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Medical centers including hospitals, clinics and places where diagnosis and treatment are conducted generate wastes that are highly hazardous and put people under risk of fatal diseases. Although the understanding of medical waste management and control techniques is important, technical elective courses that are offered in undergraduate chemical, civil or environmental engineering place less emphasis on this area of education. In this paper, the meaning of medical waste, the risks of exposure, medical waste management regulatory acts, medical waste management procedures and control techniques are presented. The contents presented in this paper served as a supplementary material in an under-graduate elective course on waste management and as an educational guide for medical staff training on waste handling.
Journal of Environmental Protection, 2012, 3, 1625-1628
doi:10.4236/jep.2012.312179 Published Online December 2012 ( 1625
Medical Waste Management and Control
Zarook M. Shareefdeen
American University of Sharjah, Sharjah, UAE.
Received August 22nd, 2012; revised September 19th, 2012; accepted October 21st, 2012
Medical centers including hospitals, clinics and places where diagnosis and treatment are conducted generate wastes
that are highly hazardous and put people under risk of fatal diseases. Although the understanding of medical waste
management and control techniques is important, technical elective courses that are offered in undergraduate chemical,
civil or environmental engineering place less emphasis on this area of education. In this paper, the meaning of medical
waste, the risks of exposure, medical waste management regulatory acts, medical waste management procedures and
control techniques are presented. The contents presented in this paper served as a supplementary material in an under-
graduate elective course on waste management and as an educational guide for medical staff training on waste handling.
Keywords: Medical Waste; Medical Waste Act; Waste Management and Control
1. Introduction
Waste in general is any substance (solid, liquid, or gas)
that has no direct use and is discarded permanently. A
waste is considered hazardous if it exhibits any of the
characteristics such as being flammable, reactive, explo-
sive, corrosive, radioactive, infectious, irritating, sensi-ti-
zing, or bio-accumulative [1]. Medical waste is limited to
infectious, hazardous, and any other wastes that are gen-
erated from health care institutions, such as hospitals,
clinics, dental offices, and medical laboratories [2]. The
management of medical waste has been of major concern
due to potentially high risks to human health and the en-
vironment. In the past, medical wastes were often mixed
with household wastes and disposed in municipal solid
waste landfills.
Hassan et al., 2008 [3] report a survey on Bangladesh
hospitals that generate a total of 5562 kg/day of wastes,
of which about 77.4% are non-hazardous and about
22.6% are hazardous. The average waste generation rate
for the surveyed hospital is 1.9 kg/bed/day or 0.5 kg/pa-
tient/day. The study reveals that there is no proper, sys-
tematic management of medical wastes except in a few
private hospitals that segregate their infectious wastes.
Some cleaners were found to salvage used sharps, saline
bags, blood bags and test tubes for resale or reuse. In
Bangladesh, proper medical waste management is a new
phenomenon and government of Bangladesh is trying to
develop a new and modern approach to deal with the
medical waste properly. Project in Agriculture, Rural In-
dustry, Science and Medicine (PRISM-Bangladesh), a
reputed national NGO in Bangladesh, with the financial
support from Canadian International Development Agency
(CIDA) has recently developed a disposal facility for low
cost medical waste treatment and management in Dhaka
Similarly, the generation of medical waste in Korea
has been increasing in quantity and variety, due to the
wide acceptance of single-use disposable items (e.g.
gloves, plastic syringes, medical packages, bedding, tub-
ing, and containers) [4]. In recent years, increased public
concerns over the improper disposal of medical waste
have led to a movement to regulate the waste more sys-
tematically and stringently by the Korea Ministry of En-
vironment. Waste minimization and recycling are still
not practiced, thus significant amounts of medical wastes
are to be disposed. Incineration is the main method of
medical waste treatment in Korea.
In the United Arab Emirates (UAE), there are over 800
clinics and hospitals that generate hazardous medical
wastes [5,6]. The main method of medical waste treat-
ment in most countries of the Middle East is incineration;
however, other techniques that produce less pollution are
now being introduced. The literature shows numerous
case studies on the mismanagement of medical wastes as
described above for illustration purpose.
