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How Health Facilities Waste (RES) are classified and identified hazardous waste
(chemicals) -RESPEL- in neighboring countries? Is there in these specific regulations
for management ?. The paper describes and analyzes the current legislation on RES in
nine countries in South America, emphasizing the specific identification of RESPEL
(chemicals) generated therein.
Introduction
In this paper we are analyzed and comparatively assess current regulations regarding
the management of wastes from health (RES) in the countries of South America
(except Suriname, French Guiana and Guyana): Bolivia, Brazil, Chile , Colombia,
Ecuador, Paraguay, Peru, Uruguay and Venezuela.
Excels in each of these countries, the general classification thereof; and in more detail
specifically described, subclassification criteria residues (chemical) dangerous.
I. Bolivia
The Ministry of Health and Sports, issued in March 2002 by Ministerial Resolution No.
0131, the "Regulations for the Management of Solid Waste Generated in Health". In
Article 5, the following classification of waste (Ministry of Health of Bolivia 2003) is
performed:
Special wastes: Waste from health facilities, presenting dangerous chemical physical
characteristics to health and the environment are: corrosivity, explosivity, flammability,
pathogenicity,
radioactivity, reactivity, toxicity, with
following subcategories:
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B.2. Drug residues: expired drugs, rejected, returned from health facilities and / or
removed.
II. Brazil
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e) Other products deemed dangerous, according the
classification included in the NBR-10004, and ABNT (toxic, corrosive, flammable
and reactive).
III. Chile
In that year, the Ministry of Health, in collaboration with the Pan American Health
Organization, PAHO / WHO publishes the "Waste Management Manual for Health
Care Facilities".
In 2010, with plans to expand distribution to a larger number of hospitals and other
health facilities, launches its second edition. This regulation classifies waste health
facilities in the following categories:
Category 1: Hazardous waste: hazardous wastes are those with one or more of the
following hazardous characteristics defined in Supreme Decree No. 148 of 2003, the
Ministry of Health:
a) Acute toxic residues acute toxic substances which mentions the Supreme Decree
148/2003 include drugs such as epinephrine, phentermine and warfarin, and other
substances that may be used in support units
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diagnosis such as Clinical Laboratory and Pathology (potassium cyanide and osmium
tetroxide for example).
e) Waste reagents: lithium batteries used, waste and contaminated with picric acid (in
Histology) elements, or sodium azide (preservative used as laboratory reagents in
diagnostic in vitro).
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f) corrosive residues waste and / or contaminated with sulfuric, hydrochloric, nitric and
chromic acid, alkaline solutions of sodium hydroxide or ammonia elements.
Moreover, hazardous waste occurring more frequently in health care facilities are
(Article 4 of Decree 6/2009):
IV. Colombia
On December 22, 2000, the comprehensive management of hospital and similar waste
is regulated by Decree 2676 / 2000. Articles 4to. and 21, defined the "Manual of
Procedures for Hospital Waste Management and Allied Workers (MPGIRH)" (Ministry
of Health of Colombia 2000).
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This is considered as the document issued by the Ministries of Environment and
Health, in a coordinated manner by which are established procedures, processes,
activities to be taken for internal and external management of waste from the
generator.
The Chemical wastes They are defined as chemical residues and packaging, or any
other waste contaminated with these, which, depending on its concentration and
exposure time, have the potential to cause death, serious injury or adverse health
effects and environment. They can be classified in turn:
• cytotoxic waste: They are excess drug from cancer treatments, and elements used
in application, such as syringes, gloves, bottles, gowns, absorbent paper bags, and
other material used in the drug application.
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chromium, cadmium, antimony, barium, nickel, tin, vanadium, zinc, mercury. The
latter, from the Service of Dentistry, removal processes or preparation of
amalgams, thermometers by breakings and other accidents in which mercury is
present.
• reagents: are those which by themselves under normal conditions, when mixed or
when in contact with other elements, compounds, substances or waste generated
gases, vapors, toxic fumes, explosion or thermally react, placing a risk to human
health or the environment. They include liquid developer and fixer, laboratories,
contrast media, diagnostic reagents in vitro, and blood banks.
• Oils: are those oils with mineral or synthetic base that have become or become
inadequate to the assigned or intended use initially, such as engine lubricants and
transformers used in vehicles, fats, oils equipment and waste grease trap.
V. Ecuador
In December 2010, Ecuador, through the Official Gazette No. 338 approving the
Regulation on "Solid Waste Management in health establishments of the Republic of
Ecuador"; which replaces the previous regulation, published in the Journal No. 106, in
1997 (Ministry of Health of Ecuador 2010). In its Art.10, classification of wastes
produced in the ES provides:
Special wastes: They are generated in the auxiliary diagnostic and treatment services,
which by its physical and chemical characteristics, represent a risk or potential danger
to
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humans, animals or the environment. In turn they are divided into:
C 2. Radioactive waste: those containing one or more nuclides that emit particles or
electromagnetic radiation spontaneously, or that fuse spontaneously. Are from
chemical analysis laboratories, nuclear medicine and radiology.
