The above-listed waste types comprise wastes from human or animal health care. Wastes and materials to be treated according to the requirements of the Tierseuchengesetz - TierSG (Animal Diseases Act), the Tierische Nebenprodukte-Beseitigungsgesetz - TierNebG (Act on the Disposal of Animal By-Products) as well as the sub-legal and Federal state-specific regulations, are not dealt with here.
IIn health care institutions, waste types arise which do not fall under Chapter 18 of the Abfallverzeichnis-Verordnung - AVV (Ordinance on the European Waste Catalogue) [cf. also LAGA (Working Group of the Federal States on Waste), enforcement guide no. 18 "Guideline on the proper disposal of wastes from health care institutions" or Waste Management Concept for Saxon hospitals 1999, including updates of 2002 and 2008]. These include the following hazardous wastes:

• EWC 150110* Packings containing residues to dangerous substances or contaminated by hazardous substances,
• special chemical wastes from different chapters of the Ordinance on the European Waste Catalogue (e. g. EWC 160506*, Laboratory chemicals consisting of or containing dangerous substances or chemicals, including mixtures of laboratory chemicals),
• EWC 150202* Absorbents, filter materials (including oil filters not otherwise specified) wiping cloths, protective clothing contaminated by dangerous substances

and the following, non-hazardous wastes:

• Packings (classification in waste group 1501), except textiles,
• Films and photographic paper (containing silver and its compounds - EWC 090107 or not containing silver and its compounds - EWC 090108),
• Mixed municipal wastes (EWC 200301) - also called commercial waste similar to domestic waste,
• Bulky waste (EWC 200307),
• Bio-degradable kitchen and canteen wastes (EWC 200108).

Moreover, medical institutions use electrical and electronic devices which - at the end of their useful life - arise as electrical and electronic waste and must be disposed of according to the Gesetz über das Inverkehrbringen, die Rücknahme und die umweltverträgliche Entsorgung von Elektro- und Elektronikgeräten - ElektroG (Act on the Sale, Return and Environmentally Sound Disposal of Electrical and Electronic Equipment). Electrical and electronic devices used in medical and health care are to be classified in Group 5 or to Category 8 "Medical Products" according to the Act on the Sale, Return and Environmentally Sound Disposal of Electrical and Electronic Equipment. Implanted devices (e. g. pacemakers) and infectious devices are not covered by the Act on the Sale, Return and Environmentally Sound Disposal of Electrical and Electronic Equipment.
Especially in large medical institutions, maintenance, renovation, modification, new building and/or removal work on buildings and installations are continuously carried out. Wastes arising in this process must be classified in Chapter 17 of the Ordinance on the European Waste Catalogue "Construction and Demolition Wastes" (cf. bibliography of waste portrait 1701 Construction and Demolition Wastes (mineral).

Sharps (other than EWC 180103*, EWC 180202*) EWC 180101 / EWC 180201

The so-called sharps (syringes with cannulae, scalpels, etc.) arise where patients are treated, e. g. especially in hospitals, veterinary hospitals, surgeries, sanatoriums, nursing homes, etc., but also from private use in case of self-medication or home care of patients.



Body parts and organs including blood bags and blood preserves (except EWC 180103*) EWC 180102

Wastes falling under EWC 180102 are generated in surgery areas or ambulant institutions with corresponding activities (clinics) as well as in pathology.



Wastes whose collection and disposal is subject to special requirements in order to prevent infection EWC 180103*

Such wastes are generated in the diagnosis, treatment and care of humans and animals suffering from infectious diseases. A list of diseases according to which wastes are classified in this waste type, is contained in enforcement guide no. 18 of LAGA (Working Group of the Federal States on Waste) "Guideline on the proper disposal of wastes from health care institutions". It concerns diseases which - taking account various criteria (infectiousness, survivability of pathogens, transmission mode, extent and nature of potential contamination, amount of contaminated waste, severity of possibly caused disease and its treatability) - is subject to special requirements in order to prevent infection. The Act on the Prevention and Control of Infectious Diseases in Humans (IfSG) forms an essential basis for the classification of waste. Moreover, these wastes must be handled in compliance with the Technical Rule on Biological Substances.

