Disease Control and Prevention Center (DCC) Program“Technical Assistance for Nosocomial Infection Control andTravel Clinics for Sulianti Saroso Infectious Diseases Hospital inIndonesia”

Waste Management
Wednesday, October 18, 2017
Center Hospital of the National Center
for Global Health and Medicine
Quality Improvement Center (QIC)Emi Kuroda

Introduction
 General Matters Concerning Waste Laws and Regulations Concerning Waste
 Management of Infectious Waste
 Management of Infectious Waste for Specific
Infectious Diseases (New Infectious
Diseases/Infectious Diseases Type I, etc.)
 Safety Control of Waste Management

General Matters Concerning Waste
20 types of waste are generated as a result of business activities
e.g. sludge, waste acid, waste plastics, and scrap metal

Specially
controlledindustrial waste

Industrial
waste
Waste other than industrial waste,
which is generated as a result ofbusiness activities
e.g. paper waste

Business-related
municipal solidwaste

Waste
Waste other thanindustrial waste

Municipal
solid
waste

Industrial waste specificallydesignated as harmful

Waste generated in the daily
lives of general households

Householdwaste

Waste category“Manual for Infectious Waste Management”, Ministry of the Environment, 2017“For Proper Management of Infectious Waste” Bureau of Environment, Tokyo Metropolitan
Government, 2009

<Infectious industrial waste>e.g. blood, needles

Infectious waste<Infectious municipal solidwaste>e.g. organs, blood-tainted gauze

Specially
controlledmunicipal solid
waste
Municipal solid waste specificallydesignated as harmfulMedical waste
Waste generated at healthcare facilities as a result of medical care (commonterm)* Home medical waste: categorized as household waste

Waste generated in hospitals and clinics
1) Infectious waste2) Non-infectious waste (i.e. medical waste, not infectious waste)3) Other waste (mainly municipal solid waste including paper waste and foodscraps)* Radioactive waste* Chemical waste

Infectious waste

Waste generated at healthcare facilities, which is capable of producing an
infectious disease since it has been contaminated by an organism that is,
or is likely to be pathogenic to healthy humans. Or, waste that is likely tocause these effects.

What is infectious waste?
 Waste containing blood
 Waste that is capable of producing an infectious disease Sharps used on patients

Disposable diapers (the following items are infectious waste)1) Blood-tinged diapers
2) Diapers used by patients with specific infectious diseases• In categories specified under the Infectious Disease Law:
Infectious diseases type I, type II, and type III (and part of infectious
diseases type IV/V), designated infectious diseases, new infectious
diseases, pandemic influenza* Diapers other than the above  non-infectious waste (business-related
municipal solid waste)
Acceptance conditions for the disposal of used diapers vary between municipalities
Coordination is required between healthcare facilities, waste disposal contractors,and municipalities

Flowchart to identify infectious wasteYes

No[STEP 2] (Place of generation) Waste generated and disposed from
infectious disease beds, tuberculosis beds, operating rooms, ER, ICU andexamination rooms after treatment and tests
NoYes[STEP 3] (Types of infectious diseases) Waste generated and disposed
after the treatment or tests for infectious diseases type I, II, and III,
designated infectious diseases, new infectious diseases, and tuberculosis,
which are specified under the Infectious Disease Law. Medical devices
used and disposed of after the treatment or tests for infectious diseases
type IV and V that are specified under the Infectious Disease LawYes(however, limiting to disposable diapers of patients with specific infectiousdiseases)
No

Non-infectious waste

Infectious waste[STEP 1] (Shape) Waste corresponding to any of the following
1) Blood, blood serum, plasma and body fluids (including semen)
2) Pathological waste (organs, tissues, skin, etc.)
3) Items used for studies and tests involving pathogenic microorganisms
4) Sharps that have blood stains, etc. (including broken glass, etc.)Waste Disposal
Flowchart

Infectious waste

BedsidePreparation room

• Injection needles• Syringes with needles• Blood collection needle
holder• SURFLO (outer andinner sheaths)• Sharps

