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Waste Management 28 (2008) 1219–1226


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Characteristics of healthcare wastes


a,*
L.F. Diaz , L.L. Eggerth a, Sh. Enkhtsetseg b, G.M. Savage a

a
CalRecovery, Inc., Concord, California, USA
b
Ministry of Health, Ulaanbaatar, Mongolia

Accepted 15 April 2007


Available online 24 July 2007

Abstract

A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic
steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated
in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on
the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of
these wastes, particularly in developing countries, often is problematic.
This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in devel-
oping countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although
some information has been collected by the authors and from reports available to the authors. Only data collected within approximately
the last 15 years and using prescribed methodologies are presented.
The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23 kg/bed-day. The
relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district
health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On
the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65 kg/bed-day. The characteristics
of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature
review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics
that describe wastes from healthcare facilities. Such a consensus would greatly facilitate comparative analyses among different facilities,
studies and countries.
Ó 2007 Published by Elsevier Ltd.

1. Introduction the reports dealing with analyses and evaluations con-


ducted on the performance of a particular type of treat-
One of the most important and initial steps in the devel- ment method either in industrialized or in developing
opment of a plan or in the performance of risk or cost countries do not clearly specify or characterize the quality
analyses in the field of solid waste management involves of the waste undergoing the treatment. This article provides
a thorough understanding of the quantities and properties basic information on the quantities and characteristics of
of the material that needs to be evaluated or treated. In this the solid wastes generated in various types of health-
particular case, the material under consideration is health- care facilities located in industrialized and in developing
care waste. Unfortunately, there is a limited quantity of countries.
reliable information in the open literature on the quantities The majority of the information has been obtained
and characteristics of the various types of wastes that are from the open literature, although some data have been
generated in healthcare facilities. Furthermore, most of collected by the authors and from reports available to
the authors. Only data collected within approximately
*
Corresponding author. Tel: +1 925 356 3700; fax: +1 925 356 7956. the last 15 years and using prescribed methodologies are
E-mail address: ludiaz@calrecovery.com (L.F. Diaz). presented.

0956-053X/$ - see front matter Ó 2007 Published by Elsevier Ltd.


doi:10.1016/j.wasman.2007.04.010
1220 L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226

2. Quantity ranges from 0.005 kg/patient-day (for outpatient) to


0.68 kg/patient-day (for obstetrics and gynecology). The
The quantities of waste generated in various government total amount of waste was estimated as 1.16 kg/patient-
hospitals in Peru are reported Table 1. The data in the day.
table for total hospital waste generation are reported as a The amounts of waste generated in hospitals in Metro-
function of various parameters such as kg/bed-day, kg/ politan Manila, Philippines, are reported in Table 4. The
patient-day, and kg/worker-day. The data show that, based information in the table presents the quantity of yellow
on the most common means of reporting, the six hospitals bag waste (waste that requires special treatment) and black
generated an average of 0.76 kg/bed-day of total waste. In bag waste (waste assumed to be similar to municipal solid
addition, the information in the table shows waste genera-
tion rates for various healthcare service areas such as out-
patient, surgery and delivery room. Table 3
Clinical waste generation by source in a provincial hospital in Viet Nam
The data in Table 2 indicate the amount of clinical, gen- (1992)
eral and kitchen waste generated in a provincial hospital in
Source Clinical waste generation
Viet Nam. As shown in the table, the average amount of (avg. kg/patient-day)
clinical (in this case, infectious) waste amounts to about
Medical ward 0.09
0.30 kg/patient-day. On the other hand, the average Surgical ward 0.21
amount of general waste was 0.75 kg/patient-day and that Obstetrics and gynecology 0.68
of food/kitchen waste was 0.35 kg/patient-day, for a total Pediatric 0.1
of about 1.40 kg/patient-day. Outpatient 0.005
The information presented in Table 3 indicates the Accidents and emergencies 0.05
Dental clinic 0.02
amount of clinical waste generated by the various depart-
ments of a provincial hospital of Viet Nam, reported in Total 1.155
kg/patient-day. As shown in the table, the generation Source: Saw and Hoo, 1998.

