Hospital Waste Management

HOSPITAL WASTE MANAGEMENTSubmitted bybyRajsandeep Singh

INDEX

Introduction Nature of quantum of hospital waste Types of waste Classification of hospital waste Quantum of waste Steps in waste management Categories of bio medical waste according to ministry of environment and forest BioBio-medical waste management Segregation and safe storage Colour coding and containers for disposal of biobiomedical waste Choice of bins or receptacles Handling and treating

Disposable items Chemical disinfection Recommended dilution of chlorine releasing compounds Sharps Liquid waste Radioactive medical waste NonNon-radioactive general waste Disposal of biodegradable waste Chemical hazardous waste Onsite transportation Discarding and disposal of disposable material Bibliography

INTRODUCTION

By hospital waste it means the biomedical waste generated in different departments of hospitals. Hospital waste has always been considered as potential hazardous in view of inherent potential for dissemination of infection.

NATURE OF QUANTUM OF HOSPITAL WASTE

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Three major categories of health care facilities exist in India. Outpatient clinics Outpatients and inpatient care hospitals. Sub divisional and district hospitals medical college hospitals and specialty hospitals in public sectors and in private sector.

TYPES OF WASTE1.

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Medical waste Any waste generated in diagnosis treatment and immunization of human beings. Clinical waste Waste coming out of medical care provided in hospitals. Pathological waste Human tissues, organs, body parts removed during surgery or autopsy, biopsy samples and body fluids. Infectious waste All kinds of waste which may transmit viral, bacterial or parasitic diseases.

MEDICAL WASTE

CLINICAL WASTE

PATHOLOGICAL WASTE

INFECTIOUS WASTE

CLASSIFICATION OF HOSPITAL WASTENon Hazardous waste a) Biodegradable Kitchen Waste This includes peels of fruits and vegetable skin and left over food, tea, drugs and other kitchen waste. b) Non Biodegradable waste This category includes wrappings, foils, plastic bags etc.1.

2. Hazardous waste a) Potentially infectious waste i. Dressings and swabs contaminated with blood, pus and body fluids. ii. Laboratory waste iii. Instruments used in patient care: these range from endoscopes, ultrasound probes, syringes and needles etc. iv. Potentially infected materials: Placenta tissues, tumors, organs or limbs. v. Potentially infected animals: used in research. b) Potentially toxic waste i) Radio active waste used in diagnosis or treatment of diseases. ii) Chemical waste may be toxic, corrosive, inflammable or genotoxic. Their handling should ensure that human and environmental problems do not arise. iii) Pharmaceutical waste This may enter hospital waste because surplus stock, spillage or contamination is detected or expiry date is over.

QUANTUM OF WASTE

The quantum of waste generate will vary depending upon the type of health problem, the type of care provided and the hospital waste management practices. In developed countries waste generated is 1 to 5 kgs of solid waste per day per head. But in developing countries most patients generate between 1 to 2 kgs of waste. This difference is partly due to difference in use of disposables in health care and partly due to life style of the population.

HEALTH HAZARDS ASSOCIATED WITH POOR HOSPITAL WASTE MANAGEMENT1.

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Injuries from sharps to all categories of hospital personnel. Nosocomial infection in patient from poor infection control and poor hospital waste management. Risk of infection outside hospital for waste handlers, scavengers and (eventually) the general public.] Risks associated with hazardous chemicals, drugs handled by persons handling waste at all levels. Disposable Recycled Repacked and sold without being even washed. E.g. needles and syringes. Outpatients attending health care facilities. Medical and paramedical personnel providing health care specially those handling contaminated body fluids. ROUTE OF TRANMISSION OF INFECTION FROM POTENTIALLY INFECTIOUS WASTE.1. Through non-intact skin and through mucous membranes as splashing into the eyes. 2. Inhalation of dust particles containing germs and ingestion through contaminated unwashed hands.

Steps in Waste Management1.

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i) ii) iii)

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Waste reduction and reuse- there is a growing trend in reusehealth care settings to provide or use disposable materials in all aspects of work. Some are quite necessary but hospitals should select a mixture of disposable and reusable materials. This will reduce waste. E.g. they can choose products with less packaging. Waste Survey This is an important component of waste management scheme to Differentiate types of waste Quantity of waste generated is determined Determine the points of generation and type of waste generated at each point. Determine level of generation and disinfection within the hospital. To find out the type of disposal carried out.

WASTE REDUCTION

CATEGORIES OF BIOMEDICAL WASTE ACCORDING TO MINISTRY OF ENVIRONMENT AND FOREST (CLASSIFICATION NOTIFIED IN BIOMEDICAL HANDLING & MANAGEMENT RULES) Category Type of waste Treatment and disposal optionIncineration / deep burial

Category 1

Human Anatomical wastes

Category 2

Animal waste (experimental animals used in research waste generated by veterinary hospitals. Microbiology and BioBiotechnology waste e.g. cultures, stocks or specimens of micromicroorganisms; live or attenuated vaccines, cell cultures etc. Waste sharps (needles, syringes, scalpels, blades, glass etc.)