Wastes which are subject to special requirements in order to prevent infection arise especially in

• clinical-chemical and infection-serological laboratories,
• microbiological laboratories, virologies,
• quarantine units in hospitals,
• dialysis departments and dialysis centers where known virus carriers are treated,
• pathology departments
• operating rooms,
• blood banks,
• obstretical wards, gynecology,
• Medical practices, treating mainly (not only sporadically) patients suffering from the diseases in question.

Wastes whose collection and disposal is subject to special requirements in order to prevent infection EWC 180202*

Wastes of this type are generated in veterinary care, research and diagnosis in medical practices and hospitals, as well as in the control of animal husbandry and slaughterhouses. These also include laboratory animals and other waste from human-medical research and diagnosis, the disposal of which is subject to the Animal Diseases Act (TierSG), the Act on the Disposal of Animal By-Products (TierNebG), the Ordinance on the Enforcement of the Act on the Disposal of Animal By-Products (TierNebV) and Federal state-specific laws and ordinances (Saxony: Saxon Implementing Statute on the Act on the Disposal of Animal By-Products and on further regulations concerning the processing and disposal of animal by-products not intended for human consumption (SächsAGTierNebG) and Saxon Implementing Statute on the Animal Disease Act - Federal State Animal Disease Act - (SächsAGTierSG). The same applies to bedding, litter and excrement from animal laboratoies as far as the transmission of infectious diseases or the spreading of animal diseases or epizootics is to be expected.

In this context, reference is made to the Ordinance on Safety and Health Protection in Handling Biological Agents (Ordinance on Biological Agents - BioStoffV) and the Technical Guidelines for Biological Agents TRBA 120 and 230.



Wastes whose collection and disposal is not subject to special requirements in order to prevent infection (e. g. dressings, plaster casts, linen, disposable clothing, diapers) EWC 180104 / EWC 180203

Such wastes are generated in the immediate nursing and care of patients, for instance in hospitals, veterinary hospitals, medical practices and in places where infectious diseases do no play an (important) role. In practice, a distinction is often made between: involving and not involving body fluids (cf. waste pictures under "Classification according to Ordinance on the European Waste Catalogue").



Chemicals consisting of or containing dangerous substances EWC 180106* / EWC 180205*

Chemicals or substances with hazardous properties arise especially in laboratories during diagnostic work, or resulting from the use of diagnostic devices in laboratories. These types of waste may also arise in pathology departments, hospitals, nursing wards or dental practices as well as in pharmacies.



Chemicals other than those mentioned in EWC 180106* / EWC 180205* - EWC 180107 / EWC 180206

The origin of non-hazardous chemicals is identical with that of hazardous chemicals.



Cytotoxic and cytostatic medicines EWC 180108* / EWC 180207*

Carcinogenic-Mutagenic-Reprotoxic medicines (CMR medicines) are generated during the production and application of carcinogenic, mutagenic or reprotoxic medicines (cf. also TRGS 525 - Handling of hazardous substances in facilities for human medical care). Cytotoxic and cytostatic medicines arise as waste in units of patient care where the respective medicines are used (e. g. oncology), pharmacies, medical and veterinary practices and laboratories.



Chemicals other than those mentioned in EWC 180108* / EWC 180207* - EWC 180109 / EWC 180208

Medicines falling under EWC 180109 / EWC 180208 are generated in hospitals, veterinary clinics, pharmacies and medical or veterinary practices, and also in private homes as leftovers and products that have passed their sell-by dates.



Amalgam waste from dental care EWC 180110*

Amalgam waste is generated in dental practices and clinics.

Heavy metals

In wastes from human and animal health care (Ordinance on the European Waste Catalogue, Chapter 18), heavy metals do not play a role with regard to the classification as hazardous wastes. An exception from this are amalgam wastes from dental care (EWC 180110*). Amalgam - mixtures of different metals with mercury - are used as teeth fillings. Heavy metals and heavy metal contents may also be relevant for chemicals (e. g. diagnosis agents) and their classification as hazardous waste.