Table 1
Unit generation of solid wastes by source of generation in various healthcare facilities in Peru
Institution Hospital – total generation Outpatient Surgery Delivery room
kg/bed/day kg/patient/day kg/worker/day kg/consult/day kg/surgery/day kg/delivery/day
Jose Olavarria (Tumbes) 0.71 2.21 0.48 0.095 2.71 2.23
Docente (Trujillo) 1.40 2.00 0.45 0.056 3.50 4.44
Regional of Ica (Ica) 0.62 1.31 0.42 0.039 1.20 1.95
Regional of Cusco (Cusco) 0.49 1.13 0.34 0.026 1.10 1.50
Daniel A. Carrion (Huancayo) 0.76 1.38 0.35 0.036 1.80 0.73
Regional of Loreto (Iquitos) 0.59 7.56 0.45 0.032 0.91 0.97
Averages 0.76 2.60 0.42 0.047 1.87 1.97
Source: Ministerio de Salud, 1995.

Table 2
Waste generation analysis by major sources in a provincial hospital in Viet Nam (1992)
Date Number of patients Ward Total ward Food kitchen Total waste
Clinical (kg) General (kg)
1 92 29 57 86 25 111
2 89 28 53 81 41 122
3 97 33 64 97 30 127
4 95 37 57 94 37 131
5 96 27 68 95 37 132
6 83 29 76 105 32 137
7 97 23 53 76 32 108
8 95 28 55 83 42 125
9 93 19 89 108 22 130
10 79 26 56 82 32 114
11 68 21 83 104 21 125
12 87 23 88 111 20 131
Averages 89.25 26.92 66.58 93.50 30.92 124.42
kg/patient 0.30 0.75 1.05 0.35 1.40
Source: Saw and Hoo, 1998.
L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226 1221