The objective of this paper is to introduce readers
about the medical waste management regulatory acts,
definition of medical wastes, risks of exposure, medical
waste management procedures and control techniques.
2. Medical Waste Tracking Act and
The Medical Waste Tracking Act (MWTA, 1988) is the
Copyright © 2012 SciRes. JEP
Medical Waste Management and Control
first act to regulate medical wastes [7]. It was imple-
mented after life-threatening incidents occurred due to
the lack of proper medical waste disposal systems. One
example of such incident was on June 1987 when 12
children in Indianapolis, Indiana, played with vials they
found in a dumpster outside a medical office. The vials
were filled with blood, and two of them were infected
with AIDS. After medical wastes were found washing up
on several East Coast beaches, USEPA (US Environ-
mental Protection Agency) prompted US Congress to
enact the MWTA in 1988 [8]. The Act required EPA to
create a two-year medical waste demonstration program.
For the purpose of the demonstration program, the
MWTA: a) defined medical waste and those wastes to be
regulated; b) established a cradle to grave tracking sys-
tem utilizing a generator initiated tracking form; c) re-
quired management standards for segregation, packaging,
labeling and marking, and storage of the waste; and d)
established record keeping requirements and penalties
that could be imposed for mismanagement. According to
MWTA medical waste is “any solid waste that is gener-
ated in the diagnosis, treatment, or immunization of hu-
man beings or animals, in research, or in the production
or testing of biologicals” [8,9].
The World Health Organization (WHO) has classified
medical waste into different types: a) Infectious: mate-
rial-containing pathogens in concentrations high enough
to cause diseases on exposure. This includes waste from
surgery, lab cultures, used dressings, and others. b)
Sharps: disposable needles, syringes, blades, broken
glasses. c) Pathological: tissues, organs, body parts, hu-
man flesh, blood and body fluids. d) Pharmaceuticals:
drugs and chemicals that are returned, spilled, expired or
contaminated. e) Chemical: waste resulting from diagno-
sis, or cleaning material. f) Radioactive: waste contami-
nated with radioactive substances used in diagnosis and
treatment of diseases. g) Pressurized containers including
gas cylinders and h) Substances with high heavy metal
content: broken mercury thermometers, blood pressure
gauges. Infectious, pathological and sharps are the most
dominant types of medical waste [10].
The definition of medical waste excludes waste con-
taining microbiological cultures used in food processing,
urine, saliva, and nasal secretions unless they contain
blood. Like any household and office, medical facilities
also generate general wastes such as paper and plastic
that are not dangerous to human beings [9]. Medical
waste such as sharps (i.e. needles, syringes, scalpels, etc.)
can endanger human in a non-infectious way.
Depending on the institutions, the quantities of medi-
cal wastes produced vary [11]. Households are consid-
ered to be small quantity generators, while hospitals are
considered to be large quantity generators (>100 kg/
month or more of medical waste). Medical wastes in-
cluding infectious and sharp wastes account for about
35% of the total waste generated in hospitals. The re-
maining 65% of the wastes are non-infectious. Unlike
industrial wastes which vary depending on the type of
processes or sectors (i.e. chemical, petroleum, municipal
etc.), medical waste compositions remain more or less
the same.
Regardless of its quantity and where it is generated,
medical waste has serious sometimes fatal effects on
exposure. Medical staff, janitors, medical center visitors
and patients are exposed to the risk of infection and dis-
eases as a result of exposure. Thus, medical waste haz-
ards and risks exist not only for the waste generators and
operators, but also for the general community including
children who play near disposal areas. The possible ex-
posure pathways include direct contact, airborne trans-
mission, contaminated water sources and the environ-
ment in general.
3. Medical Waste Management Techniques
There are several methods to minimize the hazards re-
sulting from medical waste [10].
