Hospital waste managementWorkshop : Hospital waste managementWorkshop Dr. Chandan Sabale
Dr. Mrs. M.P.Ghatole
Dr. Mrs. S.N.Kothadia
Dr. Aparna Takpere
Dr. Sufia Siddiqui
Dr. Vijaya Jeure Introduction : Introduction Biomedical waste - is defined as the waste generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production of testing biologicals.
Biomedical waste is generated in different departments of the hospital. In health care settings, about 85% of the waste generated is non hazardous, about 10% is infectious and 5% non infectious but hazardous waste. Classification of Hospital waste : Classification of Hospital waste Non hazardous waste
kitchen waste, office waste, wrapping papers and bouquets, etc.
Kitchen waste - left over food , swill , peels and dirty water.
Bio-degradabale waste – peels of fruits and vegetable skin and left over food and other natural kitchen wastes.
Non bio-degradable waste - wrappings foils plastic bags etc.
potentially infectious waste
A. Dressings and swabs contaminated with blood, pus and body fluids,
B. laboratory wastes including laboratory samples, cultures stocks of infectious agents , laboratory glass ware.
C. Instruments used in patient care: these range from diagnostic equipment such as endoscopes , ultrasound probes , syringes and needles , sharps and other instruments. Slide 4: D. Potentially infectious materials , placenta , tissues, tumors ,organs or limbs which are removed during surgery.
E. potentially infected animals used in diagnostic or research studies
F. pathological waste- human tissues, organs, body parts removed during surgery or autopsy or medical procedures and specimens of body fluids.
Potentially toxic waste
A. Radioactive – these may be solid , liquids and gases used for analytical procedures, body organ imaging and tumor localization and treatment.
B. Chemical waste - they may be hazardous toxic , corrosive, inflammable ,reactive or genotoxic .they require safe disposal which will ensure that human or environmental problems do not arise during storage, transport, and final disposal.
C. Pharamaceutical waste:
surplus stock , spillage , or contamination is detected or expiry date is over. Laboratory waste material : Laboratory waste material Sample collection- syringe needle, cotton swabs, lancet
Blood bank- lancet,hypodermic collection needles, plastic tubing , pvc blood bags,slides,guaze pieces , plastic tubes.
Biochemistry- test tubes , glass bottles, plastic tips, autoanalyzer cups ,plastic bottles, chemicals,blood.
Haematology-syringe needles,slides,HB tubes, capillaries,lancet,ESR tubes,chemicals,immersion oil,blood,stains
Bacteriology-syringe and needle,test tubes,glass bottles,saline bottles,plastic bottles,testing containers,slides,infectious samples,bacteriological medium with growth,culture plates, blood,immersion oil,stains
Serology-syringe and needles,blood,serum,tips,ELISA plate,reagents,
Clinical pathology-urine and stool containers,reagents,slides, filter paper,paper strips,stick wooden,chemical reagents.
Histopathology-Human tissues,organs,formalin,guaze,cotton,chemicals,stains Categories of Persons exposed to risk of infection : Categories of Persons exposed to risk of infection Other patients attending the health care facilities.
Medical and paramedical person providing health care
Persons involved in collecting and disposing the waste material
Those involved in clearing the instruments , floor surfaces and washing of glass wares and linen.
If potentially waste gets mixed with solid waste from other activities , the entire chain of workers /persons involved in solid disposal. Health hazards associated with poor hospital waste management : Health hazards associated with poor hospital waste management A. Injuries from sharps to all categories of hospital personnel (HIV and HBV).
B. Nosocomial infection in patient from poor infection control and poor hospital waste management
C. Risk of infectious outside hospitals for waste handlers , scavengers and eventually the general public.
D. Risks associated with hazardous chemicals , drugs being handled by persons handling wastes at all levels and
E. Disposable – recycled – repacked and sold may be non noticeable .
Routes of transmission of infection from potentially infectious wastes
1.through non – intact skin (preexisting cuts, raw areas) or by cuts and puncture of the intact skin.