Table 4 generated municipal solid waste was about 0.27% (the


Quantities of wastes generated in hospitals in Metro Manila, Philippines range was 0.14%–0.54%).
(1999 and 2002)
The results of a survey conducted in Guayaquil, Ecua-
Type of Quantitya Percent Waste quantity Waste quantity dor, are given in Table 6. The information in the table
waste (kg/day) (kg/bed-day) (kg/bed-day)
1999 2002
shows the quantities of wastes generated in hospitals, clin-
ics, health centers and other facilities. The data show that,
Yellow bag
Pathological 27.9 0.06
as expected, the amount of infectious wastes varied from
Infectious 29.79 0.06 0.38 kg/patient-day in relatively small establishments such
Sharps 28.24 0.06 as health centers to 0.64 kg/patient-day in hospitals and
Total yellow 85.93 30.37 0.17 0.31 in clinics. On the other hand, the quantity of non-infectious
bag wastes fluctuated from 0.35 to 2.58 kg/patient-day. The
Black bag total amount of wastes generated in the facilities was within
Domestic 158.85 0.32 the range of 0.72–3.23 kg/patient-day.
Paper 38.21 0.08
A comprehensive healthcare waste characterization
Total black 197.06 69.63 0.39 N/A
bag program was conducted in the City of Ulaanbaatar,
Mongolia. At the time of the study (2005), the City of
Total 282.99 100.00 0.56
Ulaanbaatar had a population of nearly 1 million people.
Source: Asian Development Bank, 2003. Based on the results of the survey (summarized in Table
N/A: Not available.
a 7), the number and type of facilities, and the number of
Yellow bag: waste stored in yellow bags requires special management.
patients seen each day, projections were made to deter-
mine the quantities of waste generated by the level and
waste) as reported by two different studies. As shown in the type of healthcare facility in Ulaanbaatar. The data in
table for 1999, the amount of yellow bag waste was the table are presented for medical and general waste,
0.17 kg/bed-day and that of black bag waste was 0.39 kg/ separately and combined. As shown in Table 7, outpa-
bed-day, giving a total of approximately 0.56 kg/bed-day. tient facilities generate between 0.006 and 0.1 kg/
On the other hand, the amount of waste placed in yellow patient-day of medical waste and between 0.01 and
bags during the study in 2002 was 0.31 kg/bed-day. Unfor- 0.79 kg/patient-day of general waste. On the other hand,
tunately, information is not available for 2002 on the quan- the inpatient facilities generate between 0.03 and 0.14 kg/
tity of waste put in black bags. patient-day of medical wastes and between 0.12 and
Another study conducted in a hospital in Metropolitan 0.38 kg/patient-day of general waste.
Manila reported the quantities of infectious and non-infec- Based on 365 days of treatment per year, the healthcare
tious wastes generated, which are shown in Table 5. The facilities in Ulaanbaatar produced about 781 kg/day of
amount of infectious waste was 0.34 kg/bed-day (63%) medical waste and 1874 kg/day of general waste, for a total
and that of non-infectious waste was 0.20 kg/bed-day of 2655 kg/day. The largest contributors to the waste
(37%). The total waste production was about 0.54 kg/ stream are: Level III facilities (state hospitals 1, 2 and 3
bed-day. Furthermore, information collected during this and hospital 4) with a total of 679 kg/day and Level VI
same study shows that the percentage of total healthcare facilities (other healthcare facilities), which contribute
waste of the total amount of municipal solid waste gener- about 529 kg/day. The main generators of medical waste
ated is on the order of 0.72% (the range was 0.36%– include: Level III facilities, followed by private hospitals
1.44%), whereas the percentage of infectious waste in (outpatient) and Level VI facilities. The main reason that
the outpatient service provided by private hospitals gener-
ates relatively large quantities of medical waste is because
Table 5
of the substantial numbers of patients seen each day
Quantities of waste generated in hospitals in Metro Manila, Philippines (1464/day in 2004). Together these three levels generate
(2003) about 282 kg/day of medical waste.
Source of waste Total five Average Average
days (kg) (kg/day) (kg/bed-day)
Infectious Table 6
Total infectious 1016 203 0.34 Quantities of wastes generated at healthcare facilities in Guayaquil,
Non-infectious Ecuador
PICU 106 21 0.04 Type of facility Infectious Non-infectious Total
Ward 274 55 0.09 (kg/patient-day) (kg/patient-day) (kg/patient-day)
OPD 68.3 14 0.02
Hospitals 0.64 0.99 1.63
ER-Surgery 138 28 0.05
Clinics 0.65 2.58 3.23
Total non-infectious 586.3 117 0.20
Health centers 0.38 0.35 0.72
Total 1602.3 320 0.54 Others 0.38 1.5 1.88
Source: Asian Development Bank, 2003. Source: Diaz, 2001.
1222 L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226