3.1. Segregation
Segregation is useful since it prevents the contamination
of non-hazardous waste by the hazardous waste and
making the whole waste stream hazardous. Thus, this
method will reduce the toxicity and the volume of the
waste stream. Moreover, segregation makes it easier to
transport the waste. Waste is segregated depending on
the quantity, composition, and the disposal method of the
waste stream.
3.2. Separating Different Categories of Medical
In medical centers, infectious and pathological waste,
and sharps are placed in different containers. The con-
tainers are labeled as “biohazard”, closed, water tight and
of uniform color for each type of medical waste through-
out the medical center. The size of the containers de-
pends on the volume of waste generated and the contain-
ers used are easy to handle and transport. For used nee-
dles specially designed containers are used.
The system for segregation, packaging, labeling and
marking involves separating the medical waste into
categories, as described. The packaging is done in col-
ored bags [12]. For example, yellow plastic bags are used
for infectious medical waste that is meant to be disposed
by means of incineration or deep burial in landfill. How-
ever, if they are to be treated by autoclave or microwave,
they are placed in red plastic bags or containers. In steam
autoclaving, the waste is decontaminated by the effects
of the saturated steam at elevated temperatures and high
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Medical Waste Management and Control 1627
pressure. This method is not applicable for pathological,
chemotherapy and radioactive wastes.
Hazardous waste packaged in either blue or white
transparent bags is usually treated by autoclave, micro-
wave, chemical treatment and shredding, or by landfill-
ing. As for labeling and marking, medical wastes are
popularly known to have the bio-hazard symbol. Both the
packaging and labeling are adopted worldwide. The dif-
ference is in treatment methods [12].
3.3. Disinfection
In order to reduce the toxicity of some medical wastes,
chemical disinfectants (i.e. chlorine dioxide, sodium hy-
pochlorite, or per acetic acid) are sometimes used. For
solid wastes, disinfection is effective if only waste mate-
rials are shredded. In some cases, the disinfectants them-
selves are hazardous, thus it is not recommended for
treating pharmaceutical, chemical and some types of in-
fectious waste.
3.4. Incineration
Incineration is the process of destructing waste by burn-
ing it at elevated temperatures in furnaces. The process
removes hazardous materials, reduces the mass and
volume of the waste and converts it into ash that is
harmless. Incineration is suitable for wastes that are 60%
combustible. Incineration is suitable for pathological and
infectious waste or sharp wastes. Incinerators exist in
several different types; each type has a specific function.
A mobile incinerator called “drug terminator” is used for
disposal of pharmaceuticals. A diesel fired medical waste
incinerator called “MediBurn” treats pathological and
infectious waste in small medical facilities, and laborato-
ries [13]. This unit is portable and easy to operate and it
can incinerate everything from laboratory waste to ani-
mal remains.
The advantage of incineration process is that the vol-
ume of the waste that will remain for disposal will be
reduced by 50 - 400 times [14]. Incineration has a sig-
nificant advantage of decreasing the volume of the
wastes; however its disadvantages include high costs,
smoke generation and pollution risks. Incinerators used
in hospitals produce more furans and dioxins than incin-
erators used in municipality. This higher concentration of
furans and dioxins are due to a) frequent startups and
shutdowns b) less stringent emission controls c) poor
combustion control (e.g., waste mixing and oxygen con-
trols), and d) differences in the waste feed composition
as compared with municipal solid waste [15]. Incinera-
tors are usually built with a chimney to reduce the smoke
and its effect on pollution. Moreover, incinerators are
usually located at least 100 m away from the medical
center in order to reduce the effect of smoke. A pit below
the incinerator is usually available in order to collect the
ashes. Incineration is one of the most efficient methods
of disinfecting medical waste.
3.5. Disinfection by Plasma
In this process, low temperature plasma which is pro-
duced by the plasma generator using air as working fluid
organizes a combustion process. The medical waste is
constantly mixed, thus it maximizes the heat and mass
exchange which saves any energy loss. The heat pro-
duced is used as an additional heat source in the process.
