Module 13:

On-site Transport and

Storage of Healthcare Waste
 Module Overview

• Present the basic principles of waste transport

• Present equipment specifications and describe
appropriate equipment for waste transport
• Describe routing plans
• Describe specifications for storage areas
• Describe the requirements for storage of
different kinds of wastes
 Learning Objectives
• Define the essential elements of on-site transport
equipment
• Evaluate and improve on transport equipment
designs
• Explain the basic requirements for central
storage
• Develop a plan for safe routing of different kinds
of waste
• Write procedures for cleaning and disinfection of
on-site transport equipment
 Steps in Healthcare Waste
Management
• Waste classification
• Waste segregation
• Waste minimization
• Handling and collection
• On-site transport and storage
• Treatment and disposal
 Types of Waste Transport
• There are two types of waste transport:
– Internal Transport (on-site or in-house transport) refers to the
transport of waste inside the healthcare facility, such as
• Transport from points of generation to interim storage areas
to a central storage to an on-site treatment site.
• Transport from points of generation to interim storage areas
to a central storage pending external transport to an off-site
treatment facility

– External Transport (or off-site transport) refers to the transport

of wastes from healthcare facilities to off-site storage areas and
to off-site treatment facilities
 General Principles of On-Site Transport

• Movement of waste should take place during low

activity times whenever possible
• Regular transport routes and collection times should
be fixed and reliable
• Specific routes should be planned to prevent
exposure to staff and patients
– Minimize the passage of loaded carts through patient
care and other clean areas
– Avoid pathways used for patients and the public – use
separate floors, stairways, or elevators if possible
 Example of a Healthcare Facility Site Plan
Showing Collection Points
Entrance
Reception

Ward 1 Waiting Pharmacy

Area Medical
Records

sharps

Infectious Waste
Regular Waste

Chemical Waste

Waste Storage
Waste Storage

Chemical
Infectious

Outpatient
sharps

X-ray Cafeteria & Kitchen

Department

Stairs

GROUND FLOOR
 General Principles of On-Site Transport

• Waste transport staff should wear adequate

personal protective equipment like gloves,
strong closed shoes, overalls and masks
• All waste bag seals should be in place and intact
at the end of transportation
• There should be separate, secured, storage
rooms to maintain segregation of:
– Infectious waste
– Chemical, pharmaceutical and other wastes
– General waste
 On-site Transport Equipment
• Healthcare waste should be transported within the
healthcare facility by means of wheeled trolleys, carts or
bins
• Equipment used to transport waste should not be used
for any other purpose
• Transporting waste by hand should be minimized due to
the risk of accidents and injuries from infectious
materials or improperly disposed sharps
• The use of waste chutes in a healthcare facility is not
recommended because of the difficulty of
decontaminating chutes and the increased risk of
transmitting airborne infections
 On-site Transport Equipment
• Segregation should be maintained during transport
• Infectious waste/sharps
– can be transported together (depending on the final treatment /
disposal)
– should not be transported with other hazardous waste unless
there are separate compartments
– Should be transported in color-coded trolleys that are labeled with
the biohazard symbol and the words “Danger: Infectious Waste”
• General waste
– Should be transported in trolleys of a different color (e.g., black)
• Other hazardous waste (chemical and pharmaceutical)
– should be transported separately to their respective storage areas
 Waste Transport
• Requires the use of proper PPE
 Waste Transport
• Requires good body mechanics to protect the body
from injury.
• Examples of bad and good body mechanics when
lifting

WRONG RIGHT
 Equipment Specifications
• Trolleys, carts and wheeled bins should be:
– Easy to load and unload
– Designed without sharp edges that could damage waste bags or
containers
– Easy to clean
– Lidded and labeled
– Easy to clean with a drainage hole and a plug for large bins
– Easy to push and pull
– Not too high so that the view of staff transporting waste is not
restricted
– Easily identifiable for each waste stream
– Appropriately sized according to the volumes of waste
generated at the facility
Typical Infectious Waste Trolley

• Hard plastic container

with a lid and push bar
• Durable and easy to clean
• Leak-proof
• Wheeled
• Color-coded, marked with
the biohazard symbol and
text
• Large capacity
Typical General Waste Trolley

• Hard plastic container

with a lid and push bar
• Durable and easy to clean
• Leak-proof
• Wheeled
• Different color from the
infectious waste cart
• Large capacity
Example of an Infectious Waste Trolley