Table 7 For comparison purposes, the daily production of med-


Summary of solid waste generated by the health facilities surveyed in ical waste in hospitals in Portugal is reported in Table 8.
Ulaanbaatar, Mongolia (2005)
The data are reported for four different types of waste
Facility name Average no. of patients Waste generation (Group I–Group IV) and for two levels of segregation
per day during survey (kg/patient-day)
period
(usual practices and rigorous practices). Furthermore, the
Medical General Total data are compared to the results of other analyses carried
Natl. traumatology and orthopedic teaching hospital out in the country. Generally, according to this system of
All (except 363.1 0.14 0.31 0.45 characterization, the level of risk to humans increases from
burn unit)
Burn unit 187.5 0.13 0.16 0.29
Group I to Group IV, i.e., the greatest risk is associated
Cancer center with Group IV healthcare wastes. As shown in the table,
Inpatient 208.1 0.06 0.21 0.27 the total amount of healthcare waste is fairly constant
Outpatient 62.8 0.03 0.44 0.47 and varied from 3.5 to 3.9 kg/bed-day. In the evaluation,
National center for communicable diseases the amount of Group IV waste was reduced from 0.4 to
Inpatient 480.3 0.04 0.21 0.25
Outpatient 142.0 0.03 0.34 0.37
0.08 kg/bed-day and the amount of Group III waste
State hospital no. 1 increased from 1.6 to 1.9 kg/bed-day due to a rigorous
Inpatient 472.7 0.11 0.38 0.49 process of segregation. The amount of Group I waste
Outpatient 127.3 0.1 0.3 0.4 remained constant, at about 1.9 kg/bed-day. As expected,
State hospital no. 3 a rigorous level of segregation at the point of generation
Inpatient 411.6 0.05 0.19 0.24
Outpatient 52.0 0.02 0.79 0.81
reduces the amount of Group IV (wastes that under the
Maternity 203.4 0.09 0.24 0.33 law require incineration) and, at the same time, increases
hospital no. 1 the amount of Group III (waste that presents biological
Maternal and child health research center risk). Thus, the information presented by the researchers
Inpatient 697.3 0.08 0.26 0.34 in Portugal indicates that, with proper methods of segrega-
Outpatient 304.3 0.006 0.01 0.016
Bayanzurkh 534.3 0.01 0.04 0.05
tion, the quantity of wastes that require special treatment
district health can be reduced from 10% to 2% by weight. However,
center according to Portuguese regulations, Group III wastes
Sukhbaatar 456.7 0.04 0.06 0.1 present some type of risk; thus, to be able to compare the
district health results of this work with those from developing countries,
center
Bayanzurkh 249.7 0.04 0.34 0.38
wastes from Groups III and IV should be combined. After
district such combination, non-infectious wastes would amount to
hospital 1.9 kg/bed-day and infectious wastes would amount to
Chingeltei district 232.1 0.03 0.12 0.15 about 2.0 kg/bed-day. Consequently, the wastes that would
hospital require special treatment would amount to approximately
Bayanzurkh 116.0 0.01 0.02 0.03
district family
51% of the total healthcare waste stream.
health center In summary, the total amount of healthcare waste gen-
Sukhbaatar 221.0 0.01 0.01 0.02 erated in selected hospitals in developing countries varied
district family from 0.016 to 3.23 kg/bed-day. The relatively wide varia-
health center tion is due to the fact that some of the facilities surveyed
State dental 215.1 0.01 0.07 0.08
center
in Ulaanbaatar include out-patient services and district
Forensic center health clinics; these facilities essentially provide very basic
Outpatient 58.4 0.08 0.24 0.32 services and thus the quantities of waste generated are rel-
Autopsies 4.4 58.71 0.95 59.66 atively small. The quantities generated in these facilities
Source: Enkhtsetseg et al., 2005. would be comparable to rural health clinics or health

Table 8
Daily production of medical waste in Portugal (by type)
Practice Groups I and II Group III Group IV Total quantities of waste produced
(kg/bed-day) (%) (kg/bed-day) (%) (kg/bed-day) (%) (kg/bed-day)
Usual practices 1.9 49 1.6 41 0.4 10 3.9
Rigorous segregation 1.9 49 1.9 49 0.08 2 3.9
Others 2.1 61 1.3 37 0.08 2 3.5
Source: Alvim-Ferraz and Afonso, 2003.
Group I: wastes similar to municipal wastes.
Group II: non-hazardous medical wastes, no special treatment required.
Group III: present biological risk, must be pretreated prior to disposal.
Group IV: specific wastes, compulsory incineration.
L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226 1223

posts in other countries. On the other hand, the reported development of realistic waste reduction and recycling
amount of infectious (clinical, yellow bag) waste generated programs.
in these facilities varied from 0.01 to 0.65 kg/bed-day. The The composition of hospital wastes generated in institu-
total quantity of wastes generated in a Portuguese hospital tions in Peru is presented in Table 9. The information in the
was reported to be about 3.9 kg/bed-day (1.9 kg/bed-day, table shows that a substantial amount of the wastes con-
non-infectious and 2.0 kg/bed-day, infectious). Conse- sists of paper products, plastic and textiles in the form of
quently, the data show that the total amount of healthcare cotton and gauze.
waste generated in a hospital in an industrialized country The average composition of wastes generated in vari-
is approximately 1.2 to more than 200 times that gener- ous types of healthcare facilities in Ulaanbaatar, Mongo-
ated in some developing countries. On the other hand, lia, is presented in Table 10. The data in the table also
the percentage of infectious waste in the total healthcare show the percentage of general waste produced in the
waste stream in developing countries was about 63% com- facilities. The contribution of medical waste to the total
pared to 51% in an industrialized country such as waste stream varies from about 14% to 38%, depending
Portugal. upon type of healthcare facility (excluding the Forensic
Center, where about 98% is medical waste). The informa-
3. Composition tion in the table also shows that, in general, the major
components in the medical waste stream are syringes
One important component of a waste characterization and gloves. The category ‘‘other’’ is a major contributor
program involves the determination of the composition in the large facilities that provide outpatient services. A
of the wastes. A sound understanding of the contents small percentage of medicines was found in some of the
of the waste stream, in particular the contents of the facilities, while district hospitals produced some radioac-
non-infectious fraction of the waste, is helpful in the tive residues.

