23.1  Sources and classification of healthcare waste

Healthcare waste can be defined as any waste produced by healthcare activities. It may also be known as medical waste, hospital waste or infectious waste. The major sources include hospitals, Health Posts, emergency medical care services, healthcare centres and dispensaries, obstetric and maternity clinics, outpatient clinics, and the like. Other sources are dental clinics, psychiatric hospitals, cosmetic ear-piercing and tattoo parlours, and illegal drug users. Healthcare waste can be put into one of two broad categories; non-hazardous ‘general waste’ and hazardous ‘healthcare risk waste’.

Between 75% and 90% of the waste produced in healthcare establishments is general waste. This includes papers, packaging materials, dust and the like. This can be disposed of in the same way as other non-hazardous wastes, but only if is not contaminated by contact with hazardous wastes. The remaining 10–25% of waste is hazardous and could be composed of sharps (needles, lancets, etc.), syringes, blood or body fluid, contaminated surgical instruments, delivery bowls, used gauzes and gloves, plasters, etc. It may also contain expired drugs, lab reagents and other chemicals. Your main concern here should be on managing the hazardous wastes in a safe way. However, you should not ignore non-hazardous wastes, because poor handling and segregation can lead to them being contaminated with hazardous materials.

You can categorise hazardous healthcare waste into:

• Infectious waste: waste that may contain pathogens. This includes used dressings, swabs and other materials or equipment that have been in contact with infected patients or excreta. It also includes liquid waste such as faeces, urine, blood and other body secretions.
• Pathological waste: human tissues including placentas, body parts, blood and fetuses. Anatomical waste is a sub-group of pathological waste and consists of recognisable body parts.
• Sharps: needles, infusion sets, scalpels, blades and broken glass.
• Pharmaceutical waste: expired or no longer needed pharmaceuticals; items contaminated by or containing pharmaceuticals (bottles, boxes).
• Genotoxic waste: substances with genotoxic properties (meaning they can cause genetic damage) such as certain drugs and genotoxic chemicals.
• Chemical waste: wastes containing chemical substances such as laboratory reagents, film developer, disinfectants that are expired or no longer needed, and solvents.
• Waste with high content of heavy metals: includes batteries, broken thermometers, blood-pressure gauges, etc.
• Pressurised containers: gas cylinders, gas cartridges and aerosol cans.
• Radioactive waste: containing radioactive substances from radiotherapy or laboratory research.

You should note that the last five on the list may not necessarily apply at Health Post level; however, you should be aware of these hazards in case you encounter them elsewhere.

Note also that infectious waste and pathological waste are overlapping categories. Blood, for example, is in both categories. All pathological waste should be considered as potentially infectious. Following the precautionary principle, pathological waste must be handled and disposed of as if it were infectious.