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shamebagBiotechnology

Feb 22, 2013 (4 years and 7 months ago)

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Hospital Waste Management



Waste
: Everything is made for a defined
purpose. “Any thing which is not intended
further use termed as waste”.


Any waste generated by out of hospitals can be
said to be “hospital waste”. Any waste
generated by consequent to health care
activity including those at home is “Health
Care Waste”.


According to Biomedical Waste(Management
and Handling) Rules 1998, of India,
Biomedical Waste(BMW) is
defined

as a waste
generated during diagnosis, treatment,
immunization of human being or animal or in
the research activities pertaining thereto or in
the production or testing of
biologicals
. It also
includes waste from veterinary institutes and
slaughter houses. However, radioactive waste
is not included under BMW.

INTRODUCTION

Hospitals generated large volume wastes as a by
-
product of a variety health services and
procedure carried out such as surgery, dressing of
wounds, dialysis, deliveries, laboratory and
dental procedures, PM procedures, etc. Such a
waste may be infectious or non
-
infectious. If such
waste is not properly collected, transported and
disposed off, it not only results in causation of
hospital acquired infection(
Nosocomial

infections) but also poses a major public health
hazard by causing pollution of air, water and soil.


Persons who are constantly exposed to these
wastes especially waste
-
sharps, are nurses, rag
pickers cleaners, laundry staff, etc . who are
always risk of getting fatal disease like Hepatitis B,
C, and HIV through injuries by contaminated
needles and sharps as an occupational hazard.
Also indiscriminate dumping of the hospital
wastes into backyards or into open municipal
pits, become breeding places for diseases
(mosquitoes, flies, rodents and microbes).


Epidemics can result from the contamination
of drinking water and food sources with these
infectious wastes, which are washed by rains.
Indiscriminate open burning of infectious
wastes, especially plastic will result in
emission of noxious gasses, which may
produce CA. Further, there is scope of re
-
use
of syringes, needles, polythene bags,
catheters, etc.


It is estimated that only 10
-
15% Health Care
Waste is “Infected Waste”. Non hazards “general
waste” comparable to domestic waste. Non
-
contaminated or non
-
infectious waste becomes
infected when it gets mixed with infected waste.
Hence one should not allow mixing of infected
waste with household (non
-
contaminated) waste.
This is possible only if the waste is segregated or
sorted into “Infected” and “Household” waste at
the sources or point of generation.



Quantity of Health Care Waste
:


This depends upon the type of health care
setting and the services offered. It is
estimated that 0.5 to 1 kg wastes/d/bed, in
CHC, SDH i.e. 15
-
50 kg/d, whereas in DH,
MCH. It is about 200
-
1000kg/D.


Classification of hazards waste

1.
Infectious waste
(suspect to contain pathogen)e.g. Lab
culture, waste from I.W, tissue swab, etc.

2.
Pathological waste
: (containing human tissue or fluid)e.g.
Body parts , blood and other
fliuds
, etc

3.
Sharps
(sharp materials)

4.
Pharmaceutical waste
(containing pharmaceutical

5.
Genotoxic waste
, e.g. containing
cytotoxic

dugs, genotoxic
chemicals.

6.
Chemical waste, e.g. lab. Reagent, film developer

7.
Waste with heavy metal
-

broken thermometer

8.
Pressurized containers
-
aerosol cans, gas cylinder

9.Radioactive material
-
unused liquid from radiotherapy,
excreta from pt. treated with unsealed radio
-
nucleotide.




Objectives of the HWM system
:


1. To reduce the infectious/hazards nature of waste.



2. To reduce Volume of the waste.


3. To prevent misuse or abuse of waste.


4. To ensure occupational safety and health.


5, To consider aesthetically.


6. To recycle the wastes so that it can be serve as


another utility item.



Safe Waste Management Practices Helps
:


1. To maintain order and cleanliness in the hospital.


2. To maintain a health environment for pts, staff,


and public.


3. To prevent spread of infectious diseases.


4. To project good impression of the management.


5. To attract more clientele.


6. To. Generate revenue for the institution.


Sources of health care wastes
:

Govt. Hospital and private hospital,

Nursing home,

Physician’s and Dentist’s clinics,

Dispensaries,

Medical research and training ins.,

Mortuaries

Blood banks

Lab

Slaughter houses

Vaccine center, etc


Health care waste generation
:

Health care waste generation not only differ
from countries to countries but also within the
country. It depends on numerous factors such
as type of health establishment, proportion of
pts. Treated on day care basis.

In middle and low income countries waste
generation less than high income group.


Health Hazards of health
-
care waste
:

Exposure of health
-
care waste can result in
disease or injury due to one or more of the
following factors:

1.
It contain infectious agent,

2.
It contain toxic or chemical hazards,

3.
It contain sharps,

4.
It is radioactive.



All individual who exposed to such hazards material
are potentially at risks, including who generate
the waste or who handle the waste:


The main groups who exposed:

1. Dr. and nurse, hospital maintenance personnel,

2. Pts. in health
-
care establishment,

3. Workers who facilities waste disposal

4. Visitors.


Treatment and disposal technology for wastes
.