Organic pollutants

The typical organic pollutants, which are - amongst others - contained in the waste analysis database ABANDA, like, for instance, PAH, PCB, halogenated hydrocarbons, dioxins, phenols, aromatics, pesticides, are only of minor relevance for the assessment of hazardousness of medical wastes according to the Ordinance on the European Waste Catalogue, Chapter 18. No significantly high contents of organic pollutants are known or have been published.

Organic pollutants may be contained in chemicals consisting of or containing dangerous substances (EWC 180106* and EWC 180205*). The handling of biological substances is subject to the Technical Rules on Biological Substances TRBA 250.



Pathogens and agents

EWC 180103* / EWC 180202* - Wastes whose collection and disposal is subject to special requirements in order to prevent infection

Infectious wastes contain viable microorganisms or their toxins (pathogens), which may transmit diseases to humans and/or animals, thus allowing the disease to spread. Pathogens may be contained in all body fluids, in tissues, in microbiological cultures or contaminated materials. Information on infection modes are, for instance, Working Group of the Federal States on Waste, enforcement guide no. 18 "Guideline on the proper disposal of wastes from health care institutions", or publications and information of the Robert-Koch Institute, Berlin, or of the Friedrich-Loeffler Institute.



EWC 180108* / EWC 180207* - Cytotoxic and cytostatic medicines

Cytotoxic and cytostatic medicines contain agents with carcinogenic, mutagen, teratogenic and/or embryotoxic potentials. Within the scope of the approval procedure based on the guideline of the Safety Working Party of the Medicines Agency (EMEA - European Medicines Agency) (Source: EMEA 2006: Guideline on the environmental risk assessment of medicinal products for human use. Committee for Medicinal Products for Human Use (CHMP), Doc. Ref. EMEA/CHMP/SWP/4447/00: 1-12 no checks for (eco) toxicity prescribed according to the Chemicals Act are carried out.

Cytotoxic and cytostatic medicines contain agents with carcinogenic, mutagen, teratogenic and/or embryotoxic potentials. Within the scope of the approval procedure based on the guideline of the Safety Working Party of the Medicines Agency (EMEA - European Medicines Agency) (Source: EMEA 2006: Guideline on the environmental risk assessment of medicinal products for human use. Committee for Medicinal Products for Human Use (CHMP), Doc. Ref. EMEA/CHMP/SWP/4447/00: 1-12 no checks for (eco) toxicity prescribed according to the Chemicals Act are carried out. A general assessment of the environmental risks connected with cytostatics is not yet available. An "Evaluation of the Environmental Risks of Cytostatics", commissioned by the Umweltbundesamt (German Federal Environment Agency), was carried out on the basis of literature evaluations, in order to derive further need for action concerning the evaluation of the medicines concerned (source: Universitätsklinikum Freiburg, Institut für Umweltmedizin und Krankenhaushygiene in collaboration with other institutes: Umweltrisikobewertung von Zytostatika, March 2009, texts 06/09, environment research plan of the BMU (German Federal Environment Ministry), research report 360 14 004, UBA-FB 001256). The bulletin 620 published by the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (Professional Association for Health Care and Welfare Work) contains information on the safe handling of cytostatics in human and animal health care facilities.

Medicines for animals are approved by the Friedrich-Loeffler Institute (cf. Bibliography) and the Paul-Ehrlich Institute (cf. Bibliography).

The classification as hazardous waste in the Waste Catalogue Ordinance is based on the legislation on hazardous substances (GefStoffV among others).

In the following table are included links to the waste analysis database ABANDA with which you can receive information about the chemical composition and an estimation of the hazardousness. For each waste type the number of existing analysis is indicated. In case there are less than 10 analysis no sensible statistical assessment is possible and no link is available.
For an estimation of the hazardousness you will be linked to Hazard Check, a module integrated in ABANDA. The online-help (control button with yellow question mark) will support you operating Hazard Check.

