CLINICAL WASTE MANAGEMENT

UNDER COVID-19 SCENARIO IN

MALAYSIA

Prof Dr Agamuthu, P.
Professor, Jeffrey Sachs Center on Sustainable Development, Sunway University and High-Level Foreign
Expert, Ministry of Science and Technology, China
[email protected]
Table of Contents
• Introduction
• Clinical Waste Generation in Malaysia
• Composition of Clinical Waste
• Clinical Waste Management
• Management of Expired or Discarded Drugs
• Post-treatment of ash from incineration of clinical waste
• Clinical Waste and COVID-19
• Generation of COVID-19 clinical waste by country
• Clinical Waste Management and COVID-19
• Household clinical waste management and COVID-19
• Conclusion
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Introduction
• Clinical waste is the waste originating from healthcare facilities and other
related facilities such as laboratories, autopsy or mortuaries etc.

• Clinical waste can be categorized into several categories such as infectious

waste, pathological waste, sharp waste, chemical waste

• The generation of clinical waste in Malaysia is 90 tonnes/day or 33,000

tonnes/annually

• Schedule waste regulation (2005), Environmental Quality Act, 1974, and

standard operating procedure provided by Ministry of Health, Malaysia
regulates the management of clinical waste
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Introduction (cont’d)
• COVID-19 outbreak was first identified in December 2019 and in March, it
was declared as Pandemic

• Malaysia recorded 8616 Covid-19 cases and 121 deaths as of June 28th 2020

• Increase in the number of COVID-19 cases can be correlated to the increase

in clinical waste generation

• Mainly disposable gloves, face masks and personal protective equipment

(PPE) contribute to clinical waste generation during COVID-19 pandemic
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 Littering of COVID-19 related waste 5
(Source: Nasseri, 2020)
Clinical Waste Generation in Malaysia
Years
Types of Waste
2017 2016 2015 2014 2013
Pathogenic Clinical Waste - SW 404
(tonnes) 28,375.24 23,844.91 25,523.32 21,976.12 18,152.95

Expired Drug - SW 403 (tonnes) 458.97 14,250.60 282.31 447.97 1,470.14

Discarded Drug - SW 405 (tonnes) 298.53 337.77 112.01 110.59 120.36

TOTAL (tonnes) 29,132.74 38,433.28 25,917.64 22,534.68 19,743.45

Source: Environmental Quality Reports (2013 – 2017) 6

Composition of Clinical Waste
Chemical &
Pharmaceuticals
Sharp waste waste Other waste
1% 3% 1%
Pathological waste
15%

Non-Infectious waste
80%
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 Clinical Waste Management – Regulations

Environmental Quality
(Scheduled Wastes)
The Environmental Quality

Regulations 2005
(Prescribed Premises) (Scheduled
Wastes Treatment and Disposal
Clinical waste is listed as
Facilities) Order 1989
scheduled waste in
Malaysian environmental
regulations
The Environmental Quality
(Prescribed Premises) (Scheduled
Wastes Treatment and Disposal
Facilities) Regulations 1989

Department of Environment (DOE) is responsible for all aspects of clinical waste management from collection, transportation, treatment 8
and disposal and uses online system named electronic scheduled waste management system (eSWIS) to monitor compliance
Classification of Clinical Waste
Clinical waste classification under the Environmental Quality (Scheduled Wastes) Regulations, 2005

Scheduled waste codes Types of clinical waste

SW403 Expired drugs containing psychotropic substances or containing substances

that are toxic, harmful, carcinogenic, mutagenic or teratogenic;

SW404 Pathogenic and clinical wastes and quarantined materials;

SW 405 Discarded drugs

SW421 A mixture of scheduled wastes;

SW422 A mixture of scheduled and non-scheduled wastes.