A
.

Incineration
, method of choice for most
hazardous waste.

But, recently alternative method becoming popular.

Incineration: is a high temp.(1000oC)dry oxidation
process, that reduces organic and combustible
waste to inorganic incombustible matter results
in significant reduction of waste vol. and wt(85
-
95). This process of burning is usually select to
treat waste that can not be recycled, reused.


Incineration require no pre
-
treatment.

Waste types not to be Incinerated
:

1.
Pressurized gas containers,

2.
Large amount of reactive chemical wastes,

3.
Photographic and radioactive wastes,

4.
Halogenated plastic such as PVC,

5.
Waste with high Hg or cadmium content such as
broken thermometer, used batteries, etc,

6.
Sealed ampules or ampules with heavy metals.

B.
Chemical Disinfection(CD
)

Chemical are added to waste to kill or
inactivate pathogens, its contains, disinfection
rather than sterilization. CD suitable liquid for
wastes, e.g. Blood , urine, stool, etc.

C.
Microwave irradiation
: Water contained
within waste is rapidly heated by microwaves
and infectious components are destroyed by
heat conduction.

D.
Land Disposal


Municipal disposal sites: Two type

open and
sanitary land fills. Health care waste should
not be deposited on and around open dumps.
Sanitary land fill is the choice because 1.
geographic isolation of waste, 2. Appropriate
engineering preparation, 3. Staff present on
the site to control operation and 4. organized
deposit and daily coverage.


E.
Wet and dry thermal treatment
:


Wet technology
: Infectious to high temp. and high pressure
stream.


Screw feed technology
: Non
-
burn, dry thermal disinfection
process in which waste is reduced by 80% in vol. and by 20
-
25% in wt.


F
.
Inertization
:


Mixing waste with cement and other substance before
disposal in order to minimize risk of toxic substances in
waste to migrate in surface or ground water.. Proportion of
mixing: 65% cement, 15% lime and 5% water.



Categories waste
: as per these rule, there are 10
categories of biomedical waste:


Option Waste category

Cat.
-
1 Human anatomical waste.

Cat.
-
2 Animal waste
-
animal tissues, etc.


including waste generated in vet. Hosp.


college, discharge from animal house.

Cat.
-
3 Microbiology and biotechnology waste.

Cat
-
4 Waste sharps(used and unused
-
needle,


Cat.
-
5 Discarded medicine and cytotoxic drugs

Cat.
-
6 Soiled waste
-
contaminated with blood and


body fluid
-
swab, dressing, plasters, etc.

Cat
-
7 Solid waste
-
catheters, IV set, bl.bag etc.

Cat
-
8 Liquid waste
-
waste generated from lab.

Cat
-
9 Incineration ash.

Cat
-
10 Chemicals Waste wastes of disinfectants


insecticides, etc.


Biomedical waste management in India
:


The bio
-
medical waste should be segregated in
to bags/container at the point of generation of
waste. The colour coding and type of
containers use for disposal waste is fixed.

Colour coding Type of container Treatment


Yellow Plastic bag Incineration


/deep burial

Red Disinfected container Autoclaving/Micro


/Plastic bag /chemical


Blue/White Plastic bag/ As above/destruction


Puncture proof container


Black Plastic bag Disposal in secured


land fill

Strategy Adopted For Hospital waste Management

1.
Waste reduction strategy.

2.
Waste assessment strategy.

3.
Waste recycling strategy.

4.
Hospital waste disposal.


Waste reduction strategy:

Objectives

Reducing Waste quantity by a significant %.

Decreasing waste disposal efforts and
expence
.

Recycling all paper and cardboard waste

Enhance hospital’s reputation in community


Waste assessment strategy:

Waste assessment indicates type and amount of
waste generated in the hospital.

Hospital Waste Disposal


This is the critical part total hospital waste
management, because any failure in this aspect
hazards consequence GOI has prescribed certain
procedure and guidelines as follow:



1. Collection of wastes


2. Source segregation


3. Transportation


4. Storage


5. Treatment


Thus waste ,management is a comprehensive
term, comprising collection, segregation,
transportation, storage, treatment and
ultimate safe disposal of waste.

Dos and DONTs of Health Care Waste
.

DOs

i
. Segregate all waste at the point where they
generate

ii. Have at least 4 types of container in each area of
gen

One to collect kitchen garbage

Second to collect infected waste

Third to collect all type of waste sharp

Forth waste paper, wrapper, etc.

iii. Do designate a separate place to keep mop, etc.



iv. Ensure 5
-
6 lat./50
-
60pts. indoor, 1lat. at OPD.

v. Do ensure adequate availability of H
2
O
for lat.

DON’Ts

Do not consider any type of health waste in a causal manner

Do not through any type of health care waste into street bins

Do not encourage reuse of the disposables

Do not attempt to recycle and/or dispose without ensuring
adequate decontamination

Do not be ignorant of the legislative provisions regarding
waste management especially health care waste.

Do not incinerate all kinds of waste.