This trolley at a hospital in

Lebanon has separate
compartments for infectious
waste (red), soiled linens
(blue), and sharps
containers. It also has
compartments for cleaning
and disinfecting solutions,
and supplies of color-coded
bags.
Example of an Infectious Waste Trolley

In settings where no color-

coded trolleys are
available, a standard
wheeled trolley could be
used with color-coded
bags by affixing a
biohazard label with text
on the outside of the
wheeled trolley.
Examples of Wheeled Bins to Transport
Larger Amounts of Infectious Waste
 Example of a Wheeled Bin to Transport
Larger Amounts of Infectious Waste

In settings where no
color-coded bins are
available, a standard
wheeled bin could be
used with color-coded
bags by affixing a
biohazard label with
text on the outside of
the bin.
 Push-carts for Low-Resource Settings
• Ideally made up of
robustly constructed
stainless steel with
good, durable castors
• Mainly used to remove
or transfer one or two
bins/containers of
waste from the storage Image courtesy of WHO.int

room or treatment room

to the garbage trolley
outside the ward
 Example of a Push-cart

Push-cart used in
India with separate
compartments for
different color-coded
waste bins or
containers Image courtesy of rajswasthya.nic.in
Push-carts for Low-Resource Settings
• A leak-proof and
covered trolley made
of stainless steel with
wheels and a handle
on one side
Image courtesy of WHO.int

• A leak-proof and
covered wheelbarrow
to collect general
waste from hospital
premises
Example of a Wheeled Bin
for Chemical Waste

This wheeled bin (bottom

photo) has a lid (not
shown) and a sloped
bottom with a plugged
hole for drainage and
cleaning. It is used with
trays (top photo) to hold
cytotoxic and other
chemical wastes. The bin
is made of chemically-
resistant stainless steel.
 Cleaning Transport Equipment

• Transport equipment should be cleaned and

disinfected daily with an appropriate
disinfectant
Example of a Cart Cleaning Station

This cart cleaning station at a

hospital uses sodium
hypochlorite solution for
disinfection followed by rinsing
with a pressure hose to clean
infectious waste wheeled bins.
The station has a local exhaust
vent and sewer drain. It is
located next to the central
storage area where infectious
waste is picked up by an
external transporter for
treatment at an off-site
autoclave treatment plan.
 Routing
• Waste collection has to be carried out from
“clean to dirty”
• Starting from the most hygienically sensitive
medical areas, a fixed route needs to be planned
around other areas and interim storage sites
• The frequency of collection has to be carefully
planned to ensure there are no overflowing
waste containers
• Cross contamination with other transported items
should be avoided
 Routing Plan

• The routing plan will depend on:

– Waste volume and number of bags
– Waste type
– Capacity of ward storage area
– Capacity of the transport equipment
– Transport distances and times between
collection points
 On-site/Interim Storage
• Interim storage is the place within a department or
floor of a healthcare facility where waste is stored
temporarily before being brought to the central
storage area
• Waste generated on the wards could be stored in
dirty utility rooms or closets used for storing
cleaning equipment, dirty linen, and other waste
• If dirty utility rooms are not available, then the
waste can be stored in the wards at designated
and labeled areas away from patients
 On-site/Central Storage

• Central storage is the place within a healthcare

facility where waste should be brought for safe
retention until it is treated or collected for
transport off-site
 General Requirements for Storage Areas
The storage area should:
•have an impermeable, hard-standing floor with good drainage
•be easy to clean and disinfect (a tiled floor and walls are recommended)
•have facility to keep general waste separated from infectious and other
hazardous waste
•have a water supply for cleaning purposes
•have easy access for staff in charge of handling the waste
•have a lock to prevent access by unauthorized persons
•have easy access for waste-collection vehicles
•be protected from the sun, rain or snow
•be inaccessible to animals, insects, and birds
 General Requirements for Central
Storage Areas
The storage area should:
•have good lighting and at least passive ventilation
•not be situated near fresh food stores and food preparation areas
•have a supply of cleaning equipment, protective clothing, and waste
bags or containers
•have a washing basin with running tap water and soap for the staff
•be cleaned regularly at least once a week
•have a capacity appropriate to the volumes of waste generated
•be labelled in accordance with the hazardous level of the stored
waste
Labels for Central Storage Areas

No entry for unauthorized Biohazard sign for Toxic sign for chemical and
persons for all storage areas infectious and sharps waste hazardous pharmaceutical waste

