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Hospital Waste Management

Hospitals produce many different types of waste.

Management writer Peter Drucker called the hospital the "most complex human organization ever devised."

They are bigger than most facilities the produce medical waste. And they produce different kinds of waste so they present a challenge to the professional medical waste manager. Large facilities often produce problem waste, regardless of their primary activity, and hospitals end up making hazardous waste.

Waste management at hospitals overlaps with safety and risk management. Your hospital probably has safety procedures in place and many have an infection control officer whose job it is to worry about the spread of disease. You also have facility management people who collect waste (as would happen in any building complex), and systems for fire control and suppression, personnel management in times of emergency, and evacuation and shut down criteria and procedures.

Waste aside, hospitals store and use materials that can hurt people. Flammable (and potentially explosive) gases and liquids, radiation sources, poisonous and cytotoxic medicines and cleaning chemicals, and physical objects that pose piercing threats (e.g. needles) and crushing threats (e.g. heavy items) are among the items hospital managers have to worry about.

This site is about waste and how to handle it, but hospital employees and administrators should remember that today’s raw materials are tomorrow’s waste. A lot of the waste ends up hazardous because it was hazardous before it became waste, not because of hospital activities.

Most waste produced in hospitals is not specially regulated waste and does not differ substantially from waste produced at any other large facility where people work. This includes paper, food waste, etc. The toilets and showers from the hospital drain to municipal sewage system. How much of hospital waste is this regular old municipal solid waste?

We estimate 15 to 25 percent of hospital waste (by weight) is hazardous (or somehow regulated). That means most of it is not substantially different from the waste produced at an office building of comparable size and with a comparable population. This waste is classified as municipal solid waste (MSW) and can be put in the same landfill as waste from households and businesses outside the healthcare world. An estimated 10 percent (by weight) of hospital waste is infectious medical waste, and an estimated 3 percent is radioactive waste. About 2 percent is pathological waste. These are industry-wide numbers so individual hospitals might be have different percentages.

One study found that the operating room typically produces 20 to 30 percent of a hospital’s overall waste stream.

Waste that is classified as hazardous under the Resource Conservation and Recovery Act (RCRA) - usually because it has corrosive, flammable, or toxic chemicals in it - makes up 2 percent to 8 percent of total waste. In the US, this form of hazardous waste is subject to federal regulations by the EPA, while infectious waste - while it may be dangerous - is not covered by federal laws. Most US states and some local governments have regulations regarding storage and disposal of infectious waste.

Categories of waste at your hospital

You can employ whatever waste categories makes sense for you, but because the regulatory system and waste management community have set designations, we recommend you at least start with these categories.

Radioactive waste

Waste that is radioactive must be stored in secure containers with the radiation symbol on it. Healthcare waste that is radioactive is classified as "low-level radioactive waste". It ultimately is sent to a landfill for disposal. There is often some sort of treatment before disposal to reduce the volume and make the waste more solid (to reduce likelihood of leaching of radioisotopes in a landfill), but this treatment usually does not happen at the hospital.

Infectious waste and Pathological waste

Strictly speaking, infectious waste is anything that might cause disease in a human or animal who came in contact with it. Waste thought to have pathogens (bacteria, etc.) in enough quantity to infect a living host is consifered biohazardous. In actual practice, materials with bodily fluids on them, even if there is no sign of disease in the person whose body they came from, are managed as infectious waste. This means blood, semen, amniotic fluid, cerebrospinal fluid, and fluid from the pericardial, pleural, and peritoneal cavities. Cultures and stocks from laboratory work are infectious waste. Used tubing, bandages, swabs and tissues are biohazardous waste.

Actual solid (or semi-solid) body parts, including materials that have been removed by surgeons, are pathological waste, which may be thought of as a type of infectious waste, although it may be subject to different cultural and legal restrictions for treatment and disposal.

Infectious waste must be disinfected or deactivated to some level so it does not present a hazard to employees and members of the public. Administrators and infection control officers worry about preventing HCAIs (healthcare associated infections.) The waste does not have to be sterilized before disposal -- that would be overkill because landfills are not sterile. However, any waste that is known to contain particularly virulent pathogens must be handled appropriately. At one time, hospitals disinfected biohazardous waste so that it could be sent to a landfill. Now it is more common for the waste to go to another facility for treatment and packaging before it goes to the landfill, but deactivation of virulent infectiousness should still happen at the hospital.