839 types of waste are listed in the "Abfallverzeichnis-Verordnung" (Ordinance on the European Waste Catalogue). Approximately 200 of those are given as so called "mirror entries". These types of waste can be marked as hazardous or non-hazardous. Therefore, there is a problem of distinction for official execution and economy. The Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit (Federal Ministry for the Environment, Nature Conservation and Nuclear Safety) issued "Hinweise zur Anwendung der Abfallverzeichnis-Verordnung" (Information of the application of the Ordinance on the European Waste Catalogue ").

The classification of waste into waste marked as hazardous and waste marked as not hazardous, however, is handled differently by the individual Federal States:

Avoidance, minimization

According to the requirements of the Gesetz zur Förderung der Kreislaufwirtschaft und Sicherung der umweltverträglichen Beseitigung von Abfällen - Kreislaufwirtschafts- und Abfallgesetz - KrW-/AbfG (Act for Promoting Closed Substance Cycle Waste Management and Ensuring Environmentally Compatible Waste Disposal), waste must firstly be avoided and its amount be reduced as far as possible. In the area of health care, waste is avoided and its amount minimized in line with the following approaches:

• Use of big packs,
• Avoidance of unnecessary packaging,
• Use of products in in returnable packaging instead of those in one-way containers
• Recycling of returnable products,
• Switch-over to low-waste processes,
• Avoidance of unnecessary products,
• Switch-over to ecofriendly products.

These possibilities can be implemented by a multitude of measures (cf., for instance, Abfallwirtschaftliches Branchenkonzept für sächsische Krankenhäuser 1999, einschl. Fortschreibungen 2002, 2008; Waste Management Concept for Saxon Hospitals, 1999, incl. updates 2002, 2008).



Collection and provision

The wastes are collected at source separately by waste types according to the Ordinance on the European Waste Catalogue. Only in cases where the collection and recycling is economically unreasonable, can wastes be collected unseparated and classified in a suitable waste type in Chapter 18 of the Ordinance on the European Waste Catalogue.

From their sources of generation, wastes are generally transported to central internal collecting points (storage and handover points), and made available for disposal after preliminary preparation (e. g. disinfection). All internal processes must be carried out in such a manner as to avoid the formation of dust and aersols, gases and contaminations of the environment. The wastes must be collected and transported in suitable containers (tearproof, puncture-proof, impervious to fluids, tightly closable), and cooled, if necessary (EWC 180103*). The waste containers must be secured to prevent entry by unauthorized persons.

The prerequisites for the proper and cost-efficient disposal are the separate collection and handling of wastes. The basis to this is a well-founded waste disposal concept in the health care facility concerned. The business concept must be focused on the clear separation of waste, the extensive training of the local staff and the responsible persons, an efficient internal logistic system as well as the selection of appropriate internal treatment methods and external disposal channels

The LAGA Vollzugshilfe Nr. 18 "Richtlinie über die ordnungsgemäße Entsorgung von Abfällen aus Einrichtungen des Gesundheitsdienstes" (Working Group of the Federal States on Waste, enforcement guide no. 18 "Guideline on the proper disposal of wastes from health care institutions") contains provisions on the collection and the transport to central collecting points and to internal treatment facilities. The enforcement guide also includes wastes from animal health care.

The following items are mentioned by way of example:

• the required space concept for the waste collection, especially for multi-component systems,
• the normally daily transport of organic wastes from the source of generation to the central collecting point,
• the clear marking the wastes and hazardous substances that the collecting containers hold,
• the precautionary measures to prevent leakages of waste containers,
• the unauthorized opening of containers, refilling and sorting of wastes falling under EWC 180101, EWC 180102, EWC 180103*, EWC 180104, EWC 180108* and EWC 180201, EWC 180202*, EWC 180203, EWC 180207*,
• the cleaning and, if necessary, the decontamination of returned containers before their return transport,
• the inadmissibility of waste chutes for hygienic reasons,
• the compliance with technical standards (ventilation, prevention of dust and smell nuisance as well as pest infestation, possibilities of disinfection of surfaces nd cleaning, change of protective clothing) of central collecting points for the waste types EWC 180102, EWC 180103*, EWC 180202*,
• the storage of wastes according to EWC 180102 and EWC 180103*, in order to prevent the formation of gas (cooling of stored goods, storage times attuned to storage temperature),
• the securing of occupational health and safety during the disintegration and/or compaction of wastes,
• the treatment of waste types EWC 180103* and EWC 180202* exclusively in the disinfection installations approved by the Robert-Koch Institute (cf. list of the approved disinfection agents and methods).