No eating or drinking No smoking

Example of a Central Storage Area
at a Hospital
Example of a Central Storage Area
at a Hospital
 Storage of Infectious Waste and
Sharps
• The storage area should have a biohazard sign
• Regular inspection and cleanup (at least weekly) of
storage areas should be part of HCWM plans
• Workers should be trained in site spillage
procedures
• Sharps can be stored without problems, but other
infectious wastes must be kept cool if storage times
are exceeded, or refrigerated at a temperature of
3°C to 8°C if stored for more than a week
 Storage Times for Infectious Waste

• Storage times for infectious waste (e.g. the time

gap between generation and treatment) should
not exceed the following if the storage area is
not cooled:

Temperate climate Warm climate

72 hours in winter 48 hours during the cool

48 hours in summer season
24 hours during the hot
season
 Pathological Wastes Storage

• Considered as biologically active waste

– Expect gas formation and pathogen growth
• Storage should be air-conditioned or
refrigerated (e.g. in the morgue) and should
be stored at a temperature of 3°C to 8°C
• In some cultures, body parts are given to the
family for ritual procedures or are buried in
designated places
 Pharmaceutical Wastes Storage
• Classification (WHO, 1999)
– Non-hazardous waste which can be stored in the non-
hazardous storage area:
• Ampoules with non-hazardous content (e.g.
vitamins)
• Fluids with non-hazardous contents like vitamins,
salts (NaCl), amino salts…
• Solids, semi-solids like tablets, capsules, granules,
powders for injection, mixtures, creams, lotions,
gels, suppositories, etc.
• Aerosols, including propellant-driven sprays and
inhalers
 Pharmaceutical Waste Storage
• Hazardous wastes that should be stored in
accordance with their chemical characteristics or
specific requirements for disposal:
– Controlled drugs (should be stored under
government supervision)
– Disinfectants & antiseptics
– Anti-infective drugs, like antibiotics
– Genotoxic drugs (genotoxic waste)
– Ampoules with antibiotics
 Chemical Wastes Storage
• Consider characteristics of the different chemicals to be
stored and disposed
– inflammable, corrosive, explosive
• Spillage kits, PPE and first aid equipment (eye-
shower, etc.) should be available
• Should have adequate lighting and good ventilation;
constructed of materials suitable to withstand
explosion or leakage
• Storing liquid chemicals
– storage should be equipped with a liquid and
chemical proof sump or catch- containers under the
storage containers
 Chemical Wastes storage
• Storage compartments should be labelled in
accordance to their hazardous class
• Liquid and solid waste should be stored
separately
• If possible the original packaging should be used
for storage
• Labels should have the following:
– Hazard Symbol(s), Waste classification, Date,
Point of generation (if applicable).
 Examples of Chemical Waste Storage

Safety cabinet for Flammable substances Liquid chemicals on a

flammable inside the safety chemical-resistant
substances cabinet plastic container

Images from the WHO Blue Book

 Radioactive Wastes Storage
• Should be stored in containers that prevent
dispersion
• Should be labelled with the type of radionuclide,
the date, and details of required storage
conditions
• Waste with > 90 days half-life time has to be
collected and stored externally in accordance to
local regulations
 Radioactive Wastes Storage
• Storage must be equipped with sufficient shielding
material, such as lead shielding walls or as movable
shielding material
• Should be flameproof and have surfaces easy to
decontaminate
• Area must be clearly marked with “RADIOACTIVE
WASTE” and the international hazard label should be
placed on the door
• Radiation levels outside the storage should not exceed
2.5 µSv/hr.
What is Wrong With This Picture?

Note: The yellow bag is infectious waste.

What is Wrong With This Picture?

Note: Yellow is the color code

for infectious waste.
What is Wrong With This Picture?

Note: Yellow is the color code for infectious waste.

 Country- Specific Requirements

• Add your country specific requirements or

guidelines for transport and storage of HCW on-
site.
 Pictures

• You may add pictures of carts, equipment, and

storage areas in the current facility or other
facilities in the country.
 Discussion
• How does your facility store and transport wastes? Are there written
guidelines for properly storing and transporting the wastes? Are
different types of wastes kept separate during transport and storage?
What are some alternative methods for dealing with these wastes that
may or may not be practiced in your facility? Are safety procedures or
practices in place to ensure that staff members and the public are not
exposed during the processes?
• Do you know about your country’s or region’s regulations regarding
waste transport and storage?
• What are the advantages and disadvantages of different healthcare
waste transport systems? Do some seem to be safer and more
effective than others? What about storage procedures?
• How does the storage setup in your facility compare with some of the
general requirements given in this presentation?
• Any weaknesses or barriers?