Over the past few years the health care facilities in the community are improving resulting into the increase in the production of the clinical waste. The waste is produced not only at the patient’s homes or at clinics and health centres but also at various other producers like dentists, vets, laboratories, etc.  There are several organisations which are involved in the collection and disposal of the waste which includes governmental organisations and some private contractors. 

The clinical waste management has been neglected in the past. But in the last 2 – 3 years there has been a significant change observed in the management of the clinical waste. The article attempts to provide information and answers to what clinical waste management is, who produces it, how to manage and collect it.

What is clinical waste?

Clinical waste refers to the waste produced from the healthcare sector. The waste requires special treatment and disposal as it consists of various hazardous and infectious waste like cotton swabs, dressings, pharmaceutical products etc.  The waste produced by hospitals and medical settings has been classified into two categories: clinical waste and standard refuse. 

Clinical waste is produced from various medical procedures and consists of six different types of waste material ie Sharps, Infectious - waste, Pathological, Pharmaceuticals and the Radioactive waste. The disposal of the clinical waste is strictly monitored by legislation and procedures. 

Standard refuse: Apart from the clinical waste the hospitals also produce other kinds of general waste. The waste is generated from the patients, visitors, staff, offices, kitchens etc. There are no strict guidelines for the treatment of standard waste for this type of waste.  

According to the guidelines of the joint Agency (EA, SEPA, and EHS) the following clinical wastes are identified as hazardous waste:

 
(a) Infectious waste: It includes all waste that needs to be sent for specialist treatment and disposal because of its potentially infectious nature. The waste material is placed in the clinical waste bags and sharps boxes and is sent for treatment before disposing.

(b) Cytotoxic and cytostatic waste: Cytotoxic drugs or the chemotherapy drugs kill the damaged cells. Cytostatic drugs are those that inhibit or suppress cellular growth and multiplication. These two are considered as the hazardous waste and have to be disposed of properly as they even cause harm to the environment.

(c) Dental amalgam. 

Average composition of Hospital Waste in India

 Flow of clinical waste

Segregation:
According to the Hazardous Waste Regulations it is the responsibility of the waste generators to separate hazardous and non-hazardous wastes. While segregating the waste the producers should consider the concept of infectious waste this means that producers should be encouraged to part all the non-clinical waste items from the clinical waste items.  

The separation of medical waste is to some extent complicated and requires knowledge about the hazardous characteristics of each medicinal product.  The separation work should be carried out under the guidance of a pharmacist. 
 
Collection:
It is the responsibility of the producer of the waste that the waste is managed correctly.  This means that the producer should make sure that the waste is packaged, stored, transported and treated properly. 

The clinical waste can be collected in the following ways:
He can remove the waste from the site.
He may arrange for a private contractor or the local authority to collect the waste from the site.

Thirdly and lastly the clinicians can provide a ‘take-back’ service. They should collect back sharps boxes from self medicating patients.
 
Storage or Packaging:
The packaging and labelling requirements for all dangerous goods has been specified by the Carriage of Dangerous Goods Regulations. According to the regulations the clinical waste, potentially infectious waste and the medicinal waste are categorised as dangerous goods and while packaging should be labelled as such.  

Transportation:
Contractors are employed to carry medicinal waste on the behalf of the waste producers. These contractors have to be Registered Waste Carriers.  It is an offence to transport waste by an un-registered waste carrier and those transferring the waste can be fined. The drivers of the vehicles which carry dangerous goods should be trained properly and possess a vocational training certificate applicable to the class of goods (dangerous) that they carry.  

The need for the vocational training is dependent on the load that the vehicle can carry. The Carriage Regulations has termed ‘Load thresholds’ for goods, where if the vehicle is carrying more load then its carrying capacity then the driver requires training 

“The United Nations Conference on the Environment and Development (UNCED), in 1992, adopted the Agenda 21, which recommends a set of measures for waste management. The set of recommendations includes:

• Prevention and minimisation of production
  
• Reuse or recycling of wastes to the extent possible
  
• Treatment of wastes by safe and environmentally-sound methods

 

Disposal of final residues by landfill in confined and carefully-designed sites  
 
The Agenda 21 also stresses that waste producers should be made responsible for the treatment and final disposal of its own wastes; where possible, each community should dispose of its wastes within its own boundaries.”

To achieve up to standard practices in healthcare waste management and conformity with the set of laws, it is essential for all managers, producers, handlers, transporters,  disposers and other personnel involved receiving appropriate training and know how they affect the social setting in order to ensure conformity and attain long term sustainability. The central government should also assist in the grounding of "train the trainer" activities, and competent institutions for the trainers' programme should be identified.