Health Hazards due to improper management of Hospital Waste Dr ...

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Feb 21, 2013 (4 years and 3 months ago)

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Health Hazards Due to
Improper Management of
Hospital Waste


Dr. P. K. Dash,

Nodal Officer,


Municipal Corporation of Delhi

Introduction


Every

system

in

nature

progresses

towards

disintegration

and

it

contributes

to

creating

waste
.




A

modern

hospital

is

a

complex

multidisciplinary

system

which

consumes

thousand

of

items

for

delivery

of

medical

care

and

is

part

of

physical

environment
.

All

products

consumed

in

hospitals

have

some

unusable

left

over

i
.
e
.

Hospital

Waste
.

This

waste

is

great

threat

to

ecological

balance

by

polluting

environment
.



Definition


Any

unwanted

residual

material

which

cannot

be

discharged

directly,

or

after

suitable

treatment

can

be

discharged

in

the

atmosphere

or

to

a

receiving

water

source,

or

used

for

landfill

is

waste
.

(
Wilson,

1981
)




Infectious

waste

are

all

those

substances

which

cannot

be

resterilised

or

reused

within

or

brought

into

patient

care




(
Rearly,

1972
)

Definition


No standard universally accepted
definition for the terms



HOSPITAL WASTE



MEDICAL WASTE.



REGULATED MEDICAL WASTE AND



INFECTIOUS WASTE

Definition


Hospital

waste
:

refers

to

all

waste,

biological

or

non

biological,

that

is

discarded

and

is

not

intended

for

further

use



Medical waste
: refers to materials
generated as a result of patient diagnoses,
treatment, immunisation of human beings
or animals

Definition


, Infectious waste: are the portion of
medical waste that could transmit an
‘infectious disease’.


Medical waste is a sub set of Hospital
Waste and


Regulated medical waste' which is
synonymous with '"infectious waste' from a
regulatory perspective is a sub set of
medical waste.

Evolution of HW Globally


Hospital

Waste

was

brought

into

focus

in

1983

when

WHO

European

office

convened

a

working

group

at

Bergen
.

Medical

specialists,

hospital

engineers,

administrators

from

19

countries

participated

&

concluded

that

it

required

a

system

approach

involving
:

-


Awareness


Segregation


Source

reduction

of

radio
-
active

waste

Evolution of BMW (contd)


WHO

SEARO

questionnaire

survey

in

1984

conducted

largely

due

to

disturbing

media

reports

regarding

plight

of

rag

pickers
-

found

inadequacies



Beach

washings

in

1998

of

the

Florida

coast,

related

to

syringes,

lead

to

passing

of

first

healthcare

legislation

by

any

country
-

Medical

Waste

Tracking

Act

(MWTA)

MAGNITUDE OF THE PROBLEM

GLOBALLY
-

Developed countries generate 1 to 5
kg/bed/day

Developing countries
: meager data, but figures are lower.




1
-
2kg/pt./day


WHO Report: 85% non hazardous waste



: 10% infective waste


: 5% non
-
infectious but hazardous.



(Chemical, pharmaceutical and
radioactive)

INDIA
:
-
No national level study


-

local or regional level study shows hospitals



generate roughly 1
-
2 kg/bed/day


Why hospital waste is hazardous?


Infectious waste is capable of producing


an ‘infectious disease’.


Chances of this are higher with in hospitals
than outside.


This depends on factors like

1.
Dose,

2.
Host susceptibility,

3.
The presence of a pathogen,

4.
The Virulence of a pathogen and

5.

The portal of entry (most commonly absent
factors)


Infectious waste is also generated


Dental offices


Nursing homes


Laboratories


Research centers




The work environments similar to
Hospital environment.


WHAT CAUSES HOSPITAL WASTE
HAZARDOUS

1.
Chemical
-
medications, Solutions, or

2.
Bacteria's like TB, Hepatitis B and C,

3.
Gases
;
-

ethylene oxide, formaldehyde,
glutaryldehyde, waste anesthetic gases,
nitrous oxide,

4.
Chemotherapeutic agents,

5.
Laser Smoke and

6.
Aerosolized medications such as
Pentamedine


WHAT CAUSES HOSPITAL WASTE
HAZARDOUS

Physical


1.
Ionizing radiation,

2.
Lasers,

3.
Noise and

4.
Electricity

Health Hazards of Hospital Waste



The

hazards

are
:



Fire


Breeding

of

flies

and

insects


Proliferation

of

rodents


Air

pollution


Water

pollution


Land

pollution


Transmission

of

infections

viz

hepatitis

B,

HIV,

other

microbes


Mechanical

injury


Re
-
circulation

of

waste


Loss

of

aesthetics


Nuclear

waste

hazards

&

carcinogenic

effects


Improper

management

of

hospital

waste

can

cause

serious

environmental

problems

in

terms

of

air,

water

and

land

pollution
.