RCRA Hazardous waste

The pathology and histology departments may produce waste containing solvents, which could possibly push the waste into RCRA hazardous waste. The pathology, dialysis, and nursing departments use formaldehyde which is classified by the government as a carcinogen. Formaldehyde is used to disinfect equipment and to preserve biological tissue. If your facility has an autopsy unit or prepares bodies for burial, formaldehyde is used there, too. Your operating theater may employ glutaraldehyde to disinfect and sterilize surgical equipment.

Pharmaceutical waste and Chemotherapy waste

The hospital’s in-house pharmacy typically carries more individual medicines than a retail drug store does. Large hospitals may stock 3000 to 4000 unique medicines. The management burden of having this many drugs on site are substantial. A well-functioning inventory record system assists the hospital management in understanding what is coming in, going out, and on the shelves at any time. This has value in itself - in operations management - plus it aids waste management systems which benefit from accurate materials information. In hospitals, waste epinephrine is the most common hazardous drug waste generated. It comes out of is used most often in cardiac care units and during orthopedic and ophthalmic surgical procedures but may be generated anywhere in the facility to treat cardiac arrest and allergic reactions.

Pharmaceutical waste is a challenge in itself. You probably want to keep in a separate collection stream. It can meet the standards for RCRA hazardous waste. Some drugs are poisonous and carcinogenic. Chemotherapy agents often make dangerous waste.

Hospitals should maintain a special list of cytotoxic drugs on site for safety purposes and this list will inform waste management practices.

Pharmaceutical wastes can be hazardous or non-hazardous, and liquid or solid in nature. Some are genotoxic. Sort pharm waste into substreams.

Non-hazardous (keep in an area for non-hazardous pharm waste)

  • ampoules with non-hazardous content (e.g. vitamins)
  • fluids with non-hazardous contents, such as vitamins, salts, and nutrients
  • solids or semi-solids, such as tablets, capsules, granules, powders for injection, mixtures, creams, lotions, gels and suppositories
  • aerosol cans, including propellant-driven sprays and inhalers. (Caution, check to see if some of these cans should be classified as hazardous waste.)

Hazardous waste that should be stored in accordance with their chemical characteristics (e.g. genotoxic drugs) or specific requirements for disposal (e.g. controlled drugs or antibiotics)

  • controlled drugs (Schedule Drugs identified as having abuse potential and hence a target for thieves)
  • disinfectants and antiseptics
  • antibiotics
  • ampoules with, for example, antibiotics

Due to its toxicity genotoxic waste should be stored away from other waste in a secure location. Use PPE when handling it. Few hospitals attempt to treat this waste on site. Make sure your waste disposal contractor knows what is genotoxic and carcinogenic pharmaceutical and knows how to handle it.

MSW

If you have a waste management plan in place, most of your waste should be MSW. Avoid contaminating regular, garden-variety waste with biological, hazardous, or radioactive material and you will have a lot less to worry about.

MSW can be collected on a less regular schedule than regulated waste. Your custodial staff may have a pattern for emptying trash cans, etc. But MSW collection and transport is on a push system, not a pull one.

You will have to work out collection of MSW with a local garbage hauler. (They call themselves “waste management companies”.) They have trucks set up to unload dumpsters. You will get charged by the dumpster load or truck load, typically. In other words, by volume. You will probably find it useful to have a compactor on site to crush your MSW and increase its density. This will save costs. Work out the numbers, but it is almost certainly true.

Compostable Waste

Ambitious hospital waste managers may want to try a composting system. As with recycling this will cut your quantity of MSW and may get you brownie points for community service. You won’t get any money for the compost material and you may have to pay to have it hauled to a compost facility. Check whether there are compost facilities in your area and whether there are incentives from local authorities. You can also ask operators of compost facilities for recommendations on waste haulers, and sometime these operators have their own trucks for that purpose.

Food waste will make up most of what you send to composting. If you have grass clippings from facility maintenance, that might qualify also. Hospitals often have a lot of flowers in the waste, so they can also qualify.

Recycling

Hospitals are usually large enough that a recycling system is economically beneficial. There is nothing special about the healthcare industry in this respect; wherever people work there is usually a lot of waste that can be recycled. Look at your local ordinances and options. You can probably get recyclable materials hauled away cheaper than it would cost to put them in the MSW stream. Recycle companies have rules about what they will accept and you want to follow their rules. Set up your waste management plan, including containers and instructions for facility personnel, to segregate waste materials that can be recycled.

