ICS 13.030.30  
 
Reference number  
RS 209: 2020  
© RSB 2020  
  
 RWANDA 
STANDARD  RS 
209  
 
Second  edition  
2020 -mm-dd 
 
Waste within healthcare facilities — 
Handling and disposal — Code of practice  
   
DRS 209: 2020  
©RSB 2020  - All rights reserved                  ii 
 In order to match with technological development and to keep continuous progress in industries, 
standards are subject to periodic review. Users shall ascertain that they are in possession of the latest 
edition  
 
 
 
 
 
 
 
 
© RSB 2020  
All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized 
in any form or by any means, electronic or mechanical, including photocopying and microfilm, without 
prior written permission from RSB.  
Requests for permission to reproduce this document should be a ddressed to:  
Rwanda Standards Board  
P.O Box 7099 Kigali -Rwanda  
KK 15 Rd, 49  
Tel. +250 788303492  
Toll Free: 3250  
E-mail: info@RSB.gov.rw  
Website: www.RSB.gov.rw   
ePortal: www.portal.RSB.gov.rw   DRS 209: 2020  
iii                ©RSB 2020  - All rights reserved  
 Contents  Page 
1 Scope  ................................ ................................ ................................ ................................ ......................  1 
2 Normative references  ................................ ................................ ................................ ............................  1 
3 Terms and definitions  ................................ ................................ ................................ ...........................  1 
4 Symbols (and abbreviated terms)  ................................ ................................ ................................ ........  8 
5 Occupational hazards and health risks  ................................ ................................ ...............................  8 
6 General provisions  ................................ ................................ ................................ ................................  9 
6.1 segregation of wastes.  ................................ ................................ ................................ ..........................  9 
6.2 In-house control  ................................ ................................ ................................ ................................ .. 10 
6.3 Closure and bagging of waste -holding plastic bags  ................................ ................................ ....... 11 
6.4 Intermediate and final storage areas  ................................ ................................ ................................ . 11 
6.5 Movement of waste  ................................ ................................ ................................ .............................  12 
6.6 Disposal  ................................ ................................ ................................ ................................ ................  12 
6.7 Maintenance and cleaning operations  ................................ ................................ ..............................  13 
6.8 Spill or accident clean ups  ................................ ................................ ................................ .................  14 
7 Human/animal anatomical waste  ................................ ................................ ................................ ....... 14 
7.1 Composition  ................................ ................................ ................................ ................................ .........  14 
7.2 Subcategories  ................................ ................................ ................................ ................................ ...... 15 
7.3 Human anatomical waste  ................................ ................................ ................................ ...................  15 
7.4 Animal anatomical waste  ................................ ................................ ................................ ....................  16 
8 Infectious non anatomical waste  ................................ ................................ ................................ ....... 18 
8.1 Compositio n ................................ ................................ ................................ ................................ .........  18 
8.2 Containment  ................................ ................................ ................................ ................................ .........  18 
8.3 Collection  ................................ ................................ ................................ ................................ .............  19 
8.4 Final storage areas  ................................ ................................ ................................ ..............................  19 
8.5 Disposal  ................................ ................................ ................................ ................................ ................  19 
9 Sharps and similar waste  ................................ ................................ ................................ ...................  20 
9.1 Composition  ................................ ................................ ................................ ................................ .........  20 
9.2 Containment  ................................ ................................ ................................ ................................ .........  20 
9.3 Collection  ................................ ................................ ................................ ................................ .............  20 
9.4 Disposal  ................................ ................................ ................................ ................................ ................  20 
10 Chemical/pharmaceutical waste  ................................ ................................ ................................ ........  21 
10.1  Chemical waste  ................................ ................................ ................................ ................................ .... 21 
10.2  Hazardous chemicals  ................................ ................................ ................................ ..........................  22 
10.3  Pharmaceutical waste  ................................ ................................ ................................ .........................  22 
11 Pressurized container waste  ................................ ................................ ................................ ..............  26 
11.1  Containment  ................................ ................................ ................................ ................................ .........  26 
11.2  Collection  ................................ ................................ ................................ ................................ .............  26 
11.3  Disposal  ................................ ................................ ................................ ................................ ................  26 
12 General waste  ................................ ................................ ................................ ................................ ...... 26 
12.1  Characteristics  ................................ ................................ ................................ ................................ ..... 26 
12.2  Containment  ................................ ................................ ................................ ................................ .........  26 
12.3  Collection and disposal  ................................ ................................ ................................ ......................  27 
12.4  Kitchen waste  ................................ ................................ ................................ ................................ ...... 27 DRS 209: 2020  
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 12.5  Non-clinical glass waste (Containment and disposal) ................................ ................................ .... 27 
13 Movement of waste to final disposal sit e ................................ ................................ .........................  27 
13.1  General  ................................ ................................ ................................ ................................ .................  27 
13.2  Movement  ................................ ................................ ................................ ................................ ............  27 
13.3  General and decontaminated waste  ................................ ................................ ................................ . 28 
14 Best environmental practices concerning health -care waste management  ................................  28 
14.1  General  ................................ ................................ ................................ ................................ .................  28 
14.2  Health -care waste management  ................................ ................................ ................................ ........  28 
14.3  Training of personnel  ................................ ................................ ................................ .........................  29 
14.4  Collection at the site of waste generation  ................................ ................................ ........................  29 
14.5  Transportation to the intermediate storage area  ................................ ................................ .............  29 
14.6  Best Available Techniques (BATs) for the incineration of health -care waste  ..............................  30 
Annex  A (informative)  Waste disposal methods  ................................ ................................ .........................  33 
 DRS 209: 2020  
v                ©RSB 2020  - All rights reserved  
 Foreword  
Rwanda  Standards are prepared by Technical Committees and approved by Rwanda Standards Board (RSB) 
Board of Directors in accordance with the procedures of RSB, in compliance with Annex 3 of the WTO/TBT 
agreement on the preparation, adoption and application of st andards.  
The main task of technical committees is to prepare national standards. Final Draft Rwanda Standards 
adopted by Technical committees are ratified by members of RSB Board of Directors for publication and 
gazettment as Rwanda Standards.  
RS 209 was p repared by Technical Committee RSB/TC 013, Water and Sanitation . 
In the preparation of this standard, reference was made to the following standard:  
1) MS 615: 2005, Waste within healthcare Handling and disposal practice facilities — Code of practice  
The assistance derived from the above source is hereby acknowledged with thanks.  
This second edition cancels and replaces the first edition RS 209: 2014 which has been technically revised.  
Committee membership  
The following organizations were represented on the Technical Committee on Water and Sanitation (RSB/TC 
013) in the preparation of this standard.  
Ministry of Emergency Management (MINEMA)  
Ministry of Trade and Industry (MINICOM)  
Ruliba Clays  
Paragraph of participants Rwanda Development Board (RDB)  
Rwanda  Mines, Petroleum and Gas Board (RMB)  
Rwanda Polytechnic (RP)  
Rwanda Utility Regulatory Authority (RURA)  
Shine Engineers Multisectoral Company Ltd (SEMC)  
Standards for Sustainability (SFS)  DRS 209: 2020  
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 University of Rwanda - College of Science and Technology (UR -CST)  
Rwanda Standards Board (RSB) – Secretariat  
 DRS 209: 2020  
1                ©RSB 2020  - All rights reserved  