Table 9
Composition of hospital wastes generated in Peru (% by weight)
Institution Mixed paper Cardboard Plastic Plaster Placenta, other Glass Cotton, gauze Other
Jose Olavarria Hospital (Tumbes) 23.0 9.8 13.5 0.0 0.0 5.5 14.7 33.5
Docente Hospital (Trujillo) 37.0 3.0 9.7 2.0 2.1 4.0 15.5 26.5
Regional Hospital of Ica (Ica) 15.6 8.5 12.8 0.0 19.0 8.0 14.6 21.5
Regional Hospital of Cusco (Cusco) 22.2 0.0 9.1 3.7 0.6 14.4 17.7 32.3
Daniel A. Carrion Hospital (Huancayo) 15.7 4.6 15.8 2.5 4.2 8.0 26.5 22.7
Regional Hospital of Loreto (Iquitos) 18.7 3.2 9.6 0.0 21.7 8.8 12.3 25.7
Source: Ministerio de Salud, 1995.

Table 10
Average compositions of wastes generated in various types of healthcare facilities in Ulaanbaatar, Mongolia (2005, % wet weight)
Level: I II III
State specialized hospitals/facilities
Component Family health District District health State general hospitals Special facilities Forensic Maternity
centers hospitals centers center
(Outpatient) (Inpatient) (Outpatient) (Inpatient) (Outpatient) (Inpatient) (Outpatient) (Autopsies) (Inpatient)
Medical waste
Syringes 7.54 6.11 3.30 8.87 2.22 0.07 0.01 0.00 8.00
Gloves 20.96 3.23 13.38 3.17 4.35 0.03 0.06 0.00 6.47
IV 2.54 2.00 0.18 3.12 1.15 0.02 0.00 0.00 1.84
Bandages 2.12 0.29 3.36 1.73 3.84 0.10 0.02 0.00 2.49
Cotton 3.88 1.17 3.33 0.80 0.35 0.02 0.02 0.00 4.96
Pathological 0.01 0.01 0.01 98.41 7.81
Chemical 0.19
Medicines 0.66 0.68 2.10 0.90 0.77
Radioactive 0.09
Others 0.56 6.95 5.41 2.08 0.60
Subtotal 37.59 13.56 31.38 25.20 14.89 25.55 12.72 98.41 32.94
General 62.41 86.44 68.62 74.80 85.11 74.45 87.28 1.59 67.06
waste
Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Source: Enkhtsetseg et al., 2005.
1224 L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226