This technology eliminates the formation and release of
irregular forms of NOX and high-toxic substances (i.e.
dioxins) into the atmosphere. Another main advantage is
that it has low consumption of energy compared to other
mineralization (i.e. combustion) processes [14].
3.6. Emerging Technology
A new technology for management of hazardous medical
waste that transforms the regulated medical waste into
municipal solid waste is recently introduced. This
method involves shredding and grinding the infectious
medical waste bags via sharp cutting blades that are in-
stalled within the vessels. The blades rotate around 1750
revolutions per minute and the volume of the shredded
waste is reduced by 80% [16]. The steps included in
the process are loading, shredding, heating, sterilization,
cooling, draining, vacuum and unloading. The whole
process is enclosed in a compact system and there is no
intermediate handling of the waste within the process.
Due to the compact size, this system can easily be used
for on-site treatment of the waste and installed in hospi-
tals. This will reduce the transportation costs of the
medical wastes. In terms of environmental aspects, it is a
clean and chemical-free technology and does not have
any hazardous emission or radiation [16]. This method is
economical and environmentally friendly and is reliable
in terms of ease of use and maintenance. This technology
is currently practiced in the middle-eastern countries
such as Iraq, Jordan, Kuwait, Lebanon, Syria and UAE.
Similarly, a team of engineers in Idaho National
Laboratory, USA have invented a new patented technol-
ogy that helps in better management and treatment of the
medical wastes. Based on this technology, Med-Shred,
Inc., (Texas, USA) has developed a mobile shredding
and chemical disinfecting machine that is aimed for
on-site treatment of hazardous medical waste [17]. The
machine converts the medical waste into disposable mu-
nicipal waste using shredders that shred the waste into
smaller particles which are then wetted with disinfectant
spray and immersed in a disinfection solution. The wet
waste is then dried using a hot off-gas in a drying cham-
ber. Considering the number of clinics and hospitals in
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Medical Waste Management and Control
Copyright © 2012 SciRes. JEP
middle-east, this method will be very successful if util-
ized, as it can treat the medical waste on-site which helps
in better management of wastes.
4. Conclusion
Medical wastes are highly hazardous and put people un-
der risk of fatal diseases. The understanding of medical
waste management and control techniques is important.
In this paper, introductory materials on the definition of
medical waste, medical waste management regulatory acts,
the risks of exposure, medical waste management proce-
dures and control techniques are presented.
5. Acknowledgements
The author acknowledges feedback of chemical engi-
neering students from the American University of Shar-
jah (AUS) and medical staff of Al-Qassimi Hospital,
Sharjah, UAE.
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... Typically, hospital waste could be hazardous or non-hazardous. Exposure to hazardous waste induces physical, chemical, or microbiological hazards to the population and medical care laborers related to handling, treatment, and removal of waste [1]. It is estimated that around 15% of the total MW is assumed to be hazardous MW [2] and this value could reach as high as 35%, depending on the characteristics of the waste and the remaining is nonhazardous. ...
... Hazardous waste is divided into infectious and non-infectious or dangerous waste. Infectious waste contains pathogens that could provoke an infectious disease in a susceptible host; thus, it requires special treatment to inactivate the corresponding biohazards [1]. On the other hand, dangerous waste could produce poisoning, intoxication, reproductive health problems, or physical injuries. ...
... Rather than utilizing external water input, converters use the dampness present in the treatment chamber to acquire steam disinfection. It is a clean and chemical-free technology, reliable in terms of usability and maintenance, and does not discharge any unsafe emissions or radiations [1]. Shredding is carried out via sharp cutting blades, for which the volume is decreased. ...
