Safe management of wastes from health-care activities

Definition and characterization of health-care waste:

Health-care waste: Definition an d classification: Infectious waster; pathological waste; sharps; pharmaceutical waste; genotoxic waste; chemical waste; waste with high content of heavy metals; pressurized containers; radioactive waste.

Sources of health-care waste; health-care waste generation; physicochemical characteristics of hazardous health-care waste

Health impacts of health-care waste:

Hazards of health-care waste: Types of hazards; persons at risk; hazards from infectious waste and sharps; hazards from chemical and pharmaceutical waste; hazards from genotoxic waste; hazards from radioactive waste; public sensitivity.

Public health impact of health-care waste: Impacts of infectious waste and sharps; impacts of chemical and pharmaceutical waste; impacts of genotoxic waste; impacts of radioactive waste

Survival of pathogenic microorganisms in the environment; needs for further research and epidemiological surveys.

Legislative regulatory, and policy aspects: International agreements and underlying legislative and regulatory principles; legal provisions; policy document and technical guidelines

Health-care waste managements planning:

The need for planning; international recommendations for waste managements

National plans for health-care waste managements: Purpose of a national management plan; action plan for the development of national programme

Waste management plan for a health-care establishment: Assignment of responsibilities; management structure, liaison paths, and duties; assessment of waste generation; development of a waste management plan; implementation of the waste management plan

Managements of health-care waste from scattered small sources: Basic principles; private medical or dental practitioners; research activities; nursing homes; home treatment; ambulance services; veterinary centers.

Waste minimization, recycling, and reuse; safe reuse and recycling.

Handling, storage, and transportation of health-care waste:

Waste segregation and packaging

On-site collection, transport, and storage of waste

Off-site transportation of waste: Regulation and control system; Special packaging requirements for off-site transport; labelling radioactive waste; preparation for transportation; transportation vehicle or container; routing

Treatment and disposal technologies for health-care waste:

Incineration: Principles of incineration; pyrolitic incineration; rotary kilns; incineration in municipal incinerators; incineration options that meet minimum requirements; environmental control technology for incinerators

chemical disinfection; Simple chemical disinfection processes; commercial treatment system based on chemical disinfection

Wet and dry thermal treatment; screw-feed technology

Microwave irradiation

Land disposal: Municipal disposal sites; encapsulation; safe burial on hospital premises; land disposal of residues

Inertization

Application of treatment and disposal methods to health-care waste categories:

Infectious waste and sharps

Pharmaceutical waste: Disposal of small quantities of pharmaceutical waste; disposal of large quantities of pharmaceutical waste

Cytotoxic waste

Chemical Waste: Disposal of general chemical waste; disposal of small quantities of hazardous chemical waste; disposal large quantities of hazards chemical waste

Waste with high heavy-metal content; pressurized containers

Radioactive waste: Radioactive waste classification; radioactive waste segregation and characterization; management options for radioactive health-care waste

Collection and disposal of wastewater:

Characteristic and hazards of wastewater from health-care establishments: Microbiological pathogens; hazardous chemicals; pharmaceuticals; radioactive isotopes; related hazards

Wastewater management: Connection to a municipal sewage treatment plant; on-site treatment or pretreatment of wastewater

Options for establishment that apply minimal waste management programmes: Lagooning; minimal safety requirements; sanitation

Costs related to health-care waste management: Principles; methods if financing; cost estimation; recommendations for cost reductions

Health and safety practices for health-care personnel and waste workers:

Principles

Workers' protection: Protective clothing; personal hygiene; immunization; management practices; special precautions for clearing up spillages of potentially hazardous substances; response to injury and exposure

Cytotoxic safety

Emergency response: Principles; dealing with spillages; reporting accidents and incidents

Hospital hygiene and infection control:

Objective

Epidemiology of nosocomial infections: The transition from contamination to infection; the sources of infection; the routes transmission

The prevention of nosocomial infection: Principles of infection patients and standard precautions; cleaning; sterilization; disinfection; hand hygiene

Training:

Public education on hazards linked to health-care waste

Education and training of health-care personnel: Principles; implementing a training course

Training of health-care waste management operators: Training for staff who transport waste; training of treatment plan operators; training of landfill operators

Minimal programmes for health-care waste management:

Basic principles

Health-care waste segregation: The waste categories; segregation and packaging; safe handling and storage

Minimization and safe recycling of health-care waste: Chemical and pharmaceuticals; pressurized containers; mercury; recyclable sharps

Treatment and disposal of hazardous health-care waste: Thermal processes: wet thermal disinfection; chemical disinfection; containment processes

Management of hazardous health-care waste by waste categories: Infection waste and sharps; pharmaceutical waste; chemical waste; cytotoxic waste; radioactive waste; pressurized containers; used batteries and thermometers

Worker's training and safety at work

Annex: Guidance levels of activity for procedures in nuclear medicine for a typical adult patient; chemical reduction methods for cytostatic drugs; clearance levels for radioactive waste; procedure to be followed in the event of accidental contamination by mutagenic and carcinogenic products

Inglés