 Waste within health care facilities — Handling and disposal — 
Code of practice   
1 Scope  
1.1 This standard develops criteria for segregation, collection, movement, storage and on -site disposal of 
waste within healthcare units, biological research facilities, and veterinary facilities.  
1.2 It als o covers disposal of waste materials after removal from site of health care facility, the special 
precautions which may apply to infectious substances (or the transportation thereof), and efficiency of 
incinerators.  
1.3 This standard does not cover the dis posal of e -wastes (Covered by RS 276 -1 and RS 276 -2), radioactive 
wastes and the design of landfill dedicated to special wastes from healthcare facilities  
2 Normative references  
The following documents are referred to in the text in such a way that some or a ll of their content constitutes 
requirements of this document. For dated references, only the edition cited applies. For undated references, 
the latest edition of the referenced document (including any amendments) applies.  
RS 181: 2013 Solid waste handling , transportation and disposal – Code of practice  
3 Terms and definitions  
For the purposes of this standard, the following terms and definitions apply  
3.1  
chemical waste  
waste comprises discarded solid, liquid and gaseous chemicals e.g. from diagnostic or e xperimental work or 
from cleaning, housekeeping or disinfected procedures. Chemical waste may be hazardous or non hazardous. 
For the purposes of choosing the most appropriate waste -handling method, hazardous chemical waste is 
considered to be waste that is :  
a) toxic;  
b) corrosive (acids of pH < 2.0 and bases of pH > 12.0;  
c) inflammable;  
d) reactive (explosive, water reactive, shock sensitive);  
e) genotoxic (carcinogenic, mutagenic, teratogenic or otherwise capable of altering genetic material).   
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 NOTE  Non-hazardous chemical waste consists of chemical other than those described above such as sugars, amino 
acids and certain organic salts.  
3.2  
clinical glass  
glass possibly contaminated with blood and body fluids or chemicals e.g. blood collection tubes,  laboratory 
glass, medication vials  
3.3  
collection  
accumulation of waste from several primary or intermediate storage sites for movement to a waste holding 
area or from several waste holding areas for movement to a final storage area  
3.4  
colour coding   
application of indelible colour to a container in order to identify the category of waste for which it is to be used  
3.5  
container  
any receptacle for the storage of wastes. Containers can be classified into two subgroups  
3.5.1  
reusable waste contain er  
waste container that is:  
a) reusable;  
b) fabricated of metal or rigid plastics;  
c) with high resistance to burning, impact and corrosion;  
d) suitable for the waste it is to contain;  
e) colour -coded or identified according to the type of waste for which it is int ended by one of the following 
methods:  
1) if the container is made of plastics, the plastics may be dyed in the appropriate colour; and  
2) a band of colour not less than 50 mm in width may be applied to the container.  DRS 209: 2020  
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 3.5.2  
single -use waste container  
A waste container that can be any of the following:  
a) sharps container;  
b) waste -holding plastic bag;  
c) cardboard container; or  
d) specialized container.  
3.5.3  
“sharps” container  
A container that:  
a) is steady enough to resist puncture under siege conditions an d to the point of disposal;  
b) is clearly identified as containing sharps e.g. by the use of the word “Sharps” or symbol recognized by the 
facility;  
c) has lids capable of being tightly secured; and  
d) if used for containing cytotoxic waste, has cytotoxic symbol  displayed clearly and visibly.  
3.5.4  
cardboard container  
container made from cardboard and that is:  
a) colour coded or identified according to the type of waste for which it is intended (see Table 1).  
b) rigid; and  
c) leak resistant.  
3.5.5  
specialized containers  
specialized containers are colour -coded or identified according to the type of waste for which they are 
intended (e.g. paint cans)   
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 3.6  
cytotoxic  
having a deleterious effect upon cells commonly used in reference to pharmaceuticals  used in the treatment of 
cancer e.g. antineoplastics chemotherapy  
3.7  
disposal  
removal of waste from the site of health care facility and its final destruction, or the onsite incineration of waste  
3.8  
general waste  
waste that has not been included i n the other waste categories and does not pose a disease -related risk or 
threat to people or the environment. The general waste category includes:  
a) office waste;  
b) kitchen waste;  
c) non-clinical glass waste; and  
d) all other similar wastes.  
3.9  
hazardous wast e  
any waste or combination of wastes which pose a substantial present or potential hazard to human health or 
living organisms because they are lethal, non degradable and persistent in nature and requires special 
precaution in its storage, collection trans portation, treatment and disposal. Hazardous waste includes 
explosives, flammables, volatile, radioactive, toxic and pathological waste  
3.10  
human/animal anatomical waste  
3.10.1  waste consisting of:  
a) tissues;  
b) organs;  
c) body parts;  DRS 209: 2020  
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 d) products of conception; and  
e) animal carcasses.   
3.10.2  This waste category is divided into the subcategories of:  
a) human anatomical waste;  
b) infectious animal anatomical waste; or  
c) non-infectious animal anatomical waste.  
NOTE  The following are considered to  be non -anatomical wastes:  
a) blood and body fluids;  
b) extracted teeth;  
c) nail clippings; and  
d) hair.  
3.11  
health care facilities  
all places (sites) where professional health services are dispensed to human patients or biological research is 
carried out and includes inter alia, clinics, hospitals, rehabilitation centres, sick bays (old age homes), day 
units, clinics (mobile and stationery), veterinary facilities  
3.12  
infectious non -anatomical waste  
any waste contaminated with viable microorganisms capable of transmitting, and reasonably likely to transmit 
disease. This includes:  
a) all microbiology lab wastes that have not been decontaminated;  
b) waste from surgeries and autopsies performed on patients with infectious diseases; and  
c) all wastes contaminated with  a causative agent from patients designated as requiring specific hospital 
communicable diseases protocols.   
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 3.13  
movement  
transfer of waste materials between storage areas within the health care facility, or to the final disposal site 
away from the health care facility  
3.14  
non-clinical glass  
glass from maintenance and kitchen areas e.g. broken windowpanes and discarded gl ass bottles  
3.15  
pharmaceutical waste  
Pharmaceutical products such as drugs and medicinal chemicals that are no longer usable in patient 
treatment such as those that have been returned from patient care areas, have become out -dated or 
contaminated or ha ve been stored improperly, or are no longer required  
3.16  
pressurized container waste  
Consists of aerosol cans or disposable compressed gas containers that may explode if incinerated or 
accidentally punctured  
3.17  
refrigerated storage  
storage of waste  at a temperature of 4 °C or lower  
3.18  
segregation  
separation of waste according to classification prior to storage  
3.19  
“sharps”  
waste including but not limited to:  
a) needles,   
b) syringes;  DRS 209: 2020  
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 c) blades;  
d) clinical glass; and  
e) any other clinical items capab le of causing a cut or puncture.  
3.20 
soiled utility room  
intermediate storage room within the facility where waste from the patients’ bedside is temporarily stored  
3.21 
storage  
accumulation of waste after segregation in a specified container in a predetermined location  
3.22 
storage areas  
3.22.1  
final storage area  
area of the facility where waste is stored just before being disposed of  
3.22.2  
incinerator  
appliance capable o f withstanding heat, and designed to efficiently destroy, by combustion, solid, semi -solid, 
or liquid waste at specific conditions, such that the residue contains little or non -combustible material  
3.22.3  
intermediate storage area  
area of the facility w here waste is stored following collection from primary storage area and before being 
removed to final storage area. This includes the means by which the waste is transported  
3.22.4  
primary storage area  
area of the facility where waste originates   
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 3.22.5   
system  
waste management system belonging to the health care facility  
3.23  
waste holding  
storage of waste collected from all primary storage areas such as laboratory wing, operating rooms, or patient 
rooms  
4 Symbols (and abbreviated terms)  
UNEP  United Nations Environment Programme  
TEQ Toxic Equivalency  
SNCR  Selective Non Catalytic Reduction  
BAT  Best Available Technology  
SCR  Selective Catalytic Reduction  
HCl  Hydrogen chloride  
PDRSD/F  Polychlorinated dibenzo -p-dioxins/dibenzofurans  
HF  Hydrogen f luoride  
SO 2  Sulphur dioxide  
NO  Nitrogen oxide compounds  
5 Occupational hazards and health risks  
5.1 To minimize the occupational health risk associated with handling and disposal of health care waste, 
occupational health care programmes shall:  
a) provide for routine medical check -up for personnel handling waste and periodic review of the medical 
records;  
b) include written procedures to handle and report sharps injuries sustained while engaged in waste 
disposal;  DRS 209: 2020  
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 c) introduce safe or less hazardous subs titutes for chemical agents with exposure hazards (substance 
distribution inventories are helpful in finding out what agents are actually in use).  
d) require closed storage for volatile agents’ traces of which, or brief exposure to which, are a health hazard ;  
e) require use of proper venting and exhausting in accordance with the established principles of 
occupational hygiene;  
f) provide appropriate personal protective equipment with disinfections and disposal arrangements for 
workers involved in various stages of  waste handling and disposal;  
g) include an assessment waste management procedures on a regular basis, to assure compliance with this 
standard and all applicable regulations;  
h) include a training programme for all persons handling wastes; and  
i) include appropr iate protective equipment and washing facilities.  
5.2 Health facilities shall have (freely available to all personnel concerned) written policies and procedures, 
which include requirements for at least:  
a) the cautionary labelling of the containers of hazard ous materials;  
b) material safety data sheets;  
c) appropriate worker training for each system element;  
d) locations of particular waste containers;  
e) protection of proprietary information; and  
f) when applicable, compliance with relevant national and local regulations  
6 General provisions  
6.1 segregation of wastes.  
6.1.1  Waste shall be segregated according to the following categories that are detailed in Table 1:  
   