4. Other characteristics Table 13


Bulk densities of various components of healthcare wastes in Guayaquil,
Ecuador
4.1. Bulk density
Component No. of samples Bulk density (kg/m3)
Bulk density is defined as the uncompacted mass of a General wastes 10 56.22
material occupying a known volume. Bulk density gener- Kitchen wastes 12 322.19
Yard wastes 14 126.25
ally is reported as mass per unit of volume, e.g., kg/m3. Paper/cardboard 6 65.14
In waste management, it is important to know the bulk Plastic/rubber 6 85.35
density of the waste or components of the waste for a num- Textiles 6 120.27
ber of purposes. Some of these include: determination of Sharps 6 429.11
storage space, definition of size for the collection vehicle Food wastes 6 580.19
Medicines 6 959.71
and estimation of the requirements for processing equip-
ment (compaction, size reduction, disinfection and others). Source: Diaz, 2001.
The results of analyses conducted in Peru and in the
Philippines to determine the bulk density of various types
Table 14
of healthcare wastes are presented in Tables 11 and 12.
Bulk density of medical wastes generated in North America
The data in Table 11 show that the bulk density for the
Component Bulk density (kg/m3)
entire waste stream ranged from 137 to 359 kg/m3, with
an average of 218 kg/m3. The average bulk density for Human anatomical 810–1215
Plastics 80–2330
common (general) waste was 211 kg/m3, that for contami-
Swabs, absorbents 80–1000
nated waste was 226 kg/m3 and that for special waste was Alcohol, disinfectants 780–1000
139 kg/m3. The results of analyses conducted in one hospi- Infected animals 490–1300
tal in Metro Manila, which are presented in Table 12, show Glass 2840–3650
that the bulk density for non-infectious waste was 151 kg/ Bedding, shavings, paper, fecal matter 320–750
Gauze, pads, swabs, garments, paper, cellulose 80–1000
m3, while that for infectious waste was 262 kg/m3.
Sharps, needles 7300–8100
In this case, the data can be compared for the following Fluids, residuals 1000–1020
types of wastes: non-infectious (common) and infectious
Source: U.S. Congress, 1990.
(contaminated). The results show that the average bulk
density for non-infectious waste varied from 151 to
211 kg/m3, while that for infectious waste fluctuated from
226 to 262 kg/m3. The bulk densities of various components of healthcare
wastes generated in Guayaquil, Ecuador, are given in Table
13. The data in the table show that the densities vary from
Table 11 about 56 to 960 kg/m3.
Bulk density of hospital wastes by type of generator in Peru (kg/m3) For comparison purposes and as a source of additional
Hospital Total Common Contaminated Special information, the bulk densities for several components of
waste medical wastes generated in the United States are presented
Jose Olavarria 142 130 164 – in Table 14. The data in the table show the wide range of
(Tumbes) values for some of the materials found in the wastes.
Docente (Trujillo) 137 121 155 – If possible, healthcare institutions should also try to
Regional of Ica 261 220 273 550
obtain additional information on the physical and chemical
Regional of Cusco 237 242 216 –
Daniel A. Carrion 170 210 140 – characteristics of the wastes that require treatment, primar-
(Huancayo) ily in order to determine the method that would be most
Regional of Loreto 359 343 407 286 appropriate for the materials. Physical and chemical char-
(Iquitos) acteristics of healthcare wastes are important for purposes
Averages 218 211 226 139 of defining the specific type of equipment required for the
Source: Ministerio de Salud, 1995. treatment. Prior to embarking on this type of data collec-
tion effort in developing countries, it is important to ascer-
tain whether or not there are experienced laboratories and
Table 12 technicians available to conduct the type of sample collec-
Bulk density of wastes generated by hospitals in Metro Manila, tion and analytical measurements that are required.
Philippines
Type of waste Bulk densitya (kg/m3) 4.2. Moisture content, heating value and other characteristics
Non-infectious 151
Infectious 262 The results of various types of analyses conducted on the
Source: Asian Development Bank, 2003. main components of the non-infectious waste stream in hos-
a
Moisture content as received. pitals in Guayaquil, Ecuador, are presented in Table 15.
L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226 1225

Table 15
Summary of analysis and heating value of components of hospital waste generated in Guayaquil, Ecuador
Component Moisture content (%) Heating value (Kcal/kg) Volatile solids (%) Ash (%) Nitrogen (%) Phosphorus (%) Sulfur (%)
Paper/cardboard 16.20 2899 83.3 3.64 0.24 0.047 0.641
Plastic/rubber 14.87 7076 93.0 0.83 0.22 0.053 0.168
Textiles 30.41 1985 83.7 3.86 0.36 0.076 1.170
Food residues 44.95 3269 41.9 2.20 2.13 0.033 0.302
Medicines 64.18 3340 74.5 18.25 0.05 0.151 0.498
Kitchen wastes 47.07 2087 52.5 3.21 0.18 0.077 0.276
Garden wastes 40.24 1863 50.4 9.98 2.04 0.209 0.415
Source: Diaz, 2001.