2.Through mucous membranes such as splashing into eyes
3.Inhalation of dust particles containing germs.
4.By ingestion - through contaminated unwashed hands , contaminated water and foodstuff.
All the health workers employed in / outside the hospital must be vaccinated against Hepatitis B
All the health care workers put on heavy duty gloves while dealing with infectious waste specially sharps
Sharps should not be left casually on counter tops , food trays or beds as grievous injuries can result
Recapping needles should discouraged .In situation when recapping is unavoidable , the single handed method be utilized Primary steps to effective health care waste management : Primary steps to effective health care waste management Evaluate the present scenario this entails preaudit and auditing of hospital wastes.
Preparation of job charts for hospital waste management.
Asses all cost associated with waste management
Define management policies for waste management
Train the trainees and employers
Evaluate technical procedures , costs and policies yearly
Steps in waste management – waste survey, waste minimization, waste segregation and safe storage and waste treatment and waste handling , waste transportation, waste disposal. Waste survey : Waste survey Waste survey is an important component of the waste management scheme. A survey helps in evaluating both the type and quantity of waste generated in the hospital
Differentiate the types of waste
Quantify the waste generated.
Determine the points of generation and type of waste generated at each point
Determine the level of generation and disinfection within the hospital.
To find out the type of disposal carried out. SCSM GHS Dr.V.M.M.C. SOLAPURWASTE DISPOSAL SURVEILLANCE : SCSM GHS Dr.V.M.M.C. SOLAPURWASTE DISPOSAL SURVEILLANCE Data regarding waste surveillance In our civil hospital : Data regarding waste surveillance In our civil hospital Generated in your hospital daily :- Total Wt. 75-80 Kg
Maxium soiled waste and sharps produced are in Gyn , Surgery and Medicine wards
Many wards do not have colour coded bags and container(TB and IDH) (Ortho surgery and paed- no container)Those wards which have such bags and containers but the fact is that the whole waste is thrown into in a big cardboard box (Sharps+soiled waste+plastics ) and then it is filled in colour bags and transported
Only in few wards the sharps are separated from syringes and the syringes are disinfected with .Na hypochlorite solution before disposal
Most of the wards have needle destroyer but their use is questionable
Some say our work load is too much and so it is not possible to use it(Surgery) it makes irritating noise,
Some wards don’t have a needle destroyer(IDH,TBW,Ortho,Med, CS, ANC,Inj room-OPD)
Only in some ward (LR) the sharps are seen to be separated in separate container through our ward staff say that is done so
All the departments agree that the infectious waste is separated from noninfectious waste but we can see that the whole waste but we can see that the whole waste is thrown in the same cardboard box
There is confusion among staff regarding use of needle destroyer. Categories of Biomedical wastes : Categories of Biomedical wastes Segregation : Segregation Biomedical waste should be segregated into bags / containers prior to storage /transport for disposal and be labeled and carry necessary information as per recommended rules
If the infectious waste is mixed with the entire waste it will be treated as infectious waste.
Thus , by segregation a hospital can
Reduce total treatment cost
Reduce the impacts of the waste on the community and
Reduce the chances of infecting health care workers Handling and treating waste material : Handling and treating waste material Bins with lids lined with polythene bags or inner chamber for bucket should be used
The bins and bags should also be labeled with the biohazard symbol and if required , for the types of waste they have to be used for.
Personnel involved in infectious waste handling should be provided suitable protective wear and should be properly trained
Polythene bags placed in the bins have to be changed with each shift or when they are ¾ full.
Untreated biomedical waste should not be kept stored beyond a period of 48 hrs. In case of if it becomes necessary to store the biomedical waste to store it beyond a period permission of authority and must ensure that the waste does not affect human health and environment.