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 Table 1 ━ Summary of colour coding/labelling requirements  
1  2  3  
Waste category  Waste sub -category  Colour -coding/labelling  
Human/animal anatomical waste  Human anatomical  Red  
Infectious animal anatomical  Orange, Red  
Non-infectious animal anatomical  Blue  
Infectious non -anatomical waste    Yellow  
Sharps and similar waste    Sharps or recognized symbol  
Chemical/pharmaceutical waste  Chemical waste  
  Black, Dark Green, or recognized 
coding  
Pharmaceutical waste excluding 
cytotoxic pharmaceutical waste  Cytotoxic hazard symbol.  
Radioactive waste    Radiation hazard symbol  
Pressurized container waste    Black or Dark Green  
General waste  Office waste  
Kitchen waste, non -clinical glass 
waste  
Non-clinical non -anatomical waste  Black or Dark Green  
Blue, or Green  
Blue Black or Dark Green  
6.1.2  All wastes should be handled so as to ensure that it is segregated at source, contained in packaging 
that holds the contents to the point of disposal, and disposed in a manner that is practical and efficient yet 
minimizes any hazard. By minimizing the hand ling of waste, fewer people are be exposed to it. Potentially 
offensive unrefrigerated waste shall be timeously removed.  
6.1.4  It is recommended that plastics materials that are to be included in the stream of waste to be 
incinerated be non -halogenated. Ma terials bearing heavy metals should not be used. The most commonly 
used Plastics; Polyvinyl Chloride (PVC) yields hydrogen chloride upon incineration.  
Examples  Non-halogenated plastics include polystyrene, polyesters and polyolefins such as polyethylene a nd 
polypropylene.  
6.2 In-house control  
6.2.1  Each generator/originator of biohazardous waste shall prepare, maintain and implement a written plan 
to minimize, identify and handle all waste generated within the facility and shall provide a training programme 
for all staff to familiarize them with:  
a) procedures for the segregation, collection, storage, labelling and movement of waste specified by this 
standard;  
b) personal hygiene, especially hand washing; and  DRS 209: 2020  
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 c) the hazards of those materials to which workers may be  exposed. This training shall be continuously 
assessed and reinforced.  
6.2.2  The in -house control of wastes produced by health care facilities should be managed in accordance 
with 6.2 of this standard, under the supervision of the facility’s infection con trol committee or a designated 
department.  
6.2.3  This written plan shall be reviewed periodically to ascertain its effectiveness.  
6.2.4  An inspection programme shall be established to ensure that the procedures specified by this 
standard are followed.  
6.2.5  It is the responsibility of the waste generator to indicate disposal instructions and assist in the best 
practicable disposal of such waste.  
6.3 Closure and bagging of waste -holding plastic bags  
6.3.1  Bags containing waste, no matter how they are close d shall be such that their contents are prevented 
from escaping.  
6.3.2  A single bag is normally adequate, if it is impervious and sturdy (not easily penetrated) and if the 
articles can be placed in the bag without contaminating the outside of the bag othe rwise, double bagging shall 
be used.  
6.4 Intermediate and final storage areas  
6.4.1  All waste -storage areas shall meet the requirements of the local authority regulations.  
6.4.2  Intermediate and final storage areas shall:  
a) be totally closed;  
b) be separated fr om supply rooms or food preparation areas;  
c) have access restricted to authorized personnel only; and  
d) have access restricted to authorized personnel only.  
6.4.3  Health care facilities that refrigerate stored waste shall use:  
a) lockable, closed storage faci lity; and  
b) lockable, domestic -type freezer unit that is dedicated to the accumulation of waste for disposal. This 
waste shall be stored at a temperature of 4 °C or lower with freezing being preferred method of storage.  
6.4.4  Storage facilities should be r easonably sized for the predicted storage needs.   
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 6.4.5  Health care facilities shall prepare a contingency plan for dealing with the storage of refrigerated 
waste in the event of excess waste being produced, incineration facilities becoming inoperative or 
refrigeration/freezing facilities becoming inoperative.  
6.4.6  Health care facilities shall prepare a contingency plan to deal with the disposal of waste in the event of 
a disruption of disposal services.  
6.4.7  Users of this standard shall refer to local authority regulations for information regarding the ventilation 
of waste -storage areas.  
6.5 Movement of waste  
6.5.1  Manual handling of waste materials shall be minimized;  
6.5.2  Carts used for carrying waste shall:  
a) be capable of containing the waste;  
b) be designed to prevent spills;  
c) be constructed of materials that permit affective cleaning and disinfections; and  
d) be used solely for the transportation of waste.  
NOTE  Open carts may be used to transfer waste contained within waste containers.  
6.5.3  Wast e containers shall be moved only when properly closed.  
6.5.4  Specific routes for the movement of wastes shall be planned in order to minimize its passage through 
patient care areas and other clean areas.  
6.5.5  Infection waste shall have specially designe d movement procedures that completely eliminate contact 
with unprotected skin of the handler. These procedures shall be written and implemented by specially trained 
personnel and shall be reviewed periodically to align them with local, national or internat ional regulations.  
6.5.6  A regularly scheduled cleaning programme should be established for waste disposal chutes.  
6.6 Disposal  
6.6.1  The healthcare facility shall dispose wastes in accordance with  national regulations.  
6.6.2  Handling and disposal of general wa stes shall be in accordance with RS 181.  
6.6.3  Waste disposal chutes/conveyors shall be avoided but if they are provided, shall be used for general 
waste purposes only.  DRS 209: 2020  
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 6.7 Maintenance and cleaning operations  
6.7.1  Protective apparel  
6.7.1.1  The following protect ive apparel shall be worn, as necessary, by any personnel engaged in 
cleaning of reusable waste containers, waste -movement carts or final storage area:  
a) waste -resistant overalls;  
b) heavy -duty water proof gloves;  
c) rubber boots;  
d) protective goggles or face sh ield; and  
e) appropriate respiratory equipment to protect them from gases and odours.  
6.7.1.2  When not in use, protective apparel shall be stored in an area designated for this purpose.  
6.7.2  Reusable waste containers and waste movement carts  
6.7.2.1  These shall be thoroughly cleaned in accordance with facility’s established procedures.  
6.7.2.2  The frequency or cleaning operations shall be in accordance with facility’s established 
procedures.  
6.7.2.3  Reusable waste containers and waste movement carts shall be thoroughly cleaned before any 
maintenance work is performed on them.  
6.7.2.4  Reusable waste containers shall be inspected for holes or leaks every time they are emptied and 
their colour coding renewed if necessary.  
6.7.3  waste holding plastic container  
Plastic bag used as a container and that shall be:  
a) steady enough to resist puncture, leaking and braking under individual usage conditions and to the point 
of disposal., except where;  
b) colour coded or identified according to the type of waste for which it is  intended.  
6.7.4  Storage sites  
Floors, walls and ceilings of intermediate and final storage area shall be thoroughly cleaned in accordance 
with the facility’s established procedures.   
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 6.8 Spill or accident clean ups  
6.8.1  Health care facilities shall have a docum ented policy and procedure for managing spills of hazardous 
substances.  
6.8.2  The procedure for managing a soil shall include the following:  
a) all staff shall be trained and educated on method for the containment and isolation of each type of spill 
shall b e prepared;  
b) persons shall have specific management training in the management of spills;  
c) information concerning individual substances and their clean up shall be readily accessible to all staff and 
available on 24 h basis.  
d) proper equipment shall be avai lable for:  
1) spill clean -up; and  