SAW. Paraguay
Management of waste from health facilities is based on three instruments: the Law No.
3361/2007 ( "Of the waste generated in health establishments and Allied"), Decree No.
6538/2011 Regulatory ( "Instrument for Comprehensive Management of Medical
Waste "); and the
"Manual of
Procedures for Comprehensive Management of Waste Generated in Health Facilities
and Allied Workers "prepared by the Ministry of Public Health and Social Welfare in
2011, with technical support from PAHO-WHO.
In this context, the waste generated in health establishments are classified into (Article
19 of Law 3361 and Article 26 of Regulatory Decree No. 6538/11..) (Ministry of Health
of Paraguay 2011):
Chemical wastes: drugs and other hazardous waste. They are chemical compounds
as laboratory reagents and production of biological agents and drugs not radiological or
chemical radioactive source, expired drugs, expired reagents, containers that
contained substances and
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chemical products, plates radiographic, liquid fixative,
broken thermometers and amalgams.
VII. Peru
special waste: are those hazardous wastes generated in hospitals, with physical and
chemical characteristics, so potentially hazardous corrosive, flammable, toxic,
explosive and reactive, for the exposed person. In turn, they are divided into three
types:
VIII. Uruguay
Management "Solid Waste Hospital" is regulated by Decree 135/99 (18 March 1999)
together between the
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Ministry of Public Health and the Ministry of Housing, Spatial Planning and the
Environment. (Ministry of Public Health of Uruguay 1999). They are classified as:
• infectious
• Sharp or cutting
• special
• Common solid waste
Special wastes: are those generated in ancillary activities centers health care that, if
they are not well come into contact with infectious agents pose a risk to health or the
environment, for its properties of corrosivity, reactivity, toxicity, explosiveness,
flammability, irritability and / or radioactivity, and that they are included in some of the
following groups: chemicals and pharmaceuticals, such as substances or chemicals
with one of the aforementioned characteristics, or that are genotoxic or mutagenic
expired medicines, contaminated, damaged or outdated, even when discarded without
being used, oncological and radioactive medication.
hub of health care, generator hospital solid waste, must have a plan for
waste management, which includes intra-institutional management,
transportation, treatment, and disposal, as appropriate for the health and
environment, and in accordance with provided in this Decree.
IX. Venezuela
Decree No. 2218 signed in 1992, establishes the "Rules for the Classification and
Waste Management in Health", which should make mandatory all establishments. In its
Article 5, the following classification (Official Gazette of the Republic of Venezuela,
Decree No. 2218 1992) described:
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• Type B: potentially hazardous waste one
• Type C: Infectious Waste
• D Type: organic and / or biological waste
• Type E: special waste
Type E: special waste: These are products and pharmaceutical or chemical waste,
radioactive materials and flammable liquids. As well as any listed as dangerous not
between the above groups. The management of these wastes separately and it will be
governed by the provisions of the Rules for the Control of Generation and Management
of Hazardous Wastes. (Official Gazette of the Republic of Venezuela, Decree No. 2211
1992).
conclusions
In this review of the rules of South America, on the classification of RES and
identification of chemical RESPEL generated in the ES, it was verified that except
Suriname, Guyana and French Guiana, which countries could not find any
information, in all other countries,
one hazardous wastes all materials, without being its dangerous nature, location, contact or any other circumstances may be considered
contaminated, those from areas of hospitalization in patients and outpatient included.
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Bolivia and Peru, classifies them Lessons ( A, B and C), calling "special waste" those
with characteristics of chemical hazard, both.
Paraguay and Venezuela classifies them Types. For the first type they are: I, II, III, IV
and V, V being the chemical residue; while for Venezuela, the types are determined
with letters A, B, C, D and E, E being defined as the "special waste" (with
characteristics of chemical hazard).
In Brazil, they are classified groups ( A, B, C, D and E), the B, the chemical origin.
In Chile, they are classified Categories ( 1, 2, 3 and 4), the one the of hazardous
chemical waste.
In Uruguay, they are divided into infectious, sharp or cutting, common and special
solid waste; It is determined by the characteristics of chemical hazard, the last.
Bibliography
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MINISTRY OF HEALTH OF COLOMBIA. 2002. Manual of
Procedures for Comprehensive Management of hospital waste
Y Similar MPGIRH.
http://www.alcaldiabogota.gov.co/sisjur/normas/Norma1.jsp?i= 36291
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BRAZIL CONAMA RESOLUTION No. 358. 2005. Available at:
http://www.mma.gov.br/port/conama/res/res05/res35805.pdf
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