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The management of medical waste is of great importance due to its infectious and hazardous nature that pose considerable amount of risks to the environment and public health. This study evaluated medical waste management practices in selected hospitals in Bauchi. It involved reconnaissance survey, questionnaire survey and interviews. Stratified random sampling technique was used, in which one hospital was selected in each of the ten (10) administrative wards of the study area, namely; Birshi, Makama A, Makama B, Tirwin, Dan Kade, Dawaki, Dan Amar A, Dan Amar B, Hardo and Dan iya ward. The results revealed that majority of the hospitals do have receptacle medical waste containers in and around the hospitals. All the public hospitals have color coded receptacles/storage containers while the private hospitals do not use color coding for their receptacles/containers. Majority of the waste handlers in all the hospitals were aware of the use and importance of personal protective equipment (PPE) but majority of them rarely use appropriate personal protective equipment during work. Another finding on personal hygiene shows that majority of the respondents were at risk of the effect of waste contamination due to improper personal hygiene that can limit the occupational safety considerations and subsequently pass hazard among the waste handlers. It is, therefore, recommended that Government should promote regular monitoring and evaluation of hospital waste management practices and performance of the systems periodically.
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The COVID-19 pandemic has been affecting world economies, business revenues, and the livelihood of many individuals, and has also resulted in accumulated medical waste. Countries, governments, and health workers are striving to contain this virus by applying different strategies and protocols. This research investigates and identifies the significant determinants that influence the acceptance and Adoption of non-hazardous medical waste recycling behaviour in Kuwait. This article questions whether healthcare workers in Kuwait are actually behaving differently regarding non-hazardous medical waste recycling during the pandemic as opposed to previously. The study uses a deductive research approach involving a quantitative methodology by applying the theory of planned behaviour as a framework. From an overall perspective, individuals have positive intentions and behaviours toward recycling. However, COVID-19 and the fear of spreading the virus had a positive impact on the healthcare workers' recycling behaviour in public hospitals in Kuwait.
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The management of hazardous wastes has changed dramatically over the past two decades and will continue to evolve as knowledge of both the hazards and management methods grows. This book provides a comprehensive introduction to a complex interdisciplinary field. Part 1 provides background material for a complete understanding of hazardous wastes. Part 2 examines the methods currently used by management in industry to understand the magnitude of hazardous waste problems and how to avoid many of the problems of the past. Part 3 contains a selection of treatment and disposal methods. Because literally hundreds of such methods exist, the authors chose some of those methods in contemporary practice and a few emerging technologies to permit an in-depth presentation for the processes selected. Part 4 covers site remediation. This includes the characterization of a site, the assessment of risks that it poses, and the development and selection of remedies.
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Medical waste is infectious and hazardous. It poses serious threats to environmental health and requires specific treatment and management prior to its final disposal. The problem is growing with an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh. However, research on this critical issue has been very limited, and there is a serious dearth of information for planning. This paper seeks to document the handling practice of waste (e.g. collection, storage, transportation and disposal) along with the types and amount of wastes generated by Health Care Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas provided us with relevant information. The methodology for this paper includes empirical field observation and field-level data collection through inventory, questionnaire survey and formal and informal interviews. A structured questionnaire was designed to collect information addressing the generation of different medical wastes according to amount and sources from different HCE. A number of in-depth interviews were arranged to enhance our understanding of previous and existing management practice of medical wastes. A number of specific questions were asked of nurses, hospital managers, doctors, and cleaners to elicit their knowledge. The collected data with the questionnaire survey were analysed, mainly with simple descriptive statistics; while the qualitative mode of analysis is mainly in narrative form. The paper shows that the surveyed HCE generate a total of 5,562 kg/day of wastes, of which about 77.4 per cent are non-hazardous and about 22.6 per cent are hazardous. The average waste generation rate for the surveyed HCE is 1.9 kg/bed/day or 0.5 kg/patient/day. The study reveals that there is no proper, systematic management of medical waste except in a few private HCE that segregate their infectious wastes. Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse. The paper reveals that lack of awareness, appropriate policy and laws, and willingness are responsible for the improper management of medical waste in Dhaka City. The paper also shows that a newly designed medical waste management system currently serves a limited number of HCE. New facilities should be established for the complete management of medical waste in Dhaka City.