Table 16
Physical–chemical characteristics of hospital wastes by type of generator in São Paolo, Brazil
Point of Moisture content Carbon Hydrogen Sulfur Volatile solids LHV (Kcal/ HHV (Kcal/ Chlorine
generation (%) (%) (%) (%) (%) kg) kg) (%)
Maternity 59.3 32.3 4.7 0.3 94.3 1589 4990 0.0
Nursing 24.1 30.8 3.6 0 95.8 2858 4236 0.0
Orthopedics 7.8 27.6 2.9 1.4 – – 3826 0.0
Surgery 28.6 27.9 3.9 0.5 89.5 2417 3893 0.0
Emergency 12.2 32 3.6 0.3 95.9 3463 4303 0.0
Source: Ministerio de Salud, 1995.
LHV: lower heating value.
HHV: higher heating value.

Table 17 1. This literature review and an attempt at a comparative


Moisture content and calorific value of medical wastes in the United States analysis of data points out the need to reach consen-
Component Moisture content Heating value sus on a worldwide basis on the terms and charac-
(wt%) (kcal/kg) teristics used to describe the various types of wastes
Human anatomical 70–90 444–2000 generated in healthcare facilities. One reason for
Plastics 0–1 7700–11100 resolving this shortcoming is that comparative analy-
Swabs, absorbents 0–30 3100–6700 ses such as this one, as well as the exchange of infor-
Alcohol, disinfectants 0–0.2 6100–7800
mation, are severely compromised by ill-defined and
Infected animals 60–90 500–3600
Glass 0 0 ambiguous terms. Without well-defined terms, major
Bedding, shavings, paper, fecal 10–50 2200–4500 difficulties and misunderstandings are bound to occur
matter when discussing and analyzing the characteristics of
Gauze, pads, swabs, garments, 0–30 3100–6700 healthcare wastes. For example, the terms hospital
paper, cellulose
waste, biological waste, clinical waste, medical waste,
Sharps, needles 0–1 0–33
Fluids, residuals 80–100 0–1100 yellow bag waste and common waste are typically
encountered in the literature, and they can have simi-
Source: US Congress, 1990.
lar meanings or be subsets of one another, which sub-
stantially inhibits using and comparing data from
The data in the table provide the results of thermo–chem- different countries.
ical analyses, including heating value, for several compo- 2. The range of hospital waste generation (both infectious
nents of the waste. and mixed solid waste fractions) varied from as low as
Other physical–chemical characteristics for hospital 0.016 kg/bed-day (maternal and child research center in
wastes generated in São Paulo, Brazil, (by type of genera- Ulaanbaatar, Mongolia) to 3.23 kg/bed-day (clinics
tor) are presented in Table 16. The data in the table show in Guayaquil, Ecuador). This relatively wide variation
the wide ranges in characteristics exhibited by the wastes. in quantities generated is due to the fact that some of
The moisture contents and heating values for several the facilities surveyed in Ulaanbaatar include out-
components of medical waste generated in North America patient services and district health clinics; these facili-
are given in Table 17. ties essentially provide very basic services and thus
the quantities of waste generated are relatively small.
5. Conclusions The quantities generated in these facilities would be
comparable to rural health clinics or health posts in
Based on the data reviewed and analyzed for this article, other countries. On the other hand, the reported
several important conclusions can be drawn: amount of infectious (clinical, yellow bag) waste varied
1226 L.F. Diaz et al. / Waste Management 28 (2008) 1219–1226

from 0.01 kg/bed-day (family health centers in Ula- Asian Development Bank (2003). Metro Manila solid waste management
anbaatar, Mongolia) to 0.65 kg/bed-day (clinics in project [TA 3848-PHI], Final report, vol. 8, Medical Waste Manage-
ment.
Guayaquil, Ecuador). Diaz, L.F. (2001). Manejo de residuos de establecimientos de salud en
3. The characteristics of the components of healthcare Guayaquil, Ecuador, (Management of healthcare wastes in Guayaquil,
wastes such as the bulk density and the calorific value Ecuador), Pan American Health Organization, January 2001.
have substantial variability. Some of the reasons for this Enkhtsetseg, Sh., Enkhjargal, G., Eggerth, L.L., Diaz, L.F., 2005.
variability may be the different moisture contents and Characterization study of healthcare wastes generated in Ulaanbaatar,
Mongolia, Prepared for the WHO, Western Pacific Regional Office,
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and operation of treatment systems for healthcare hospitales administrados por el Ministerio de Salud (Diagnostic of
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