Incineration / deep burial

Category 3

Local / Autoclaving/ MicroMicrowaving incineration

Category 4

Disinfection (Chemical) autolcaving/ Microwaving and mutiliation/ shredding

Category 5

Discarded medicines and cytotoxic drugs (outdated contaminated and discarded drugs and medicines). Soiled Wastes (items contaminated with blood, body fluids including cotton, dressings, soiled plaster, linens, bedding etc. Solid wastes (Disposable items other than the waste sharps as tubing, catheters, IV sets, etc.) Incineration ash (Ash from incineration of any BioBiomedical waste)

Incineration / Destruction and disposal in land fills.

Category 6

Incineration / Autoclaving / MicroMicro-waving

Category 7

Disinfection by chemical treatment/ Autoclaving / Microwaving and mutilation / Shredding. Disposal in municipal land fills.

Category 8

Category 9

Chemical Wastes (Chemicals used in biological production and those used in disinfection such as insecticides.

Chemical treatment and discharge into drains for liquid and secured land fills for solids.

MEDICAL WASTE INCINERATOR

BIOBIO-MEDICAL WASTE MANAGEMENTPyrolytic incinerator (py(py200) for rapidly destroying all bio medical waste material generated. The double chamber incinerator can reduce 70 to 90 kg/hr bio waste.

SEGREGATION AND SAFE STORAGEIncorrect classification of waste can lead to many problems at a later stage. Segregation should be done at the point of generation to keep general waste from becoming infectious. Thus by segregation hospital can 1. Reduce total treatment cost 2. Reduce the impacts of this waste on the community. 3. Reduce the chances of infecting health care workers.

COLOUR CODING AND CONTAINERS FOR DISPOSAL OF BIO-MEDICAL WASTE BIOColour codeYellow

Type of containerPlastic bags

Waste categoryHuman & Animal waste, microbial and Bio technological waste and soiled wastes Microbiological and biotechnological waste soiled wastes and solid waste Waste sharps and solid waste

Treatment optionsIncineration / deep burial

Red

Disinfected container or plastic bag Plastic bag /Puncture proof container Plastic bag

Autoclaving / Microwaving / Chemical treatment Autoclaving / Microwaving / Destruction and shredding. Disposal in secured landfills.

Blue

Black

Discarded medicines, cytotoxic drugs, incineration ash and chemical wastes.

CHOICE OF BINS OR RECEPTACLESHospital managers may prefer to use plastic or metal bins for waste storage in order to save on the cost or paper work of buying large number of one strip sacs. If reusable containers are to be used, considerable thought should be given to methods of cleaning and disinfecting them in unpleasant task that would tend to be avoided unless there is a high degree of motivation and supervision. The containers should be smooth and well rounded from inside to allow effective and complete cleaning. The size and number of receptacles should be appropriate to the amount of wastes produced, assuring the collection takes place twice a day, or more often in operation theatres or ICUs.

HANDLING AND TREATINGThis term refers to the process that modifies the waste in some ways before it is taken to its final resting place. It mainly requires disinfection or decontamination by chemical disinfection of waste right at the source, so that it is no longer the source of pathogenic organisms. After this the residue can be handled safely, transported, stored and disposed.

POINTS TO BE KEPT IN MIND WHILE DEALING WITH INFECTIOUS WASTESa)

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Infectious waste must be separated at the points of generation itself. Bins with lids lined with polythene bags, or with inner chamber for bucket should be used. A lidded bin will discourage inadvertent use by others. The bins and bags should be labeled with biohazards symbol and if required for the types of waste they have to be used for. Personnel involved in infectious waste handling should be provided with suitable protective with 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 3/4th full. 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 the 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.

DISPOSABLE ITEMSItems like single used products, syringes, IV bottle, catheters, sharps and rubber gloves are often recycled and have the risk of being reused illegally, therefore it is imperative that chemical disinfection be followed for them. Disposables have to be dipped for a minimum duration of - 1 hour in the chemical disinfectant or autoclaved or microwaved.

CHEMICAL DISINFECTIONChemical disinfection has a wide application in small health care facilities. A good disinfectant is bleach. For chemically treating the waste and optimum concentration of bleach has to be prepared. The concentration prescribed by WHO is 10gm of bleach in 1 litre water. However it must be noticed that medical waste that have been chemically disinfected should continue to be treated as hazardous, unless careful bacteriological testing has shown disinfection to be complete.