Polythene bags carrying waste have to sealed /tied at the top whenever the waste is being transported within or outside the hospital
Infectious wastes from wards, ICU , OT, OPD and the labs should have a common specific bin allotted for them at the final point of disposal . This bin should be covered and protected from the public at all times Chemicals used for disinfection : Chemicals used for disinfection 1Phenol and related compounds
A. crude phenol-in 5%strenth used for mopping floors and cleaning drains
Cresol – 3 to 10 times as powerful as phenol 5 to10% used for disinfection of urine and faeces
Cresol emulsion- cresol and soap eg.lyzol,izol,2% solution of lysol for disinfection of urine or faeces
Chlorhexidine- most useful skin antiseptics.0.5% alcoholic or aqueous solution used as handlotions.cream with lotions containing 1% recommended for burns.
Dettol- 5% used for disinfection of instruments and plastic equipment contact of at least 15 min.required.
2.Quarternary ammonium compounds
A.Cetrimide – cetavolon used in 1-2% strength
b. Savlon- clinical thermometers plastic appliances etc.can be disinfected in savlon in 1 in 6 in spirit
Halogens and their compounds
A.bleaching powder: 5 % solution suitable for a period of 1 hour
Sodium hypochlorite – 5 % sodium hypochlorite solution use for decontaminating
Alcohol- 70% used as skin antiseptic
Formaldehyde gas used for disinfection of rooms. Needle and syringes : Needle and syringes Destroy the Needle and separate sharps in plastic box provided and send to pharmacy stores. Slide 19: Destroy the syringe hub and collect in separate blue box & send it along with sharps like scalpel blade to pharmacy store Slide 20: Infectious material like biopsy material, organs, blood soiled cotton swabs, tampons and gauze pieces collect in red bags.
Send to Incinerator. Slide 21: Plastic IV canulas, catheter etc.
( after burning the needle) are to be mutilated & collected in blue box then send to pharmacy store& needle to be collected along with sharps. Liquid waste : Liquid waste Liquid waste- hospital generates liquid waste – infectious or chemical. to avoid the exposure to the general public it is necessary that the waste be properly treated. The liquid pathological waste should be treated with a chemical disinfectant. The solution should be treated with a reagent to neutralize it .This can be flushed into the sewer system
For blood , serum sample and body fluids of laboratory should be collected in red bags from penicillin bulbs and send it to incinerator.
Put empty penicillin bulbs in the sodium hypochlorite solution Slide 23: Non biodegradable waste can be disposed off in a municipal bins
Non infectious waste material like paper, food waste, drug cartoons to be collected in black bag and send for Municipal collection. Non hazardous waste : Non hazardous waste Disposal of biodegradable waste
Kitchen waste can be utilized in different ways according to the quantity of waste . In large hospitals technologies like biodegradation can be installed . In smaller establishments , kitchen waste can be composed
Kitchen waste or ward waste is collected in green colored container and put in bio culture pit.
The biodegradable waste is comparatively easy to handle. It should be disposed after its biodegradation which can be accomplished by bio digestion (using bacteria or earthworms or by pit . After complete decomposition it can be used as biofertilizer.) Transport : Transport On site transportation
segregated wastes have to be transported within the facility from the point of generation to the final waste disposal site. All bags should be fastened and small trolleys can be used in large facilities .Trolleys and carts should be large enough so that the waste is not piled up on them in an unsafe way. They should be stable to minimize the risk of propping over hazardous waste and even after decontamination should never be transported with general municipal wastes.
Biomedical waste should be collected and deposited with sanitary inspector upto 11.30 a.m. and send to the incinerator.
Waste from surgery wards and hospital wards should be collected and send to the incinerator by 11.30 a.m.
The biomedical waste shall be transported only in vehicles which may be authorized Slide 26: Do not burn any waste in the hospital premises. Keep the Hospital premises clean. This is the beginning of health : This is the beginning of health THANK YOU