The needles
were autoclaved and buried. The plastic portions of the syringes were autoclaved, crushed in a
locally-made hammermill shredder, and then sold to a plastic manufacturing plant that remelted the plastics and made them into coathangers, flower pots and covers for electrical
wiring.
Slide 24: Sharps Waste
Management in a LowResource Setting
Transport of sharp within the facilities should be carefully planned.
Go through some of the listed options for final disposal of sharps waste. The feasibility of each
option may depend on the specific region or facility.
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UNDP GEF Project on Global Healthcare Waste
Slide 25: Demonstrations
You may choose to move this slide and the associated demonstrations to the end of the
presentation.
The trainer demonstrates the use jet injectors devices; use of retractable syringes, sheathed
syringes, hinged recap syringes, shielded IV catheters and butterfly needles, self-blunting
needles, and other safe needle devices available in the country; the use and proper disposal
auto-disable syringes; the use of needle destruction technologies and electrical or mechanical
needle cutters; the construction of safety boxes and acceptable alternatives to commercial
sharps containers. The trainer invites the participants to try the devices, and the trainer and
participants discuss the advantages and disadvantages of each.
Slide 26: Blood and Body
Fluids
Present the types of waste contaminated with blood and body fluids that require universal
precautions. Go over the special procedures for handling and disposal of bulk blood and body
fluids, including management of suction canister waste, use of absorbents, clean-up
procedures, use of PPE to prevent exposure to splashes and aerosols, and emergency response
to blood splashes.
Slide 27: Management of
Blood and Body Fluids
Go over the special procedures for handling and disposal of bulk blood and body fluids:
general disposal, where volume of blood poses a risk, disposal of blood bags, treatment of
suction canisters.
Ask participants:
What they do in their facility?
Do you use PPE?
How do you disinfect?
How do you dispose?
What is the spill or emergency response plan?
Slide 28: Management of
Blood and Body Fluids
Slide 29: Management of
Blood and Body Fluids
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UNDP GEF Project on Global Healthcare Waste
Slide 30: Cultures and Stocks
Describe some sources of cultures and stocks, which are highly infectious wastes
Slide 31: Cultures and Stocks
Describe procedures for management and disposal of cultures and stocks: use of PPE, on-site
steam or chemical disinfection, use of an on-site autoclave
Slide 32: Pathological and
Placental Waste
Describe the treatment and disposal options for pathological waste and placenta waste.
Slide 33: Summary of
Treatment and Disposal
Methods
Slide 34: Discussion
Present the table summarizing treatment and disposal methods
References (in order as they
appear in slides)
Blue Book, Chapter 3, 12
Ask participants: If some of these technological options are not available or feasible, what
should the facility do to handle the waste?
Generate a discussion about major topics in this module using the review questions.
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UNDP GEF Project on Global Healthcare Waste
ACTIVITY: MODULE 17: EXERCISE (1 HOUR)
The purpose of this activity is to get participants thinking about management, treatment and disposal of sharps and infectious
wastes 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 17 EXERCISE: SPECIFIC INFECTIOUS WASTES
Instructor will present the module and objectives and ask participants to:
1. Describe/write the current guidelines/protocols specifically for your healthcare facility for managing:
– Sharps
– Bulk blood and body fluids
– Cultures and stocks
– Pathological wastes
2. Think about patient and workers safety.
3. Think about PPE provided.
4. What are some ways to overcome barriers present in your country/region/facility for effective management of
infectious and sharps waste?
De-brief
Instructor will identify the key gaps in management and disposal of infectious and sharps waste and discuss ways to improve
management.
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