Items that have not beenused on patients• Injection needles• Syringes (including thosewith needles)• Ampules/vials• Liquid medicine bottles• IV bags• Gloves used for coinjections

Portable sharps
disposal container

Sealable plastic
waste bin

* Note 1: Wastes that are blood-stained,
infectious or possibly infectious,and those after RI tests

Treatment room/soiled
utility room

Treatment room/soiled
utility room/infectious
patient room

Items used on patients••••••••••••

Injection needles
Syringes with needles
IV tubingIV bags with tubing
Blood bags
Puncture needles
Scalpels
Guide wires
Ampules
Vials
Liquid medicine bottles
Suction bags with solidifyingagents• Items used for administrationof anti-cancer agents

Sealable plastic
waste bin•
•
•
•
••
••••

•

Syringes without needles
Catheter tips
IV bags
Liquid medicine plastic
bottles (includingdisinfectant)
Drainage supplies that are
not sharp
Empty drainage bags/bottles
Oxygen mask/cannulas
Gauze
Alcohol swabs
Personal protective
equipment
Part of disposal diapers(Note1)

Cardboard box for
infectious waste* Including private
items

Non-infectious waste

Combustible

Non-combustible• Paper waste• Food scraps• Clothes• Woodchips• Plants• Disposal diapers• Disposal towels(Note 1)Semi-transparent
plastic bags

• Packaging of medical
materials (needles,syringes, etc.)• Plastics• Vinyl• Dirty plastic trays suchas lunch boxes• Rubber• Metals• PotterySemi-transparent
plastic bags
For dedicatedcontainers

Semi-transparent
plastic bags

Recyclables• Bottles• Cans• Plastic bottles• Newspapers• Magazines• Cardboardboxes• Batteries

Semi-transparent
plastic bags
Same bag for all
items

General garbage
container
To be prepared byeach department

Laws and Regulations Concerning Waste• Waste Management and Public Cleansing Law• Manual for Infectious Waste Management under the Waste
Management Law… were revised in March 2017, based on the “Basic Guidelines forStrengthening Measures on Emerging Infectious Diseases”• Guidelines for Infectious Waste Management• Voluntary Standards for Incineration of Industrial Waste to Reduce theFormation of Dioxins<Other>• Basic Environment Law• Air Pollution Control Act• Water Pollution Control Law• Noise Regulation Law••••

Vibration Regulation Law
Offensive Odor Control Law
Additional regulations of municipalities
Agreement on environmental pollution control,etc.

Collection and transport

Manifest

Industrial waste collection and transport
contractor
Specially controlled industrial waste collectionand transport contractor

Consignment
contract

Payment ofappropriate fees

Consignment
contract

Manifest

Business generating waste

Intermediate treatment

Consignment
contract

Industrial waste disposal contractor
Specially controlled industrial waste
disposal contractor

Final disposal“Manual for Infectious Waste Management”
Ministry of the Environment, 2017

Industrial waste disposal contractor

Consignment
contract

Collection and transport
Industrial waste collection and transport
contractor

Manifest The speciallycontrolled industrial
waste manager
checks forappropriate
management

Healthcare facilities, etc.

Manifest

 Control Manifest ofIndustrial Waste(Manifest)

Manifest

 Entrustment ofinfectious waste
management

Manifest indicating the completion of intermediate
treatment/ final disposal

Treatment Flow

Matters concerning proper management of waste(Revisions of the Manual for Infectious Waste Management under theWaste Management Law)
Revised in May 2012 and March 2017 by
the Ministry of the Environment

 Strengthening measures to ensure proper management by businesses that aregenerating wasteStricter manifest system

Business that is generating waste: Copy of manifest  “Archive for 5 years”
Electronic manifest: Notification of disposal completion  “Record deadline”
Creation of a system to notify the outsourcer of an industrial waste disposal
contractor

