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  2. 2. Account o Home o My Documents o My Collections o My Shelf o View Public Profile o Messages o Notifications o Settings o Help o Log Out / 36Download this Document for FreeBIO-MEDICALWANAGEMENT M T S A EContents: Bio-Medical Waste Management1 . I n t r o d u c t i o n 2.Types Of Bio-medical w aste3.Effects of Bio-medical waste4.Collection and treat ment of Bio -medical w aste5.Case Study: INHSKAYLYANI Hospital6 . C o n l u s i o nINTRODUCTIONAll over the country, unsegregated and untreated biomedicalwaste is being indiscriminately discarded into municipalbins, dump sites, onroadsides, in water bodies or is being incompletely and improperly burnt inthe open. All this isleading to rapid proliferation and spreading of infectious,dangerous and fatal communicable diseases like hepatitis, AIDSand severaltypes of cancers. In urban and rural areas alike, incidence and prevalence of several such human diseases hasincreased and the per capita medicalexpenditure has also gone high several folds. Although, yet to be proven,morbidity orillness amongst both urban and rural dwellers has increasedalbeit for different reasons.The Ministry of Environment andForests, Govt. of India has notified theBiomedical Waste (Management and Handling) rules 1998 withsubsequentamendments (June 2nd 2000 and September 2003). However, only 5-10% of institutions in the country haveimplemented the Rules or are following themat present.Unfortunately, some western countries, in the garb of managingtheirbiomedical wastes, are adding to our problems by exporting their wastes topoorer countries.The improper handling,treatment, storage, transport and disposal of wastecan lead to serious problems like:- The entire waste from a healthcareestablishment, which includes non-infectious as well as infectious waste, if unsegregated and untreated is mixedwith therest of the waste in a healthcare establishment, will convert the entirenon infectious general waste (75-80%) also intoinfectious waste.- The indiscriminate disposal of sharps within and outside institutions leadingto occupational hazardslike needle stick injuries, cuts, and infections amonghospital employees, municipal workers and ragpickers.-Injuries dueto the sharp especially among ragpickers and hospital /municipal workers increases the incidence of Hepatitis B, C, E andHIVamong these groups who transmit these diseases to others in the communityand also succumb to such fatal diseases.-The problem with medical waste lies in the fact that it is not handled andtreated according to its type, which leads tohazardous working conditions forhospital personnel and exorbitant investment in technology that creates moreproblems.Hospital waste is generated duringthe diagnosis, treatment, orimmunization of human beings or animals or in research activities in thesefields or in theproduction or testing of biologicals. It may include wastes likesharps, soiled waste, disposables, anatomical waste,cultures, discardedmedicines, chemical wastes, etc. These are in the form of disposable syringes,swabs, bandages, bodyfluids, human excreta, etc. This waste is highlyinfectious and can be a serious threat to human health if not managed inascientific and discriminate manner. It has been roughly estimated that of the 4kg of waste generated in a hospital at least1 kg would be infected.- Undestroyed needles and syringes being circulated back to Recycling,through unscrupulous
  3. 3. traders who employ the poor and the destitute tocollect such waste for repackaging and selling in the market.- Reuse ofdisposable like syringes, needles, catheters, IV and dialysis sets arecausing spread of infection from healthcareestablishments to the generalcommunity.- Disposal of hospital waste and veterinary hospital waste in municipaldumpsiteresulting in animals especially cows feeding on the blood soakedcotton and plastics, and this in turn leading to diseaseslike bovinetuberculosis which through milk can infect humans.- The indiscriminate dumping of untreated hospital wastein municipal binsincreasing the possibility of survival, proliferation and mutation of pathogenic microbial population inthe municipal waste. This leads toepidemics and increased incidence and prevalence of communicable diseasesin thecommunity.- Incidence and prevalence of diseases like AIDS, Hepatitis B&C tuberculosisand other infectious diseasesincreasing due to inappropriate use, storage,treatment, transport and disposal of biomedical waste.- Chances of vectorslike cats, rats, mosquitoes, files and stray dogs gettinginfected or becoming carriers which also spread diseases in thecommunity.Bio-medical waste:―Bio-Medical Waste‖ is any waste,which is generated during the diagnosis, treatment or immunization of human beingsor animals. These wastes are also generated during researchactivities or in the production or testing of biologicalmaterial.Redefining it scientifically, Biomedical waste is defined as ―any solid, fluid orliquid waste, including its containerand any intermediate product, which isgenerated during its diagnosis, treatment or immunization of human beingsoranimals, in research pertaining thereto, or in the production or testing of biological and the animal wastes from slaughterhouses or any other likeestablishments.‖―Any waste that is generated in the diagnosis, treatment or immunization ofhuman beings or animals, in research pertaining thereto, or in the productionor testing of biologicals.