2) the protection of employees.  
e) the procedures for proper disposal of waste spills according to the waste management policy of the 
facility shall be prepared;  
f) the procedures for each type of spill shall be documented and made  available in the area where the spill 
is likely to occur;  
g) all incidents shall be documented for the purpose record keeping;  
h) any employee exposed to a spill shall be treated and monitored by the facility; and  
i) if necessary, evacuation and internal disaster plans shall be implemented.  
7 Human/animal anatomical waste  
7.1 Composition  
Human and animal anatomical waste consists the following:  
a) tissues;  
b) organs;  
c) body parts;  DRS 209: 2020  
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 d) products of conceptions; and  
e) animal carcasses.  
NOTE  The following are considered t o be non -anatomical wastes:  
a) blood and body fluids;  
b) extracted teeth;  
c) nail clippings; and  
d) hair.  
7.2 Subcategories  
The human/animal anatomical waste category shall be subdivided into:  
a) human anatomical waste;  
b) infectious animal anatomical waste; and  
c) non-infectious animal anatomical waste.  
7.3 Human anatomical waste  
7.3.1  Containment  
7.3.1.1  Human anatomical waste shall be placed within a waste container that is colour -coded orange.  
7.3.1.2  When human anatomical waste is being packed, handlers of waste shall wear:  
a) a gown;  
b) disposable gloves; and  
c) any other protective equipment.  
7.3.2  Collection  
7.3.2.1  Waste containers shall be moved in accordance with the requirements given in 6.5.1  
7.3.2.2  Human anatomical waste shall be collected and moved to its final designated a rea by the most 
direct route possible avoiding patient care areas. This waste shall not be combined with other waste during its 
collection.   
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 7.3.3  Final storage area  
7.3.3.1  Human anatomical waste shall be segregated stored and refrigerated at a temperature low er than 
4 °C or preferably frozen.  
7.3.3.2  For ease of handling, for transportation and disposal, human anatomical waste shall be stored in 
containers that are:  
a) colour coded red (see Table 1)  
b) rigid; and  
c) leak proof.  
7.3.3.3  The recommended maximum stor age time for human anatomical waste in intermediate storage 
areas is 1 week if waste is refrigerated.  
7.3.3.4  Health care facilities shall prepare a policy for the maximum storage time of frozen human 
anatomical wastes based on the facilities, storage cap acity and appropriate regulations and legislation.  
7.3.3.5  Final storage area shall meet requirements given in 6.4.2  
7.3.3.6  Final storage areas shall be thoroughly cleaned on regular basis.  
7.3.4  Disposal  
Human anatomical waste shall be incinerated.  
7.4 Animal anatomical waste  
7.4.1  Containment  
7.4.1.1  Infectious animal anatomical waste shall be placed within a waste container:  
a) that is colour coded orange or red;   
b) the infectious animal anatomical waste may be placed within a waste container that is colour coded red, 
provided that the infectious animal anatomical waste and human anatomical waste are not intermixed 
within the same waste container,  
7.4.1.2  Human anato mical waste is treated with respect. For this reason, human anatomical waste and 
animal anatomical waste are placed within separate waste containers. The issue of whether to incinerate 
human and infectious animal anatomical wastes together or separately is  decided by the institution in 
accordance with the national regulations.  DRS 209: 2020  
17                ©RSB 2020  - All rights reserved  
 7.4.1.3  Non-infectious animal anatomical waste shall be placed within a waste container that is colour 
coded blue.  
7.4.1.4  The handling and disposal of infectious animal anatomical waste shall be in accordance with local 
authority regulations and appropriate standards; handlers of this waste shall wear:  
a) a gown;  
b) disposable gloves; and  
c) other protective equipment.  
7.4.2  Collection  
7.4.2.1  Waste containers shall be moved in accordance with  requirements given in 6.5.3;  
7.4.2.2  Animal anatomical waste shall be collected and moved to its final destination by the most direct 
route avoiding patient care areas. This waste shall not be combined with other waste during its collection.  
7.4.3  Final stora ge area  
7.4.3.1  Infectious animal anatomical waste shall be segregated, stored and refrigerated at a temperature 
lower than 4°C or preferably be frozen.  
7.4.3.2  For ease of handling transportation and disposal of infectious animal anatomical waste shall be 
stored in containers that are:  
a) colour -coded orange or red   
b) rigid; and  
c) leak proof.  
7.4.3.3  For ease of handling, transportation and disposal, non -infectious animal anatomical waste shall 
be stored in containers that are:  
a) colour -coded blue;  
b) rigid; an d  
c) leak proof.  
7.4.3.4  The recommended maximum storage time for animal anatomical storage waste in intermediate 
storage areas is 1 week if the waste is refrigerated.   
©RSB 2020  - All rights reserved                  18 
 7.4.3.5  Health care facilities shall prepare a policy for the maximum storage time of frozen animal 
anatomical wastes, based on the facility’s storage capacity and appropriate regulations and legislation.  
7.4.3.6  Final storage areas shall meet the requirements gi ven in 6.4.2.  
7.4.3.7  Final storage areas shall be routinely decontaminated on a regular schedule decided upon by the 
facility infection control committee or designated department or designated responsible person.  
7.4.4  Disposal  
7.4.4.1  Infectious animal anatomical waste shall be incinerated appropriately.  
7.4.4.2  Non-infectious animal anatomical waste shall be:  
a) incinerated (on -site incineration is the preferred method of disposal);  
b) transported to a designated landfill site for burial in accordance with local authority regulations; and  
c) removed by an appropriate disposal company in accordance with local authority regulations.  
8 Infectious non anatomical waste  
8.1 Composition  
Infectious non -anatomical waste includes:  
a) all microbiology labora tory wastes that have not been decontaminated;  
b) waste from surgeries and autopsies performed on patients with infectious diseases; and  
c) all wastes contaminated with a causative agent from patients designated as requiring specific hospital 
communicable dise ases protocols.  
NOTE 1  The policy of universal precautions dictates that blood and tissue from all patients be handled in a safe 
manner, thereby removing the need for patients to be identified as requiring blood precautions. In enforcing BSI (Body 
Substan ce Isolation), all specific communicable disease protocols except for respiratory isolation, are withdrawn. In this 
way, all patients who in the past would have been subject to blood precautions, enteric precautions, etc., are now treated 
identically.  
NOT E 2 In order to afford users of this standard the flexibility to establish their own policies and procedures, infectious 
non-anatomical waste has been defined in such a way as to give guidance to those facilities requiring it, while not 
restricting others from introducing the policies of universal precautions and BSI.  
8.2 Containment  
8.2.1  Infectious non -anatomical waste shall be placed within a waste container that is colour -coded yellow.  DRS 209: 2020  
19                ©RSB 2020  - All rights reserved  
 8.2.2  Infectious liquids shall be:  
a) contained in sealed, single -use containers before being placed within a waste container that is 
colourcoded yellow (see Table 1); or  
b) where this means of containment is considered inappropriate, the disposal of such liquids into sanitary 
sewers shall confo rm to local authority by -laws.  
8.2.3  When infectious non -anatomical waste is being packed, the handlers of the waste shall wear:  
a) a gown;  
b) disposable gloves; and  
c) other protective equipment.  
8.3 Collection  
Waste containers shall be moved in accordance with t he requirements of 6.5.3  
8.4 Final storage areas  
8.4.1  Final storage area shall meet requirements of 6.4.2  
8.4.2  For ease of handling for transportation and disposal, infectious non -anatomical waste may be stored 
in containers that are:  
a) colour coded yellow (see Table 1);  
b) rigid; and  
c) leak proof.  
8.5 Disposal  
8.5.1  The preferred method of disposal of infectious non -anatomical waste is on site incineration. 
Acceptable alternatives are:  
a) off site incineration  