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Clinical Waste Management – Regulations (Cont’d)
• Clinical waste management guidelines requires scheduled wastes to be
managed properly before disposal as it could be harmful

• Generators of scheduled waste need to notify the DOE of any scheduled

wastes generated and keep up-to-date inventory of scheduled waste
generated, treated and disposed as per regulation

• Scheduled wastes may be stored, recovered and treated within the

premises of a waste generator

• Waste generators shall conform to the requirements of the consignment

note system when transporting wastes to ensure it reaches the approved
destination and are carried out by licensed transporter and the treatment
shall only be carried out at prescribed premises licensed by the DOE
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Clinical Waste Management – Disposal
• Disposal of clinical waste is performed as followed;
• Separation of clinical waste from generated waste
• Labelling of clinical waste
• Disposal into proper containers and bags
• Collection by licensed contractors for disposal and treatment at 12
incineration facilities nationwide

• The waste is disposed of according to color coded containers

or plastic bags (Zaimastura, 2005)
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 Clinical Waste Bag
Blue plastic bag / container is used for wastes to be autoclaved, yellow is for wastes that are to be incinerated
and black is for general household wastes (DOE, 2009)

Yellow bag for disposal of clinic waste Blue bag for autoclaving clinical waste
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 Clinical Waste Bins

Two wheel clinical waste bin Pedal operated clinical waste bins Mobile pedal operated
clinical waste bin

Sharp waste bins 13

 Management of Expired or Discarded Drugs
Guidelines for Clinical Waste Management by DOE Malaysia
Description of Clinical Waste Waste Management Guidance
Pharmaceuticals which have become unusable Class I - pharmaceuticals such as camomile tea, cough
for the following reasons:- syrup, and the like which pose no hazard during collection,
intermediate storage and waste management: managed
• expiry date exceeded jointly with municipal wastes

• expiry date exceeded after the packaging has Class II - pharmaceuticals which pose a potential hazard
been opened or the ready-to-use preparation when used improperly by unauthorized persons: managed
prepared by the user; or in an appropriate waste disposal facility

• use is not possible for other reasons (e.g. call-

Class III - Heavy metal – containing unidentifiable
back campaign) pharmaceuticals: managed in an appropriate waste
Wastes arising in the use, manufacture and disposal facility
preparation of, and in the oncological treatment
of patients with, pharmaceuticals with a Intermediate storage of these wastes takes place under
cytotoxic effect (mutagenic, carcinogenic and controlled and locked conditions. For reasons of
teratogenic properties) occupational safety, cytotoxic pharmaceutical wastes must
be collected separately from pharmaceutical waste and
disposed of in a hazardous waste incineration plant 14
Clinical Waste Management – Concession Companies

List of concession companies that manage clinical waste in Malaysia

Company Service for Government /Private

Radicare Sdn Bhd Government hospital, clinic, medical institute
Edgenta Medisure Sdn Bhd Government hospital, clinic, medical institute
Medivest Sdn Bhd Government hospital, clinic, medical institute
Sedafiat Sdn Bhd Government hospital, clinic, medical institute
One Medicare Sdn Bhd Government hospital, clinic, medical institute
Future Nrg Sdn Bhd Private hospital and clinics
Kualiti Alam Sdn Bhd Private hospital and clinics

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Biohazard symbol and labelling of clinical waste

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Clinical Waste Management - Temporary Storage
• Some hospitals store the clinical waste generated at cold rooms as a
temporary storage until dedicated lorry arrives

• Collection can be daily or 3 times a week depending on the quantity

• Transportation is done only by the special lorry licensed to transport

hazardous waste which belongs to the concession companies

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 Clinical Waste Management - Treatment
• Almost all pathological or
infectious clinical waste is
38,433
incinerated in Malaysia 40,000.00

QUANTITY OF CLINICAL WASTE

35,000.00 29,133
25,918 28,375

(METRIC TONNES)
30,000.00
22,535
• Only Class III or cytotoxic 25,000.00 19,743
25,523

pharmaceutical waste is 20,000.00 18,201 21,975

16,291
required to be incinerated 15,000.00

10,000.00

• Class I pharmaceuticals may 5,000.00

be disposed in municipal -
2013 2014 2015 2016 2017
disposal site Source: Environmental Quality Reports (2013 – 2017)
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 Clinical Waste Management – Treatment (Cont’d)