Obligations to make waste available

The disposal of wastes is subject to obligations to make waste available vis-à-vis public-law waste disposal authorities. Provisions on the obligations to make waste available and on the wastes concerned are contained in the Gesetz zur Förderung der Kreislaufwirtschaft und Sicherung der umweltverträglichen Beseitigung von Abfällen (Kreislaufwirtschafts- und Abfallgesetz - KrW-/AbfG), (Act for Promoting Closed Substance Cycle Waste Management and Ensuring Environmentally Compatible Waste Disposal), in the Waste Acts of the German Federal states as well as in the respective statutes of the Landkreise (administrative districts) and towns and kreisfreie Städte (cities independent from district administration) and the waste disposal associations.

Where hazardous wastes are concerned, obligations to offer waste vis-à-vis "hazardous waste disposal companies" exist in some Federal States. Further information is available on the Internet (cf. bibliography "List of hazardous waste disposal companies in the Federal Republic of Germany").

The storage, transport and disposal of hazardous wastes are subject to the obligation to furnish proof according to the Nachweisverordnung - NachweisV (Ordinance on Waste Recovery and Disposal Records). Effective April 1, 2010, the Elektronische Abfallnachweisverfahren - eANV (electronic supervision procedure) will enter into force in replacement of the conventional procedure. Further information on the verification procedure and on eANV is available on the Internet under www.abfall.sachsen.de (cf. bibliography).

The possibilites of disposing of wastes according to Chapter 18 of the Ordinance on the European Waste Catalogue are described in enforcement guide Nr. 18 of the Working Group of the Federal States on Waste "Guideline on the proper disposal of wastes from health care institutions". The disposal facility concerned must be equipped to fulfil the approval-related and technical requirements set for the disposal of the waste type concerned. For the selection of suitable disposal installations, online information systems on this subject are availabe, like, for instance, www.abensa.de.

In some exceptional cases, some liquid wastes according to Chapter 18 of the Ordinance on the European Waste Catalogue can be disposed of through the sewage systems (cf. entry of the pertaining waste type), strictly in compliance with the requirements of Federal State-specific criteria for discharging waste water into water bodies [cf. bulletin and joint agreement between SMUL and Landesärztekammer Sachsen (Medical Association of the Federal state of Saxony) on the discharge of waste water from dental practices into public sewage systems of the Free State of Saxony], as well as with municipial waste management statutes.

To determine the disposal routes, the conditions on site must be scrutinized. Different conditions on site may well lead to different disposal variants attuned to the individual wastes.



Recycling

Separated amalgam from dental care (EWC 180110*) must be collected in appropriate containers and be marked according to the relevant regulations. The return of amalgam to the manufacturer or distributor for recycling is possible. The operator of the amalgam separator must keep records of the delivery of the separated material to a waste management company (certificate of delivery), indicating quantity and date of delivery.

The sorting and recycling of all other wastes mentioned in EWC Chapter 18 is generally prohibited on hygienic grounds and on the grounds of occupational health and safety. Excepted therefrom are non-infectious wastes according to EWC 180101, EWC 180104 and EWC 180203* (after disinfection by an approved procedure), if the competent authority confirms the compliance with the requirements relating to occupational health and safety, especially the requirements relating to the protection against health risks and the requirements under the Gewerbeabfallverordnung (Ordinance on Commercial Waste).

Chemicals according to EWC 180106*, EWC 180205*, EWC 180107, EWC 180206, having a sufficient heating value, can be treated thermally (energy recovery).



Disposal

EWC 180101, EWC 180201

Their disposal together with the waste types EWC 180104 bzw. EWC 180203 is possible, subject to compliance with requirements pertaining to epidemic hygiene and requirements pertaining to occupational health and safety. The opening of the collecting containers is prohibited. Once the wastes are compacted (press containers, packing press), they should not be transferred into other containers. Thermal treatment is recommended for the disposal of such wastes.