b) autoclaving and then handling the decontaminated wast e as general waste;  
c) disposal into sanitary sewers; and  
d) other treatment technologies deemed acceptable to the regulatory authority.   
©RSB 2020  - All rights reserved                  20 
 8.5.2   In all cases, disposal shall be in accordance with national and local authority regulations.  
9 Sharps and similar wa ste  
9.1 Composition  
Sharps and similar wastes include:  
a) needles;  
b) syringes;  
c) blades;  
d) clinical glass; and  
e) any other clinical items capable of causing a cut or puncture.  
9.2 Containment  
9.2.1  container specified in 4.5;  
9.2.2  Sharps containers should be so located as to permit the safe and convenient disposal of sharps.  
9.2.3  The recapping of needles is not recommended. Needless shall not be clipped, bent or broken.  
9.3 Collection  
9.3.1  Before a sharp container is moved the lids  shall be securely in place.  
9.3.2  Sharps containers shall be three -quarter filled since overfilling may pose a hazard to those persons 
using and discarding the containers.  
9.3.4  Sharps containers shall be removed to a point of use when they are suitably  full.  
9.3.5  Sharps containers shall be moved in accordance with the requirements of 6.5.3  
9.4 Disposal  
9.4.1  Filled sharps containers shall be treated or handled for disposal by any of the following methods. The 
preferred method is the on -site incineration . Other methods outlined below may be chosen for healthcare 
facilities, based on the individual facility’s experience and local conditions. In all cases, disposal shall comply 
with national and local authority regulations:  DRS 209: 2020  
21                ©RSB 2020  - All rights reserved  
 9.4.1.1  On-site incineration ; incineration decontaminates and renders sharps unusable. The sharps 
containers shall be made of a material suitable for incinerations.  
NOTE  Removal and handling of the ash from the incineration may pose a physical hazard to personnel through 
scraps and punc ture of wounds from the remaining portion of sharps.  
9.4.1.2  Off-site incineration ; off-site incineration has the same benefits and risks outlined in 9.4.1.1 above.  
NOTE Additional exposure risk is incurred through increased handling in transportation an d exposure to the environment 
in a transportation accident causing container rupture.  
9.4.1.3  Landfill ; authorities having jurisdiction over landfill sites may allow burial of sharps containers with 
compacted or uncompacted waste, although this method is not a recommended practice.  
9.4.1.4  In addition to transportation risks, if the security of the container; transportation or landfill sites were to 
fail, waste handlers and scavengers risk transmission of infection by inoculation with unknown consequences .  
9.4.2  New technology ; the above methods take into account existing technology and handling methods. 
New handling and disposal methods may be considered by facilities as they arise.  
NOTE  Autoclaving of filled sharps containers before final disposal is not recommended because it can result in 
incomplete decontamination of contents  
10 Chemical/pharmaceutical waste  
10.1 Chemical waste  
Chemical waste comprises discarded solid, liquid and gaseous chemicals, e.g. from diagnostic and 
experimental work, or from clean ing, housekeeping or disinfecting procedures. Chemical wastes may be 
hazardous or non -hazardous. For the purposes of choosing the most appropriate waste -handling method, 
hazardous chemical waste is considered to e -waste that is:  
a) toxic;  
b) corrosive (acids o f pH > 2.0 and bases of pH >12.0);  
c) flammable;  
d) reactive (explosive, water reactive, shock sensitive); or  
e) genotoxic (carcinogenic, mutagenic, teratogenic or otherwise capable of altering genetic material).  
NOTE Non -hazardous chemical wastes consist of ch emicals other than those described above, such as sugars, amino 
acids, and certain organic and inorganic salts.   
©RSB 2020  - All rights reserved                  22 
 10.2 Hazardous chemicals   
10.2.1  General  
10.2.1.1  Expert advice shall be obtained prior to disposal of hazardous chemicals. Chemical waste shall 
be segreg ated to avoid chemical reactions; e.g. bases shall not be contained together with acids.  
10.2.1.2  Suitable methods for chemical deactivation shall be sought using appropriate references.  
10.2.1.3  Disposal of hazardous chemicals shall be performed only by  qualified personnel. Individuals 
responsible for handling and disposal of hazardous chemicals shall have received appropriate training and 
education.  
10.2.1.4  In consideration of the fact that a chemical spill or accident may occur, the requirements of 6 .8 
shall be met.  
10.2.2  Disposal  
Healthcare facilities shall comply with national standards concerning the disposal of hazardous wastes.  
10.3 Pharmaceutical waste  
10.3.1  Composition  
10.3.1.1  Pharmaceutical waste comprises pharmaceutical products such as drugs and medicin al 
chemicals that:  
a) are no longer usable in patient treatment and have been returned from patient care areas, have become 
outdated or contaminated have been stored improperly; or  
b) are no longer required.  
NOTE  Items contaminated with pharmaceuticals do not normally pose a threat. However, those contaminated with 
catatonics and radiopharmaceuticals are considered to be cytotoxic and radiopharmaceutical wastes respectively.  
10.3.1.2  All pharmaceuticals can be abu sed or misused. Therefore, appropriate disposal precautions 
should be practiced for all pharmaceuticals.  
10.3.2  Basic safety guidelines  
10.3.2.1  Written policies or procedures shall be developed to deal with the following aspects as they 
pertain to pharmaceutic als:  
a) storage;  
b) preparation;  DRS 209: 2020  
23                ©RSB 2020  - All rights reserved  
 c) labelling products removed from original containers;  
d) use of safety equipment;  
e) emergency procedures for treating accidental contact and spills; and  
f) disposal.  
10.3.2.2  These policies or procedures shall be reviewed annually and revised as necessary to reflect 
current approved standards and legislation. These policies and procedures shall be developed in consultation 
with local authorities, Rwanda Bureau of Standards and any other relevant authorities.  
10.3.3  Basic waste disposal gu idelines  
10.3.3.1  The amount of pharmaceutical waste generated shall be minimized by careful preplanning. 
Provision for the disposal of waste shall be considered before a material is purchased or is produced within 
the pharmacy. Waste shall be minimized b y the following preplanning steps:  
a) quantities of materials purchased shall reflect the needs;  
b) quantities of materials with special disposal requirements, e.g. Chemicals, cytotoxics and biological shall 
be purchased in quantities to match the immediate nee ds;  
c) non-hazardous materials shall be substituted for hazardous ones, when appropriate; and  
d) materials shall be recovered for reuse, when appropriate.  
10.3.3.2  Appropriate precautions in packaging products for transport shall be taken to prevent handlers 
from accidental exposure due to breakage. For example, the use of sealable plastics bags helps to contain 
spills.  
10.3.3.3  Transportation of packages containing hazardous products shall be labelled to indicate the 
hazards involved and precautions to be ta ken in the event of breakage. Transportation methods used shall 
reflect the hazards involved.  
10.3.4  Handling and disposal of pharmaceuticals other than cytotoxics  
10.3.4.1  Pharmaceuticals shall be disposed of in such a manner that they can be reused. Once rend ered 
unusable, pharmaceutical waste other than cytotoxic pharmaceutical waste shall be placed within a waste 
container that is:  
a) Colour -coded black or dark green, and  
b) clearly identified as containing pharmaceutical waste utilizing a coding system recogniz ed by the facility.  
NOTE  For specific recommendations regarding the handling and disposal of:   
©RSB 2020  - All rights reserved                  24 
 a) antibiotics and antiseptics; and  
b) narcotics and other controlled drugs, users of the standard should refer to local authority regulations.  
10.3.4.2  Biologicals, such as live attenuated vaccines shall be handled and disposed of in accordance with 
annex A.  
NOTE  Some biological may require inactivation prior to handling for disposal.  
10.3.4.3  Radiopharmaceuticals shall be handled in accordance with the  relevant laws  
10.3.5  Handling and disposal of cytotoxic pharmaceuticals  