Purpose The purpose of this paper is to determine the amount of different kinds of solid wastes produced, segregated, collected, stored, transported and disposed off in the governmental hospitals of Kuwait. Design/methodology/approach The research in this paper shows that all governmental hospitals were assessed in a period of six months (September, 2005 through December, 2005 and June, 2006 through July, 2006). The weight fraction of each component in the sorting sample was calculated by the weights of the components. The amount of non‐infectious and infectious waste generated in kg/day in each ward and various hospital blocks were determined and recorded. Findings The findings in this paper indicated that the waste generation rate is between 3.87 kg/bed/day and 7.44 kg/bed/day. Subsequently, this waste consists of 10,534.5 kg (71.44 percent) of domestic waste, 4,099.4 kg (27.8 percent) of hazardous/infectious waste, and 112.1 kg (0.76 percent) of sharps. Hospital waste makes up approximately 30 percent of all the hazardous waste generated in Kuwait. Segregation of the different types of wastes is practiced in nearly all of the hospitals. All infectious/medical wastes are finally disposed of through incineration. Practical implications The paper shows that the hospitals under study do not organize training courses on hospital waste management and the hazards associated with them. There is a need to establish a detailed database regarding the quantity and quality of the waste generated by the various hospitals. Originality/value This paper systematically assesses the obstacles in the existing hospital solid waste management system in all governmental hospitals in Kuwait. Subsequently, recommendations and improvements are suggested.
The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past medical waste was often mixed with municipal solid waste and disposed of in residential waste landfills or improper treatment facilities (e.g. inadequately controlled incinerators) in Korea. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better manage the waste from healthcare facilities. This paper presents an overview of the current management practices of medical waste in Korea. Information regarding generation, composition, segregation, transportation, and disposal of medical wastes is provided and discussed. Medical waste incineration is identified as the most preferred disposal method and will be the only available treatment option in late 2005. Faced with increased regulations over toxic air emissions (e.g. dioxins and furans), all existing small incineration facilities that do not have air pollution control devices will cease operation in the next few years. Large-scale medical waste incinerators would be responsible for the treatment of medical waste generated by most healthcare facilities in Korea. It is important to point out that there is a great potential to emit air toxic pollutants from such incinerators if improperly operated and managed, because medical waste typically contains a variety of plastic materials such as polyvinyl chloride (PVC). Waste minimization and recycling, control of toxic air emissions at medical waste incinerators, and alternative treatment methods to incineration are regarded to be the major challenges in the future.
This report describes the technology used for plasma-chemical disinfection of hazardous medical waste (HMW), which employs high-temperature mineralization. This method uses low-temperature plasma produced in a plasma generator as an additional source of heat energy. The method not only neutralizes medical waste, but it also reduces by 50-400 times the volume of waste being buried. The waste-combustion process includes the following stages: two-stage combustion in the furnace at a temperature of 1000°C-1200°C and in the afterburning chamber at a temperature of 1200°C-1300°C, with dwell time of flue gases no less than 2 s; obligatory quenching (fast cooling) of flue gases; multistage cleaning of flue gases of fly ash, vapors of heavy metals, acid gases, and, if necessary, dioxins and furans; automated control of mode parameters, ejection into the atmosphere and control of all technological processes; low-consumption factors on energy and used reagents. The installation is designed for treatment of 150 kg/h of HMW and it employs a rotary kiln with parallel-current flow of burned waste and incandescent gases for plasma combustion of the waste. This allows the burning waste to be constantly mixed, which prevents fusion or baking into layers, and thus intensifies the processes of heat and mass exchange. Waste is supplied into the furnace periodically through the system of trays using pneumatic pushers. Two plasma generators are mounted on the loading end of the furnace, and one is mounted on the afterburning chamber. Slag is unloaded from the furnace by quenching it with water. After quenching, cooling, and discharging the slag, it is disposed of. The gas cleaning system consists of a Venturi scrubber, a packed-bed scrubber, a demister, and an absorber. This technological process solves several problems involved in collecting, packing, and disposing of HMW by automating the loading processes, organizing combustion regimes, and cleaning flue gases.
Waste Management at Medical Centers
WHO, (The World Health Organization), " Waste Management at Medical Centers, " 2010. 08CD.pdf