CLASSIFICATION BY NATURE OF POLLUTANTS


a) Biological

b) Chemical and

c) radio active

Categories of Hospital Waste

Category


Waste

1

Human Anatomical

2

Animal

3

Microbiology & Biotechnology

4

Sharps

5

Discarded Medicines & Cytotoxic Drugs

6

Soiled (Contaminated with Blood & Body Fluids)

7

Solid (Disposable Items other than Sharps)

8

Liquid

9

Incineration

10

Chemical

Routes of exposure



Ingestion (Swallowed materials)



Inhalation: airborne chemicals and
pathogens,



Dermal absorption
-
or through skin
openings.

Routes of exposure depends on


Durations of exposure:


Dermal absorption
-
enhanced by Scratches,
broken, roughened or abraded skin on surface
of hands, ankles, neck or facial areas


Dose of toxic components that enter
the workers body from the waste:




Retention capacity for airborne particulates that
carry toxic chemicals and pathogens is highly
dependent on particle size.

Other Routes of exposure


Water soluble toxic chemicals can be
absorbed throughout the body



Drinking and eating in hospital: should be
done in well controlled areas

Environmental problems arise from


a)

Generation of medical waste

b) Process of handling,

c) Treatment and

d) Disposal

Effects of 'improper hospital waste
management

Mismanagement of Hospital

Waste implies

a)
IMPROPER HANDLING, during


generation


Collection


transportation and


treatment



IMPROPER HOSPITAL WASTE MANAGEMENT ARE DUE TO
:

a) Improper handling; Unsafe actions: handling
without personal protective equipment (PPE),

b) Poor storage (e.g. high temperature conditions
combined with prolonged storage time before
treatment),

c) Manual Transportation for longer distances.

d) Use of uncovered containers instead of closed
plastic bags

e) Exposure times beyond acceptable limits and

f) Lack of adequate worker and equipment
decontamination process/procedures

EFFECTS OF 'IMPROPER HOSPITAL WASTE
MANAGEMENT


Hospital infections are a major health
problem all over the world



Can effect the people working or
visiting the hospital



The community is invariably effected


Transmission of Infectious Agents in
Healthcare Settings


Individuals are exposed to human sources of
microorganisms by three primary routes:




Contact transmission


Direct



organism is transferred directly from one person to
another, e.g. scabies or herpetic whitlow


Indirect
-

organism is transferred through contaminated
intermediate object or person, e.g. hands or contaminated
patient care equipment

Droplet Transmission
-

relatively large ( >5 microns) droplet
heavy with moisture that are propelled relatively short distances
from the source (3
-
6 feet) onto the mucous membranes of the nose,
mouth or eyes, of the host and environmental surfaces

Airborne Transmission
-

droplet nuclei (<5 microns) that
remain suspended in the air for long periods, that may be inhaled by
the host into the alveoli of lungs






Transmission Of Infectious Agents In All Settings Requires 3
Interrelated Elements


THE TRIAD

Source

Mode of
Transmission

Susceptible
Host

Fundamental Elements to Prevent Transmission of
Infectious Agents in Healthcare Settings



Administrative measures


Education of HC workers,
patients and families


Hand Hygiene


Personal Protective
Equipment


Safe Work Practices


Patient Placement




Transport of Patients


Environmental measures


Patient Care Equipment


Textiles and Laundry


Dishware and eating
utensils


Adjunctive measures


Personal Protective Equipment


When selecting PPE consider the highest level hazard present,
the source of the hazard, and the potential for simultaneous
exposures.


Face protection


Goggles or safety glasses with side shields


Clothing


Lab coats, scrub suits, gowns (long pants only, no open
toed shoes)


Clothing should be replaced immediately when
contaminated


Gloves


Verify that gloves are compatible with your specific
application, process and materials before using


Gloves should be replaced immediately if torn


Gloves should not be worn outside the lab area


Always wear heat resistant gloves and keep your face away
from the door when loading and unloading the autoclave




RECOMMENDATIONS


To reduce the burden of disease, healthcare waste
needs sound management, including alternatives to
incineration.


Management of Healthcare waste requires
'increased

attention’ and Diligence.


Incinerators provide an interim solution for developing
countries where options of waste disposal such as
Autoclaving, shredder, microwave or newer technologies
like plasma incinerators are limited.


Whatever the technology used, best practice must be
promoted to ensure optimal operation of the system


Best practices include
-


Construction following detailed dimensional
Plans to avoid flaws that can lead to incomplete
destruction of waste, higher emissions and
premature failure of incinerators.


Follow proper operational procedures: utilize
appropriate start up and cool down procedures.


Periodic maintenance to replace or repair faulty
components, regular inspection, maintaining
spare parts inventory, record keeping etc.


Best practices include
-


Training

and

Management
:

Regular

training

and

upgrading

skills


Making

available

an

Operating

and

Maintenance

manual

and

maintenance

program

for

incorporation

of

certification

and

inspection

programmes

for

operation

and


an excellent management oversight are an
essential components


Thank you