DISPOSABLE ITEMS

RECOMMENDED DILUTION OF CHLORINE RELEASING COMPOUNDSAvailable Chlorine Clean condition Dirty condition

Required Chlorine

0.1% 1gm / litre

0.5% 5gm / litre

Sodium hypochlorite solution 5% available chlorine Calcium hypochlorite 70% available chlorine (NaOCl Powder) Sodium dichlorosocyanurate (NaOCl Tablets) Sodium dichlorosocyanurate

20ml/litre

100 ml/litre

1.4 gm/litre

7.0 gm/litre

1.7 gm/litre

8.5 gm/litre

1 table/litre

4 tablets/litre

Chloramine (25% available chlorine)

20 gm/litre

20 gm/litre

SHARPSMajor portion of the sharps are needles, which can be cut by a needle cutter and contained in a bleaching powder solution or autoclaved or / and shredded or destroyed. Other than needles a small amount of sharp waste generated, may also be contained in a separated bin meant for sharps or in the needle cutter itself.

PRECAUTIONS IN THEIR HANDLINGa) All the health workers employed in /outside the hospital must be vaccinated against Hepatitis B. b) All the health care workers put on heavy-duty gloves while dealing with infectious wastes specially sharps. c) Sharps should not be left casually on counter tops, food trays or beds as grievous injuries can result. d) Recapping needle should be discouraged. e) In situations when recapping is unavoidable, the single handed method should be utilized.

LIQUID WASTE1. 2.

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Hospital generates liquid waste which is either infectious or chemical in nature. To avoid exposure with the general public it is necessary that the waste be properly treated. Liquid pathological waste should be treated with a chemical disinfectant. Subsequently treated with reagent to neutralise it. It can then by flushed into the sewer system.

RADIOACTIVE MEDICAL WASTEUse of nuclear medicine classified into two parts detection and treatment of diseases. Hospitals providing nuclear medicine have not only to check for radiation but also to ensure that instruments are properly maintained properly protective wear is provided not only to the physicians and other employees but also to the patients.

PLASTIC CONTAINER FOR BULK LIQUID WASTE

1 to 2 CUBIC FOOT BOXES FOR RADIOACTIVE WASTE

NONNON-RADIOACTIVE GENERAL WASTE

The general office waste comprising of the waste papers can be clubbed with other recyclable materials to be sent for recycling. Kitchen waste can be utilized in many different ways according to the quantity of waste. In large hospitals technology like bio digestion can be installed. In smaller establishments, kitchen waste can be composted. NonNon-biodegradable waste can be disposed off in municipal bins.

DISPOSAL OF BIODEGRADABLE WASTE It is comparatively easy to handle.

It can be accomplished by Bio-digestion (using bacteria or earth worms) or By Pit composting. After complete the composition it can be sued biofertilizer.

CHEMICAL HAZARDOUS WASTE

These may include solvents, chemotherapy waste, pathogenic chemicals, formaldehyde waste, radioactive waste, heavy metals like mercury and in instruments, other toxins and corrosives and waste anaesthetic gases. Minimisation of the waste, careful segregation, safe disposal of the waste which can not be recycled.

ONSITE TRANSPORTATION All bags should be fastened and small trolleys can be used in large facilities. Trolleys and carts should be large enough so that waste is not piled upon them. Some of the alternate technologies being promoted in India are : 1. Autoclave 2. Microwave 3. Chemical disinfection 4. Incineration

APOTEFROTIRAS:APOTEFROTIRAS:special refrigerator vehicles

Autoclave a) Gravity displacement autoclaves Disadvantage is that they may be air pockets left within the waste, which is being autoclaved. b) PrePre-vacuum autoclaved. 2. Microwave Microwaves caused molecules within the waste material to vibrate and generates heat within the material itself. 3. Chemical Disinfection It is cost effective and some of the commonly used disinfectants for waste are: a) Sodium Hypochlorite b) Bleach This should not be used for all medical wastes and only plastic, rubber and metals should be disinfected. It is not advisable to disinfect cloth based medical waste because it is difficult to handle wet waste and it also adds to the weight and volume of the waste. Pathological waste, also, can not be disinfected in this manner unless it is crushed, which may cause aesthetic problems.1.

HOSPITAL AUTOCLAVE

MICROWAVE PROCESS

DISCARDING AND DISPOSAL OF DISPOSABLE MATERIALThe awareness of the danger of acquiring HIV and HBV infection while handling blood and blood contaminated material has resulted in sudden increase in the usage of pre-sterlised disposable material. preThere is high possibility that unscrupulous persons may start re-cycling the redisposable material resulting in their reuse without even proper sterilization. Thus disposable material should be given high priority by ensuring its destruction and eliminating reuse.

DISPOSAL OF DISPOSABLE MATERIAL

CONCLUSION

Hospital waste in addition to posing risk to patients and personal who handle these waste, is also threat to public health and environment. It is emerging as a health hazard to community at large. Keeping in views, inappropriate management of biomedical waste, Ministry of environment and forest notified the BMW rules 1998.

The rules are meant to protect society, patient and health care workers. The most imperative component of waste management plan is to develop a system and culture through education, training and persistent motivation of health care staff.

REFERENCES

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BMW Management rules,1998 Singh IB, Sharma RK www.wilkepedia.com www.pubmed.com