Healthcare Waste Treatment by Kualiti Alam 19

(Source: Cenviro, n.d.)
Kualiti Alam Incineration Plant

Incinerator ash of clinic waste is transported to Integrated Hazardous Waste Treatment Center, is Solidified
with cement, and disposed of in secure landfill
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Clinical Waste Management (Cont’d)
• According to environmental regulations related to clinical or
schedule waste;

• Public is not allowed to handle and dispose any type of scheduled

waste including clinical waste without proper license

• Those found guilty can be sentenced to a mandatory prison and

maximum fine of RM500,000 (115,000 USD)

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Clinical Waste and COVID-19
● 27% increase in clinical waste following Covid-19 outbreak in Malaysia
(25 tonnes of COVID-19 clinical waste per day)

● Increased generation of swab, syringes, needles, sharps, blood or body

fluid, excretions, mixed waste, laboratory waste, material or equipment
contaminated with the virus, mask or disposable gloves, personal
protective equipment (PPE)

● Asian development bank estimated additional generation of clinical

waste due to COVID-19 in just 60 days to be:
16,800 tonnes in Manila 12,750 tonnes in Jakarta 9,600 tonnes in Hanoi

12,600 tonnes in Bangkok 9,240 tonnes in Kuala Lumpur 22

China struggled to cope with plethora of medical waste generated by COVID-19 outbreak in the country
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(Source: Routers, 2020)
Generation of Covid-19 clinical waste by country

Amount of waste Percentage of increase in

Country generated during covid-19 clinical waste generation References
(kg/bed/day) during covid-19 pandemic

Taiwan 0.9 – 2.7 No data Chiang et al. (2006)

Jordan 3.95 1000% Abu-Qdais et al.(2020)
Wuhan, China 0.6 – 2.5 213% Yu et al., 2020
Bandung, Indonesia 2.2 17.1% Damanhuri (2020)
Penang, Malaysia 0.4 – 1.0 27% Astro Awani (2020)

Thailand 2.9 No data IGES (2020)

Mexico 2.0 -2.2 No data IGES (2020)

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Clinical Waste Management and COVID-19
• COVID-19 related clinical waste is being managed through the same
regulations as for clinical waste or schedule waste

• COVID-19 related clinical waste is collected by assigned workers,

stored in designated areas, transported, incinerated and disposed of
by licensed companies

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Household clinical waste management and COVID-19
• Abundance of masks are not properly disposed by the public

• Penang city council observed an sharp increase in the amount of clinical

waste generated daily and warned that it could be an environmental
disaster if no action is taken to manage the waste

• Some of the clinical waste has ended up in the solid waste landfills which is
mostly PPE and face masks

• It also reported that about 9,000 face masks is disposed daily in Penang.
This also poses risk to the municipal workers who collected the waste from
households, shop lot and industrial area (The Sunday daily, 23rd June
2020).
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Littering of Facemasks used as personal protective gear by public 27
Improper Disposal of face masks

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CONCLUSION
• In Malaysia, clinical waste management is under the Federal Government
and Department of Environment
• Environmental Quality Act 1974 with recent amendments is currently being
implemented in Malaysia
• The generation of clinical waste is 90 tonnes/day or 33,000
tonnes/annually whereby about 75 to 80% is non-pathogenic waste
whereas 15% of composition is pathogenic waste and chemical and
pharmaceuticals waste, sharp waste and other waste accounts for 3%, 1%
and 1%, respectively
• The guideline on the management of clinical waste provides
comprehensive information on appropriate handling and disposal of clinical
wastes generated from hospitals and other health care facilities

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 THANK YOU

(Image Source: Pinterest, 2020)