Hesperian Health Guides

Preventing Harm from Health Care Waste

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HealthWiki > A Community Guide to Environmental Health > Chapter 19: Health Care Waste > Preventing Harm from Health Care Waste

Whether in a small health post, a larger clinic, or in the home, medical tools and health care waste must be managed safely to prevent harm.

  • Reduce the amount of waste by choosing medical supplies carefully.
  • Separate wastes where they are created.
  • Disinfect wastes that carry germs.
  • Treat chemical wastes to make them less harmful.
  • Safely store and transport waste.
  • Dispose of health care wastes in the least harmful way possible.
  • Train everyone who handles health care waste about safe methods.
health care workers wear masks as they spray cleaning solution.

No matter what methods your clinic, center, or hospital uses, make sure everyone who handles health care waste, especially new people, understands what needs to be done and why. Often, people will bring up new ideas that can make work easier and safer for everyone. Some clinics have a team of people who are responsible for training and checking safe practices.

Reducing waste

A salesman tries to get a health worker to buy plastic sheet covers.
Try our new disposable plastic sheet covers!
Does our clinic really need this?

Using fewer and less harmful materials will reduce the amount of harmful health care waste. When choosing materials for your clinic, think about what kind of waste will be produced, how harmful it will be, and how you will dispose of it.

To reduce the amount of harmful waste:

  • Avoid using disposable items if a reusable choice is available and safe to use. (Syringes and needles should not be reused.)
  • Use non-mercury thermometers if they are available. They cost more but are more durable and less dangerous if they break.
  • Do not buy more medicines than you need, and use them only when necessary.
  • Use pills instead of injections.
  • Use non-plastic items when possible.
  • Use the least toxic products to clean and disinfect whenever possible.
  • Look for IV bags, tubing, and other materials made without PVC. They are cheap and available in some places, and are always safer for patients and the community.

Separating waste

2 people working in a garden outside a health post.
Food waste from the health center can be composted and used in gardens.

Separating waste where it is created is another important step in safe handling of health care waste.

Separating wastes greatly reduces risks to health center workers and to people who collect, sell, and recycle waste. Separation also reduces the amount of waste that must be treated or buried later and reduces the cost of waste management.

Separating waste into colored containers

Many health centers separate wastes into different colored containers at the places where waste is created. For this to be a useful method, everyone in the health center needs to understand which waste goes into which color container. Different countries use different colors for each type of waste. For example, in some countries the color red means "danger." So containers for used needles and other sharp tools, and other harmful or toxic wastes are red or marked with red paint, marker, or tape.

More than half of all waste from health centers is just like household waste: paper, cardboard, bottles, cans, and kitchen scraps. When this waste is separated out, it is much easier to manage the harmful waste.

EHB Ch19 Page 426-1.png
Regular waste can be put into bags and bins and, as much as possible, recycled, turned into compost, or reused.

Containers should be:

  • placed close to where waste is created.
  • clearly marked with colors and symbols.
  • strong enough so they do not leak or break.
  • easy to seal and transport without risk of spills, leaks, or breaks.
  • big enough to hold a full day’s waste when only ¾ full.

It is best to use containers and bags that are the same color for the same kind of waste. If this is not possible, mark them with colored tape or paint. Always using the same colors can help workers who do not read — and even those who do — remember which containers are for regular waste and which are for harmful wastes.

Storing and transporting waste

A man wearing gloves and a mask removes a bag from a bin labelled "infectious."

Health care waste needs to be stored carefully until it can be safely taken to its final disposal site. Health care waste containers should be placed where waste is created and disinfected, never in hallways, bathrooms, or other places where people might spill them or fill them with mixed waste.

Seal waste bins and bags when they are ¾ full. Bins and bags ¾ full are less likely to spill or break, and will reduce the chances of injury to a worker picking them up. Never put used needles and other sharp instruments in bags. If a bag breaks or leaks, put it inside another bag. Store sealed bags in a closed room until they can be removed from the site. The room should be secure so people who collect trash to sell it cannot get to it.

Health care waste can be stored safely only for a short time. Soon it begins to smell bad and can spread infection as it decays. It is best to remove waste daily. Never store waste for more than 3 days. Your nose will tell you when you have waited too long!

Use carts or trolleys that are easy to clean to remove waste from the center. It is safest to clean carts after each use, and to use carts that have no sharp edges that could damage bags or containers during loading or unloading.

Prevent harm when handling waste:

  • Wear protective clothing to reduce risks from needles or other sharp tools, germs, or splashes from blood, other liquids or chemicals.
  • Immediately after they are used, put used needles and other sharp tools in sharps boxes. Do not put sharp things in bags or with other waste.
  • Wash hands after handling waste, and before and after working with every patient.
  • Never carry uncovered (uncapped) needles.
  • Do not let waste touch your skin. If protective clothing gets soaked through with contaminated wastes, take it off immediately, and wash yourself with lots of soap and water.
  • Protective clothing only protects if it is clean. After each use or at the end of each shift, wash or disinfect gloves, aprons, glasses, and masks. This will protect the next person who uses them.

If your center does not have protective clothing, use available materials for protection. For example, use plastic garbage bags to make protective aprons, pants, masks, and hats. Some protection is better than none at all.

Disinfecting Waste

Disinfection means killing germs that cause infection. As much as possible, health care waste should be disinfected in the same place where it is created. The most common ways to disinfect are to use chemicals (such as chlorine bleach, hydrogen peroxide, or other chemicals) or heat (boiling, steaming, pressure steaming, autoclave, or microwave).

After waste is disinfected, it can be safely buried.

What is sterilizing and what is disinfecting?

Some health care manuals use the word sterilizing rather than disinfecting. Sterilizing and disinfecting are not the same and many people confuse them.

Sterilizing means killing all of the germs on something. It is very difficult to do this.
Disinfecting means killing enough of the germs on something that so that it will not transmit infection.

Many people use the word sterilization for proper treatment of health care equipment, and the word disinfection when talking about cleaning floors and other surfaces with ‘disinfecting cleaners.’ But there are different levels of disinfection.

The treatments described in this book are ‘high-level disinfection’ which means killing almost all the germs on something. For this reason, we use the word disinfection for all of the methods in this book.

What wastes need to be disinfected?

Any materials in a health center that are contaminated with blood, body fluids, or feces, or that have been in close contact with a person with a contagious disease, need to be disinfected to prevent the spread of infection and disease.

Wastes that need disinfection:

Wastes that do not need disinfection:

EHB Ch19 Page 428-4.png
  • body parts
  • wastewater from disinfection and cleaning
  • chemicals from disinfection, cleaning, and laboratory tests
  • food waste
  • any materials not contaminated with blood or body fluids (cardboard, paper, plastics, glass, metal)
EHB Ch19 Page 428-2.png
  • used needles and other sharp tools
  • blood and other body fluids
EHB Ch19 Page 428-1.png
  • bandages, swabs, and other wastes that carry body fluids
  • other items contaminated with blood, body fluids, or feces
EHB Ch19 Page 428-3.png
  • feces from people with infectious disease (such as cholera)
  • bedding and bedpans from all people