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• Management of healthcare waste involves several steps.
• These steps includes classification, minimization, handling, separation and packaging, labeling, internal transport, and storage.

Classification of Healthcare Waste

• Healthcare waste is categorized into non-hazardous and hazardous types.

Non-Hazardous Waste

• Group 1 includes general, domestic-like waste.
• Group II consists of domestic-like healthcare waste.

Hazardous Waste

• Group III includes hazardous healthcare waste, subdivided into biological, cytotoxic/cytostatic medications, and chemical waste.
• Group IV includes non-healthcare hazardous waste.
• Group V includes radioactive waste.

Group I Waste

• Group I waste is non-hazardous and general domestic waste.
• This includes biodegradable waste, office waste, and other municipal refuse.
• Examples are paper, cardboard, clothing, wood, and metals.
• It does not involve specific healthcare items or require special handling.

Group II Waste

• Group II waste is non-hazardous, domestic-like healthcare waste.
• No special measures are needed to prevent infections from this waste.
• This includes items like diapers and empty urine bags.
• Also included are non-infectious sharps.

Group III Waste

• Group III waste is hazardous healthcare waste and poses a potential risk to workers and the environment.
• Management requires specific measures.

Subgroup IIIA : Biological Waste

• This includes items that can transmit infections, such as needles and sharps contaminated with infectious agents.
• Also included are cultures and reserves of infectious agents, infectious animal waste, live or attenuated vaccines, bodily fluids contaminated with infections, and anatomical waste like placentas and tumors.

Subgroup IIIB : Cytotoxic and Cytostatic Waste

• Cytotoxic and cytostatic waste are hazardous medications, including antineoplastic drugs, and healthcare materials in contact with them.
• The level of contamination determines the type of handling required.
• Highly contaminated waste contains over 3% of cytotoxic drugs.
• Slightly contaminated waste doesn't come into contact with this amount.
• High production areas include pharmacy services, day hospitals, and inpatient units.

Subgroup IIIC : Chemical Waste

• Chemical waste includes hazardous chemicals.
• These chemicals may be categorized as hazardous substances, be halogenated or non-halogenated solvents, aqueous solutions, acids, bases, solids, peroxides, mutagens, mercury, radiological waste, glutaraldehyde/formaldehyde, or hazardous substance containers.

Group IV Waste

• Group IV waste is hazardous but not of healthcare origin.
• Batteries, construction waste, cloths with hazardous substances, dangerous toners, paints and WEEE are examples.

Group V Waste

• Group V waste is radioactive, requires nuclear safety measures.

Waste Minimization and Segregation

• Minimization involves reducing the generation of hazardous waste.
• Segregation is the classification and separation of waste, which marks the start of the waste management process.
• Waste from Group IIIA should go into packaging near the worker handling it for disposal.
• Waste from Group IIIB (cytotoxic/cytostatic drugs) shouldn't be stored in patient rooms or nurse work areas.
• Waste should be contained as soon as possible to avoid contamination.
• Criteria for Group IIIC waste management are to separate hazardous from non-hazardous, liquid from solid, carcinogenic from non-carcinogenic, and oxidizing from reducing agents.

Waste Packaging

• Non-hazardous waste goes in polyethylene bags.
• Hazardous waste goes in semi-rigid or rigid containers like Big Bags, drums, or containers.
• Group IIIA waste packaging should be identified with the biohazard symbol.

Acceptable Containers and Characteristics

• Paper and cardboard should be placed in blue polyethylene bags (min 200 galgas) or containers of 120-240 L capacity.
• Plastics use yellow polyethylene bags(min 150-200 galgas) or containers of 120-240 L capacity.
• Glass should use white 30-60 liter containers.
• Municipal use black polyethylene bags(min 200-300 galgas).
• Sanitary Waste should be in green polyethylene bags (min 200-400 galgas, autoclosure).

Hazardous Packaging

• Biological agents use rigid, opaque, UN-approved yellow containers.
• Cytotoxic waste should be in rigid, opaque, UN-approved red containers.
• Chemical waste should be in UN-approved blue containers or drums (30-120L).
• Non-healthcare Hazardous waste uses UN-approved drums and containers, as well as big bags for solids, and they are different sizes.

Labeling, Internal Transport, and Storage

• Containers of hazardous waste must be clearly labelled with data, DNI code, LER code, packaging date and a pictogram.
• Internal transport must be carried out at least once a day, with set routes and using specifically designated trolleys.
• After transportation, cleaning and disinfection with diluted bleach(10%) is required.
• Intermediate storage must be in a restricted access area, properly signposted, ventilated (no connections with clean circuits).
• Maximum storage length is 24 hours.

Final Storage

• Hazardous waste can be stored for up to 6 months.
• Group IIIA waste must be collected within 48-72 hours, with the exception of sharps containers or vaccines.
• Storage areas must be protected from the elements and animals, in separate zones with ventilation and lighting.
• The maximum height of the packages depends on the packaging and density.
• There should be separation from the sewage system, with limited quantities stored and an updated inventory inside a secured area.

Exposure to Biological Contaminants and Risk Prevention

• Exposure to biological contaminants is addressed according to Article 15 of the Law on Prevention of Occupational Risks.
• Precautions include standard universal procedures, treating fluids as potentially infectious, hand washing before and after glove use, single-use materials, and not recapping needles.
• The use of rigid containers and safe disposal of contaminated items are required.
• Hepatitis B vaccination is a measure.
• Follow protocol for biological risk accidents.
• Wound are protected with waterproof bandages and single-use gloves.
• Frequent had washing, proper uniform and Respiratory protection devices like masks and eye protection are required if splattering is likely.
• Biological agents are classified into four groups based on their risk.

Biological Agents

• Group 1: Unlikely to cause human disease.
• Group 2: Can cause human disease and may be a hazard to workers, but is unlikely to spread in the community when effective treatment is available.
• Group 3: Can cause severe human disease and presents a serious hazard to workers, with a risk of spreading in the community when effective treatment is available
• Group 4: Causes severe human disease and poses a serious hazard to workers, with a high risk of spreading in the community and no effective treatment available.