10.3.5.1  Cytotoxic pharmaceutical waste shall be placed within a waste container that clearly and visibly 
displays the toxic hazard symbol as below together with the world cytotoxic printe d boldly directly beneath the 
symbol in letters at least 7 mm high .  
10.3.5.2  Protective equipment and clothing shall be worn to help prevent exposure of unprotected skin to 
drug, splashing of the drug into eyes or inhalation of powders or aerosols. Recommended safety apparel 
includes:  
a) a long -sleeved, water -repellent disposable protective garment, preferably with a solid front and tight fitting 
cuffs and neck;  
b) disposable latex gloves. Gloves should be changed as required;  
c) eye protection, e;g. safety  glasses, goggles or full -face masks; and  
d) respiratory protection, e.g. disposable dust and mist respirator mask (not surgical mask).  
10.3.5.3  Cytotoxic pharmaceutical waste and associated contaminated materials, e.g. needles, syringes, 
tubing, containers , preparation materials, vials and ampoules shall be separated from general waste and 
discarded into designated cytotoxic waste containers. Sharp objects contaminated with cytotoxics, such as 
needles, broken glass, etc., shall be placed into designated cyt otoxic sharp containers.   
10.3.5.4  The sharp containers shall be labelled with the toxic hazard symbol as in Annex A. Containers 
selected shall be compatible with and appropriate to the type of waste they are to contain. Where practical, 
the same type of container should be used throughout the facility. Standardization of containers fosters 
greater use and enhance identifiability among users. Sharp containers shall include the following features:   
a) a fill line;  
b) unauthorized withdraw prevention  
c) handles; an d  DRS 209: 2020  
25                ©RSB 2020  - All rights reserved  
 d) a wall bracket and lock.  
10.3.5.4  Care shall be taken to prevent penetration and leakage. Excess cytotoxic fluids shall be placed in 
sealed containers; the original container is acceptable.  
NOTE  Prior to the cytotoxic waste containers being used an ab sorbent material may be at the bottom of the waste 
containers to absorb excess fluids.  
10.3.5.5  Cytotoxic pharmaceutical wastes that can be incinerated without causing dangerous off gassing 
shall be incinerated unless incineration as a disposal means is n ot available.  
10.3.5.6  If incineration is not available chemical deactivation shall be used for some cytotoxic 
pharmaceuticals. Suitable methods for chemical deactivation shall be used for some cytotoxic 
pharmaceuticals. Suitable methods for chemical deac tivation should be sought direct from the manufacturer. 
These procedures shall be performed in a biological containment cabinet complying with the compulsory 
specifications for using appropriate precautions; protective equipment for visual and respiratory protection 
shall also be worn.  
10.3.5.7  Users of this standard should refer to appropriate national or international standards for 
information regarding the installation and field -testing of biological containment cabinets.  
10.3.5.8  Disposal of small amounts of cytotoxic pharmaceuticals into landfill sites or into municipal sanitary 
sewer may be permissible in some areas. Local authorities shall be consulted if either of these methods is to 
be used.  
10.3.5.9  The term “small amount” i s used in a descriptive sense. Local authorities state their own criteria 
for what constitutes a small amount, based on factors such as mass, volume and concentration. These criteria 
shall be applied when small amounts are being disposed of.  
10.3.5.10  After agreement has been obtained from the distributing agent, consideration shall be given to 
returning, intact, pharmaceutical products such as unreconstituted or unopened vials, ampoules or bottles to 
the distributing agent who may be the pharmaceutical ma nufacturer or the laboratory in which they were 
prepared.  
10.3.5.11  In the handling of urine and other exert from patients who have received cytotoxic 
pharmaceuticals within the previous 48 h, latex gloves shall be worn. Contaminated garments and liner sh all 
be treated as isolation linen and washed separately.  
10.3.5.12  Personnel cleaning up cytotoxic spill shall use full protective equipment and clothing such as 
gowns, double gloves, eye protection and respiratory protection.  
a) the spill shall be containe d and wiped up using absorbent powders or papers or both;  
b) the area shall be washed with a detergent followed by 70 % alcohol (aseptic areas) or water (non -aseptic 
areas) and then dried; and  
c) all contaminated materials shall be discarded into designated cy totoxic waste containers.   
©RSB 2020  - All rights reserved                  26 
 11 Pressurized container waste  
11.1 Containment  
Pressurized container waste shall be placed within a waste container that is colour -coded black or dark green.  
11.2 Collection  
11.2.1  Pressurized container waste shall not be incinerated or autoclaved.  
11.2.2  Refillable compressed gas cylinders shall be returned to the manufacturer or distributor.  
11.3 Disposal  
Pressurized container waste shall be disposed of with the general waste or as otherwise directed by the local 
authority regulations.  
12 General waste  
12.1 Characteristics  
General waste consists of waste that:  
a) has not been included in the other waste categories and  
b) does not pose a disease -related risk or threat to people or to the environment. The general waste 
category includes:  
1) office waste ;  
2) kitchen waste;  
3) non-clinical glass waste;  
4) non-infectious non -anatomical waste, e.g. blood and body fluids, facial tissues, disposable 
drapes, diapers, dressings from non -infected wounds, and decontaminated waste; and  
5) all other similar wastes.  
12.2 Containment  
Solid general waste shall be placed within a waste container that is colour -coded black.  DRS 209: 2020  
27                ©RSB 2020  - All rights reserved  
 12.3 Collection and disposal  
12.3.1  Except for kitchen waste (see Table 1) and non -clinical glass waste (table1); solid general waste 
requires no special mea sures and can safely be dealt with in the same manner as general municipal waste.  
12.3.2  The disposal of liquid waste into sanitary sewers shall comply with municipal sewerage by laws and 
national regulations and legislation.  
12.4 Kitchen waste  
Kitchen waste  shall be handled, stored and disposed of in accordance with national regulations governing 
food premises. Public health authorities shall be consulted regarding the applicable regulations.  
12.5 Non-clinical glass waste (Containment and disposal)  
Non-clinical  glass shall be placed within a container suitable for the purpose. The waste shall then be handled 
stored, and disposed of in a safe manner that protects the handler and any other persons within such vicinity  
NOTE  In many guidelines, all waste contaminate d with blood or a body fluid is classified as infectious waste. This 
enormously increases the volume of waste requiring expensive handling and disposal. Identical items are disposed of from 
homes without special handling or decontamination.  
13 Movement of wa ste to final disposal site  
13.1 General  
Waste within healthcare facilities is sometimes disposed of in municipal sites and/or landfills. This entails 
movement of waste beyond the boundaries of the facility. It is important that such transportation of waste be  
carefully designed.  
13.2 Movement  
13.2.1  Transportation of waste shall be done only by vehicles designated for this purpose.  
13.2.2  Each healthcare facility shall design a disposal schedule that is capable of prevention over 
accumulation of waste. All the w aste for collection designated place without any spillage or overflow, before 
agreed collection time.  
13.2.3  The black plastic bags shall have their mouths tightly closed and the bins shall have the lids firmly 
secured to avoid odours.  
13.2.4  The vehicle  used for transportation of waste shall be properly loaded with waste so as to avoid 
dispersal of the healthcare facility and the local authority where the local authority’s vehicles are used. It shall 
be the sole responsibility of the healthcare facility when the facility utilizes its own vehicles for such duties.   
©RSB 2020  - All rights reserved                  28 
 13.3 General and decontaminated waste  
13.3.1  Only general waste and waste that has been properly decontaminated can be transported beyond the 
boundaries of the facility.  
