Medical waste should be collected and stored prior to treatment in a way that reduces the possibility of interaction with humans, animals, or the environment. Medical waste containers are generally imprinted with the universal three-sided biohazard symbol.
If a bag with medical waste is punctured or if problematic waste gets on the outside, the bag should be immediately put inside a second bag. This “double-bagging” process is employed in many waste handling situations.
Design of the collection system is an important part of medical waste management. This means defining how and when the waste goes from the initial collection point to storage and ultimately out of the facility. There are many ways to define your collection and storage systems. Keep in mind the precautionary principle.
Whose responsibility is it to collect medical waste? Everyone who works at the facility.
When it is collected, medical waste is about 150 kg per cubic meter. If you have a compactor on site, you can roughly double that before it is hauled away.
Large facilities (hospitals, research labs) may employ wheeled carts for moving waste containers around the facility. Don’t use waste carts for transport of other things. Keep transportation hardware for waste confined to waste use.
Segregating waste is a powerful technique for reducing your disposal costs and reducing risk. People resist it because it requires work up front (ideally just after the waste is generated), but the payoff usually makes it worth the effort.
To effectively segregate you need to have clearly defined categories that everyone can understand. Employees producing waste at the ground level need to know where to channel the waste - which items to put in which waste stream. Sometimes the real world will create (or at least suggest) categories for you.
It is not necessary that every health care facility use the same waste categories, but consistency is a virtue. It is a best management practice to stick with your categories and not change them often. If you are going to be a facility that recycles in accordance with your local waste authority, great! But that means you have to set up receptacles for recyclable materials and instruct your people to use them correctly.
Sorting is part of segregating, but as a practical matter, most health care facilities sort at the point of generation, or where the waste first enters the collection system. It is usually impractical to collect your waste to a central location and then sort it. Recycling centers at the metropolitan level do that - they have huge sorting facilities. But the health care waste manager finds this impractical in most cases.
You have to rely on your people. That often makes waste managers and facility managers nervous. Many a waste manager gets frustrated by the failure of employees to segregate. But it is too expensive to sort from a central location.
Containers for infectious waste should not be placed in public areas because patients and visitors may use the containers and come into contact with potentially infectious waste items.
Static bins should be located as close as possible to sinks and washing facilities, because this is where most staff will deposit gloves and aprons after treating patients.
Consider putting posters on walls to remind employees to segregate according to your categories. They should always be reminded that it is the responsibility of the employee at the point of waste generation. Waste is everyone’s concern, not just the waste management professionals’.
You know the 80/20 rule that seems prevalent everywhere? It basically says a minority of the waste costs most of the money to treat. The exact breakdown might not be 80/20 - you’d have to do the calculation - but the principle is generally true in almost every facility that makes different types of waste. The consequence is that you can get cost savings by segregating your waste.
Different facilities have different activities and hence the optimal waste categories differ. A large hospital produces many kinds of waste and a high volume of waste. A dentist office produces a smaller volume of a more homogeneous waste. Here are some sample categories:
The categories should be established only after a comprehensive audit of the waste the facility produces. Think long and hard about the categories.
Advantages of many categories
Disadvantages of many categories
Collection schedule is up to you and depends on operations in your facility. A rule of thumb is that collection should happen at least once a day for most waste streams.
If you are a large facility, consider a bookkeeping system for regulated waste, especially radioactive and RCRA hazardous waste. At some point in the collection system, define the batch of waste and give it a number. You can even print a bar code and apply it to the container.
Contamination of collection and storage containers renders those containers in need of management as medical waste, too. You might be able to get multiple uses out of a container, but you won’t be able to return the container to the clean side of things in the future. This is actually mandated for RCRA hazardous waste and the precautionary principle makes it a good idea for all regulated medical waste (infectious, pathological). Specifically, US federal law says containers that held hazardous waste must be triple-rinsed (filled with water three times) and the wash liquid must be managed as hazardous waste. This might allow you to re-use the container for other purposes, but it ends up creating a lot of new waste. Unless the container is particularly valuable, this method is rarely used.
Many modern waste containers are designed to fit into automated systems that empty their contents into the larger containers as part of an overall waste handling system. The system may include mechanisms for washing and disinfecting the containers.
Many municipalities have occasional household hazardous waste collection days when authorities designate a place where residents bring waste from their homes. These are intended to be strictly for residential/household waste, not from commercial facilities. Different authorities have different rules, but usually these collection days explicitly prohibit infectious waste. They are not equipped to deal with it. Check with your locality before bringing medical waste to these events.
Is segregating infectious or pathological waste the same as quarantining an area?
The word quarantine is a legal and public health term. It is the forced legal restriction of people or animals to prevent the spread of communicable disease. The quarantine order specifies a period of time which those affected are not permitted to mix with general society. The idea of quarantines started centuries ago. For instance, when a ship came into a harbor, the officials in the new city might quarantine everyone on the ship for fear of plaque. After a certain period of time if the people did not display symptoms, they were released from quarantine. With advances in diagnostic technologies quarantines are employed less often than they once were.
Medical isolation is a related term for when people with communicable diseases are kept away from others. This is closed in spirit to segregation of medical waste, but still not the same thing. Patients in medical isolation usually either get better or worse over time and the time of isolation is limited.
See also: spill cleanup