EWC 180102

Body parts and organs, including containers filled with blood or liquid blood products, shall be disposed of separately in approved thermal treatment plants. The mixing with municipal waste is prohibited.

The requirements of occupational health and safety pertaining to hygiene and infection prevention as well as discharge regulations must be complied with in accordance with Federal State-specific legislation and the municipal sewage statutes. Under exceptional circumstancesindividual blood bags can be discharged into drains designated for that purpose.



EWC 180103*, EWC 180202*

The requirements of occupational health and safety pertaining to hygiene and infection prevention as well as the discharge regulations must be complied with in accordance with Federal State-specific legislation and the municipal sewage statutes. Under exceptional circumstancesfecally/orally transmissible infections, the excrement can be disposed of by discharge into the sewage system.

Infectious wastes must be collected in containers approved for that purpose. The compaction or disintegration of such wastes is prohibited. The collecting containers are burnt in installations approved for that purpose. If the waste contains neither body parts nor organs or TSE pathogens, the waste types EWC 180103*, EWC 180202* can be subjected to the disinfection treatment approved by the Robert-Koch Institute (cf. bibliography) and disposed of together with non-infectious wastes (EWC 180104).

Caution:Risk of injury from sharps!

The disinfection plants must be operated according to the given operating parameters, the compliance with which must be documented. The list issued by the Robert-Koch Institute indicates the following principal methods for disinfecting wastes:

• combustion,
• boiling with water (1 procedure),
• steam disinfection (15 procedures),
• special procedures (3 procedures),
• special procedures for liquid wastes (3 procedures).

EWC 180104, EWC 180203

Non-infectious wastes of type EWC 180104 can preferably be treated thermally (domestic waste combustion plants). If permitted under municipal waste statutes and official approval criteria, they can be disposed of in mechanical-biological or mechanical-physical waste treatment plants.

In particular cases, containers with body fluids falling under the waste types EWC 180104, EWC 180203 by analogy with the waste types EWC 180102 and EWC 180103* can be disposed of by discharging them into the sewage system, always in compliance with the discharging regulations under Federal State-specific legislation and the municipal sewage statutes.

These waste types can be disposed of together with the waste type EWC 180101 (normally in domestic waste combustion plants). If those waste types are disposed of together, the wastes can be collected together by the waste producer and be made available for disposal.

If they are disposed of together with residual waste from households (domestic waste), EWC 180104 is to be applied. If those wastes are collected and disposed of by the public-law waste disposal authorities, no special declaration is necessary.



EWC 180106*, EWC 180205*, EWC 180107, EWC 180206

The hazardous and non-hazardous chemicals include various substances and substance mixes which must be collected separately and be disposed of via different routes depending on their properties, while they can be disposed of under these collective code numbers. The available disposal routes are thermal treatment (hazardous waste combustion) and several chemical-physical treatment methods.

In practice, chemicals are rarely disposed of under the code nuber of the Ordinance on the European Waste Catalogue, Chapter 18. Normally, chemicals are collected in larger amounts and disposed of under the more specific waste codes of the chapters of the Ordinance on the European Waste Catalogue. Small collecting points where small quantities arise dispose of their chemicals together with larger collecting points, so that they also fall under the more specific code numbers of other chapters of the Ordinance on the European Waste Catalogue.



EWC 180108*, EWC 180207*

Cytostatics and cytotoxins must be disposed of in approved thermal treatment plants (e. g. hazardous waste combustion plants).



EWC 180109, EWC 180208

Although medicines must generally be collected separately, they can be disposed of together with wastes of type EWC 180104. Smaller amounts of non-hazardous expired medicines (like those from private households) can be disposed of together with residual waste from households (domestic waste).Expired medicines can be delivered to the public-law waste management authorities, either within the scope of pollutant collection or in recycling centers. The discharge into the sewage system is prohibited.

Caution: The unauthorized use by third persons (especially children) must be prevented by taking appropriate safety precautions.

Here you can find the regulations and guidelines mentioned in this waste portrait as well as links to further services for regulations.