13.3.2  In case of accidenta l-in transit -dispersal of waste, the transporter shall immediately recollect the waste 
and clean -up the area.  
13.3.3  The waste shall be disposed of as general municipal waste.  
14 Best environmental practices concerning health -care waste management  
14.1 General  
14.1.1  In order to ensure an efficient and state of the art incineration of waste a number of practices prior to 
the combustion of waste itself is considered necessary.  
14.1.2  These practices are not directly linked to the reduction and avoidance of unin tentionally produced 
Persistent Organic Pollutants (POPs) but represent general principles of health -care waste management 
which in consequence can influence the generation of waste fractions and which contribute to the safety of the 
personnel, the public and the environment.  
14.2 Health -care waste management  
The establishment of healthcare waste management involves to:  
a) characterize the nature and amount of the different waste fractions;  
b) identify options to avoid or reduce waste generation (package sizes, st ock keeping, evaluate work 
processes, reuse of equipment where feasible);  
c) draw up a list of rules how to handle the waste;  
d) specify the suitable containers for collection, storage and transport;  
e) lay down the responsibilities of the personnel;  
f) describe t he appropriate treatment options for the different waste fractions;  
g) provide for proper documentation and control of the waste disposal;  
h) describe the transportation of the waste fraction to the final disposal location and the type of final 
treatment, and  
i) calculate the costs for the different activities.  DRS 209: 2020  
29                ©RSB 2020  - All rights reserved  
 14.3 Training of personnel  
The personnel shall get thorough instructions about:  
a) risks connected with health -care waste;  
b) classification and codes of the different waste fractions and their classification cri teria; c) costs of waste 
treatment;  
c) illustration of the waste management from generation to disposal;  
d) responsibilities; and  
e) effects of mistakes and mismanagement.  
14.4 Collection at the site of waste generation  
14.4.1  The following shall be provided at the site of waste generation:  
a) small bins for the disposal of the different waste fractions at suitable places;   
b) proper packaging of the waste : Bags/containers for infectious waste and sharps shall be puncture 
resistant and leak proof. Either solid drums or bags which are placed within a rigid or semi -rigid container 
having a capacity of 30 L - 80 L shall be used. The containers may be recyclable (stainless steel) or 
single use (thick cardboard or rigid polyethylene). Pla stic materials containing chlorine shall be avoided if 
incineration takes place. Full containers shall have a locking or sealing device.  
14.4.2  Containers shall be property labelled as infectious, cytotoxic etc, waste.  
14.4.3  The personnel at the site of  waste generation shall ensure that there is no overloading of waste 
containers.  
14.4.4  Highly infectious waste shall, whenever possible, be sterilized immediately by autoclaving. It therefore 
needs to be packaged in bags that are compatible with the prop osed treatment process.  
14.5 Transportation to the intermediate storage area  
14.5.1  Once the primary containers are full they shall be taken to an intermediate storage area.  
14.5.2  The facility shall have designated areas for storage, and cleaning/washing/di sinfection of the 
containers where access is only allowed for authorized personnel.  
14.5.3  Personnel handling the waste shall wear protective clothing (gloves, shoes) during collection, 
transportation and storage).  
14.5.4  The personnel handling the waste  shall ensure:   
©RSB 2020  - All rights reserved                  30 
 a) clear transport routes and times;  
b) no comprimation of waste containing sharps; and  
c) no manual sorting of infectious waste fractions.  
14.6 Best Available Techniques (BATs) for the incineration of health -care waste  
14.6.1  Incineration is an impo rtant method for the treatment and decontamination of biomedical and 
healthcare waster. This sub -clause gives guidance on the incineration of the following (mostly) hazardous 
waste fractions: infectious health -care waste, biological health -care waste and s harps.  
14.6.2  Incineration is a high -temperature (850 °C – 1 100 °C) dry oxidation process that reduces organic and 
combustible waste to inorganic, incombustible matter and results in a very significant reduction of waste 
volume and weight.  
14.6.3  Semi -pyrolysis is a process of smouldering where thermal conversion occurs in an oxygen deficient 
atmosphere at a temperature between 500 °C and 600 °C.  
14.6.4  The incineration/pyrolysis shall be carried out in appropriate plants. The system shall be designed to  
cope with the specific characteristics of hazardous health -care waste (high water content, high plastic 
content).  
14.6.5  As the following technologies are rather sophisticated only hazardous, waste fractions should be 
burned in these plants. Other health -care waste which is similar to municipal waste should be segregated in 
advance and be subjected to different waste treatment technologies. On -site facilities (i.e. in the hospital) are 
usually equipped with incinerators up to a capacity of 1 ton/day.  
14.6.6 An incineration plant basically shall consist of the following units:  
a) furnace or kiln;  
b) afterburning chamber;  
c) dry, wet or catalytic flue gas cleaning devices; and  
d) waste water treatment plant.  
14.6.7  Simplified flow scheme of an incinerator (see Figure 1).  
  DRS 209: 2020  
31                ©RSB 2020  - All rights reserved  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1 — Simplified flow scheme of an incinerator  
14.6.8  The following firing technologies are adequate options for the thermal treatment of health -care waste:  
a) degassing and/or gasification of wastes (pyrolysis);  
b) rotary kiln; and  
c) grate specially adapted for health -care waste.  
14.6.9  If infectious waste is not burned immediately (during 48 h) it shall be deposited in a cooled storage 
room (10 °C max). Working a nd storage areas should be designed to facilitate disinfection.  
14.6.10  Flue gas cleaning.  
14.6.10.1  Flue gases from incinerators contain fly ash (particulates) composed of heavy metals, dioxins, 
furans, thermally resistant organic compounds, and gases such as nitrogen oxides, sulphur oxides carbon 
oxides and hydrogen halides. Flue gases resulting from un controlled batch mode (no flue gas cleaning) shall 
contain around 2000 ng TEQ/m3 (source: UNEP Dioxin and Furan Toolkit).  Flue gas cleaning  
Furnace (plus after 
burning chamber)  
Wastewater 
treatment  Exhaust gas  
Ash 
Wastewater  
Flue gas  
Heat recovery  
Wastewater  
Waste discharge  
Sludges (require treatment  Ash (to disposal and stabilization)  Air 
Waste   
©RSB 2020  - All rights reserved                  32 
 14.6.10.2  The following gas cleaning measures have to be combined in a suitable manner to ensure the 
application of BAT:  
a) Separation of dust and non -volatile heavy metals; Fabric fitters, electrostatic precipitators and file wet 
scrubbers are used for dust separation. Pre -cleaning of flue gases can be done with cyclones that are 
efficient for separation of larger particles;  
b) HCl, HF, SO 2, and Hg removal; the removal of acid components and Hg can be reached by different dry 
or wet adsorption methods (adsorption on activated coke or lime) as well as by scrubbing (1 – or 2 – 
stage wet scrubbing);  
c) NOx removal; primary measures consist in th e use of low -NOx burners, staged combustion and 
recirculation of the flue gas; secondary measures are SNCR and SCR.  
d) The reduction of organic emissions; and PDRSD/F can be performed by primary measures (such as 
limitation of the de -novo synthesis, optimize d combustion) and secondary measures like dust separation, 
activated coke filter, flow injection with activated coke/furnace coke and lime hydrate, catalytic oxidation.  
14.6.10.3  Due to the high investment and operational costs of the above equipment an e conomical plant 
operation seems often impossible. Therefore; centralized units preferred to decentralize on -site treatment of 
the health -care waste. Health -care waste incineration lines operated on the same site as other or municipal 
waste incineration wil l result in synergy effects and provide economic viability.  
 DRS 209: 2020  
33                ©RSB 2020  - All rights reserved  
 Annex  A 
(informative)  
 