Hospitals usually find they can recycle

  • Paper (including white office paper, computer printer paper, newspapers, magazines, and cardboard boxes)
  • Shipping pallets
  • Hard plastic items including polyethylene terephthalate beverage bottles, and High-density polyethylene (HDPE) containers for saline solutions and irrigation fluids.
  • Polystyrene packaging materials
  • Metals (including aluminium beverage cans and other metal containers)
  • Glass, and construction and demolition debris
  • Computer equipment and printer cartridges

Collection

What color system do you use?

Why types of containers do you employ? Bags, bins, etc. How and when are the bins washed?

What is the material flow of waste through the system?

Who (job title?) collects the waste from the examination rooms, operating theaters, patient rooms, radiology lab, etc, and brings them to storage? Make sure you state only a limited number of people are authorized to do this task. How are these employees trained?

How often do you empty waste containers (of all categories)? How often do your waste disposal companies come to transport the waste away?

Storage

Although waste can be collected in plastic bags, storage for more than a day is usually in sturdy containers made of plastic or metal. See our page on storage of medical waste.

How clean are hospitals? Pretty darn clean. The average household has more bacteria per square foot than a hospital does. Hospitals have a more diverse population of pathogens because they have so many more residents. You want the storage area to be ventilated and pest-free and you want to take precautions against odors.

On-site Treatment

In decades past every hospital had an incinerator onsite. Incineration can be an excellent method for treating medical waste but for various economic and social reasons, few hospitals in the US now have one. If you have one at your hospital, you save on disposal costs. But you also have the headache of incinerator operation, with an EPA permit for emissions, handling and disposal of ash, cost to run the incinerator (fuel and labor), training for staff, and emergency equipment associated with operating the unit.

Most hospitals now ship their waste that will be incinerated off-site. Central incinerators service multiple hospitals can be more efficient and generate economies of scale that individual incinerators cannot. Sometimes hospitals chains will have a disposal unit, or hospitals will form a partnership to operate the incinerator. Other models include incinerators run by independent waste companies that accept fees from waste generators. Long-term contracts are generally used as they reduce risk for everyone.

Autoclaving: Hospitals use autoclaves to sterilize medical equipment. They often have separate autoclaves for deactivating biohazardous waste.

See our page on treatment for other methods of treatment. Sometimes treatment happens at the hospital and sometimes it happens at an external TSDF (treatment, storage, and disposal facility.)

Solidification/encapsulation

Hospitals may have absorbents to make sludges or slurries more solid and less likely to spill. This type of absorbent is probably not sufficient for immobilizing waste for disposal in a landfill. Subsequent treatment usually happens at an off-site treatment facility.

The hospital waste management plan

You can’t buy a plan. You can copy elements of plans for other locations and organizations, but you must tailor them to your own situation. No two hospitals are exactly the same. If you hire a consultant who has written plans for other hospitals, he or she will probably largely copy an old plan. But it can’t be an exact copy because other hospitals don’t have your waste production details and your facility layout.

Elements you need in your plan:

Facility description - physical and geographical description. Plan of buildings.

Operational description - what kind of hospital it is, how many beds, how many operating theaters, size of emergency room, maternity ward, special focuses.

Potential accidents and known risks - as related to waste. Of course there are many hazards in a hospital;

Categories of waste you use in your inventory and management system. Estimate of monthly and/or annual production of waste in total and by category.

Methods of collecting and segregating waste - types of standard collection bins and containers, schedule for emptying them, where waste is sorted and staging areas during the collection process, if any.

How and where waste is stored on site prior to disposal. - physical description of the rooms, description of the storage containers and pallets, instructions for

Inventory and tracking system for waste. - bar codes, reports, etc.

Any treatment on site.

Plans for turning over waste to disposal companies. How often this will happen? What is the schedule for shipments? Note that under RCRA hazardous waste shipments must meet criteria for manifests.

Maximum quantity of waste that will be stored on site, broken down by category.

Contact people. Names and phone numbers of waste management personnel.

  • The waste manager, if there is one (and there should be one in a big facility)
  • The facilities manager
  • The environmental manager
  • Occupational safety manager
  • Infection control manager

Who gets a copy?

Ideally, you should be open about giving the plan to anyone who wants it. But that is up to you. There is no legal requirement that you give the plan to anyone.

 

Contact

Email: info@malsparo.com

Address: 12235 Forsythe Dr.
Austin, TX 78759



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