Disposal contractor: Difficulty in proper management of waste  “Notify theoutsourcer”
 Promoting the creation of good industrial waste disposal contractors, etc.
Education to create good industrial waste disposal contractors
Offer an exception for the valid period of permission: Normally 5 years  “7years”

Matters concerning infectious waste management(Revisions of the Manual for Infectious Waste Management under theWaste Management Law)
Revised in May 2012 and March 2017 by
the Ministry of the Environment

 Drafting a disposal plan (reduction of waste, etc.)
Drafting/disclosure of a disposal plan by managers of healthcare facilities withindustrial waste of 1,000 tons or more or specially controlled industrial waste of
50 tons or more in the previous year Specifying the deadline/archiving period for the disposal ledger
 Specifying the document content regarding collection, transport and storage of
infectious waste
 “Basic Guidelines for Strengthening Measures on Emerging Infectious Diseases”
Strengthening of measures in case of infectious diseases with pandemic
potential (Ebola hemorrhagic fever/Zika virus infection/MERS, etc.) in Japan* Provide details of the virus and precautions to contractors

Management of Infectious Waste
Packaging/labeling• Label “infectious waste” on the container• Sealable, easy-to-store, damage-resistantPortable sharps
disposal container

Sealable plastic
waste bin

Biohazard mark
Red: Liquid
Orange: Solid
Yellow: Sharp

Cardboard box for
infectious waste

Storage• Store short period of time before transport• Store separately from other wastes• Display a sign indicating infectious waste at
the storage site
• Restrict access to the storage site
• Lock the storage chamber
Transport• Use carts that are impervious/clean/easy totransport

Precautions for handling infectious waste Wear personal protective equipment when handling infectious waste* Gloves, masks (gowns, aprons, goggles, if necessary) Change the container when it’s 70% full (Do not overfill it) Do not squeeze or compress the container Avoid contact with your body during collection/transport Do not shift infectious waste into another container* Risk of scattering/leakage or injuries from sharps Segregate and store from other wastes

 Restrict access to the storage site
* Lock the storage chamber

Disposal methods of infectious waste
Methods adopted for intermediate treatment/facility or specifiedby law• Incineration (temperature of 800°C or more)• Melting (temperature of 1,200°C or more)• Sterilization (high-pressure steam sterilization, microwavesterilization)• Irradiation (gamma ray/electron ray)

Final disposal• Land disposal* Incinerator
Waste is incinerated at 900°C for 3 to 4hours.
Incinerated ash is then converted intoslag for recycling

Photo: Tokyo Waterfront Recycle PowerManagement of Infectious Waste Generated When Treating
Specific Infectious Diseases (New Infectious
Diseases/Infectious Diseases Type I, etc.)
Biohazard mark
To be sealed in a dedicated infectious waste
container (sealable, easy-to-store, damageresistant)
Or, to be sealed in double plastic bags

Disinfect the surface of the bag with 0.05 %(500ppm) sodium hypochlorite

Remove from the patient environment(patient room, etc.) and store in the medicalwaste storage room
 Incineration

Red: Liquid
Orange: Solid
Yellow: Sharp

Management of Infectious Waste Generated When Treating
Specific Infectious Diseases (New Infectious
Diseases/Infectious Diseases Type I, etc.)
Over 121Cfor over 20mins.

From thepatient room

Infectious disease ward (forpatient rooms)
High-pressure steam sterilization
Autoclave• Be sure to check the temperatureof the chamber• Do not overfill the chamber since
the waste needs to be fully
steamedFrom thecorridor• When containers or bags aresealed, leave a small space toallow for steam between them

Safety Control of Waste Management
 Notification of the Waste DisposalFlowchart Periodic check during ward rounds, etc.
 Orientation, education and training

Waste Disposal Flowchart Measures to be taken in an emergency/
accident• In case of sharps injuries, exposure to eyes ormembranes
Safety measures for waste storage sites• In case of waste leakage/spills(disinfection/cleaning of the contaminatedarea)• In case of fire/smoke of waste(initial extinguishment, etc.)• Establishment of an emergency
communication system