Waste disposal methods  
Waste Category  Examples  Disposal 
Method  Special 
considerations  Symbol  
Non-fluid 
biohazardous 
clinical waste  
  Gloves, Sponges,  
Dressings,  
Sanitary  pads, Surgical 
drapes soiled or soaked with 
blood, body fluids, or 
secretions.  Red  Bag 
with Biohazard 
symbol.  
Incineration.  
  Container ¾ full for 
disposal.  
Empty ash in pit 
latrine.  
   
 
 
Biohazardous 
fluid waste  
  Blood, blood products, body 
fluids, dialysis waste.  
  Dispose  into 
sluice.    
 
Sharps  
  Needles,  
scalpels, blades,  
razors, other  
sharps, clinical  
glass.  designated, 
puncture 
resistant, 
sharps 
containers 
Incineration.  
  Container ¾ full for 
disposal.  
Empty ash in pit 
latrine.  
  
 
Isolation waste  
  Lassa virus disease  
Marburg virus disease  
Ebola virus disease.  
*NB: any isolation waste  
not associated with viral  
haemorrhagic fevers is  
disposed of as biohazardous  
waste.  Incineration.  
  Contact national 
health authority.  
  
 
 
©RSB 2020  - All rights reserved                  34 
 Laboratory 
waste (highly 
infectious)   Cultures 
and stocks  
Diagnostic 
specimens 
Vaccines.  Incineration.   Seal bag 
when ¾ full 
and remove.   
  
Anatomical 
waste/ 
Pathological 
waste  
  Tissues, 
organs, body 
parts,  
foetuses, 
placentas, 
surgical 
wastes, etc.    Incineration.  
  Seal bag 
when ¾ full 
and remove.  
  
  
Animal waste  
  From research 
laboratory.  Incineration.  
  Seal bag 
when ¾ full 
and remove.   
  
  
DRS 209: 2020  
35                ©RSB 2020  - All rights reserved  
 Food waste  
  Milk, food, meat, 
fish, chicken, 
vegetables, etc.  Incineration 
landfill.  
  or  When ¾ full, 
seal bag and 
Take to 
disposal site.  
  
  
Domestic waste  
  Empty  bulk 
cartons  
Food containers  
Food wrappers, 
etc.  Incineration 
landfill  or  Place 
separately from 
food.  
When ¾ full 
seal and 
dispose of.  
  
Cytotoxic waste    Cytotoxic waste 
requires 
incineration  at 
1100oC. 
 This must be 
carried out by a 
licensed 
contractor      
  
 
DRS 209: 2020  
 
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©RSB 2020  - All right s reserved