‖Infectious wastesare those biomedical wastes which contain sufficientpopulation of infectious agents that are capable of causing andspreadinginfections among people, livestock and vectors. Infectious wastes includehuman tissues, anatomical waste,organs, body parts, placenta, animal waste(tissue / cell cultures), any pathological / surgical waste, microbiologyandbiotechnology waste (cultures, stocks, specimens of micro-organism, live orattenuated vaccines, etc.), cytological,pathological wastes, solid waste (swabs,bandages, mops, any item contaminated with blood or body fluids),infectedsyringes, needles, other sharps, glass, rubber, metal, plastic disposables andother such wastes.Cytotoxicsubstances, as the word suggests are toxic to cells and are oftenanti-neoplastic which inhibit cell growth andmultiplication. These drugswhen come in contact with normal cells can damage them and cause severedisability or evendeath of those affected. These drugs could be present in thewaste generated from the treatment of cancer patients or fromother work related to testing and control of cancerous cells.Infected plastics are those biomedical plastics which have been used foradministering patient care or for performingrelated activities and maycontain blood or body fluids or are suspected to contain infectious agents insufficient numberwhich may lead to infections among other humans oranimals. These generally include IV tubes / bottles, tubings, gloves,aprons,blood bags / urine bags, disposable drains, disposable plastic containers,endo-tracheal tubes, microbiology andbiotechnology waste and otherlaboratory waste.As regards its type and composition, most hospital waste is similartohousehold waste and can be disposed of in the same way. In addition to this,however, hospitals generate certain specialtypes of waste which should not behandled by domestic refuse collection services, because of the risk of infection,becausethey are hazardous in other ways, or for ethical reasons.Such waste must be collected separately at the places where it isgenerated,and disposed of in specially approved plants, e.g., incinerators. Hence, typesof hospital waste may be classifiedaccording to the disposal methodsappropriate for them, as follows:TYPES OF
  4. 4. BIO-MEDICALW A T S : EType A: Waste which does not require any special treatment.This is the waste produced by the hospital administration, thecleaningservice, the kitchens, stores and workshops. It can be disposed of in the sameway as household waste.Type B:Waste with which special precautions must be taken to preventinfection in the hospital.This is usually taken to include allwaste from inpatient and casualty wardsand doctors practices, e.g. used dressings, disposable linen andpackagingmaterials.It only constitutes a risk for patients with weakened defences while it is stillinside the hospital. Once ithas been removed from the wards it can behandled by the local domestic refuse collection service.Type C: Waste which must be disposed of in a particular way to preventinfection.This is waste from isolation wards forpatients with infectious diseases; fromdialysis wards and laboratories, in particular those formicrobiologicalinvestigations, which contains pathogens of dangerous infectious diseases, e.g.tuberculosis, hepatitisinfectious diarrhoeal diseases and which constitutes areal risk of infection when disposing of this waste. It includesneedles andsharp objects coated with blood, or disposable items contaminated with stool.Type D: Parts of human bodies:limbs, organs etc.This waste originates in pathology, surgical, gynecological and obstetricdepartments. It has to bedisposed of separately, not to prevent infection butfor ethical reasons.Type E: Other waste.Hospitals provide a service, andhence have infrastructures which can alsogenerate hazardous waste products, e. 9. chemical residues from laboratories,aswell as inflammable, explosible, toxic or radioactive waste, which must bedisposed of in accordance with statutoryprovisions.SHARPS HANDLING AND DISPOSAL:Sharps consist of needles, syringes, scalpels, blades, glass etc., whichhave the capability to injure by piercing the skin. Asthese sharps are used inpatient care, there is every chance that infection can spread through this typeof injury. Nursescan get a sharp injury before and after using a sharp on apatient. Further, sharps discarded without any specialcontainment orsegregation can injure and transmit disease to those who collect waste(including safai karamcharis,municipal sweepers and ragpickers). Therehave been reports that waste collected from the hospitals are resold,thiscreates an additional occupational and community health hazard.PLASCTICS IN HELTHCAREHospitals use plastics because they fear a spread of infection throughthe use of reusable medical equipment. Thus, plasticuse has grown withincreasing concern for infection control. However, there have been caseswhere even with the use ofplastics there has been a spread of infection inwards. Nurses complained of nosocomial infections in wards eventhoughdisposable equipment was used — they related it to improper waste disposalof disposable equipment within thewards.PVC is a thermoplastic, with approximately 40 percent of its content beingadditives. Plasticisers are added to makePVC flexible and transparent.
  5. 5. Medical equipment made from PVC:B l o o db a g s B r e a t h i n gt u b e s Feeding tubes Pressure monitor tubesCatheters Drip chamberIV ContainersParts of a syringeIV Components LabwareInhalation masks Dialysis tubesMEDICALW SE ATINCINERATIONIncineration is a complex technology that is used to burn waste. Theproblem of medical waste is one of disinfecting thewaste and not of destroying it. With the increased use of disposables in medicine, the amountof plastic going forincineration has increased manifold. The burning of plastics, especially in unregulated incinerators, creates a new set ofchemicaltoxins, some of which, are super toxins even in extremely small quantities.Incineration thus converts a biologicalproblem into a chemical one.MERCURY:AHEALTHHAZARDSources of Mercury in hospitals:1. Thermometers2. Blood pressure cuffs3. Feeding tubes4. Dilators and batteries5. Dental amalgam6. Used in laboratory chemicals like Zenkers solution andhistologicalfixatives.GLUTARALDEHYDE/ CIDEXGlutaraldehyde is a colourless, oily liquid, which is also commonly availableas a clear, colourless, aqueous solution. It is apowerful, cold disinfectant, usedwidely in the health services for high-level disinfection of medical instrumentsandsupplies and available with trade names such as: Cidex, Totacide, andAsep.Glutaraldehyde is a widely used disinfectantand a sterilizing agent(commonly available in 1 percent and 2 percent solutions) in medical anddental settings. It is usedin embalming (25% solution), as an intermediateand fixative for tissue-fixing in electron microscopy (20 percent, 50percentand 99 percent solutions) and in X-ray films.RADIOACTIVE WASTERadiations are used for wide variety applications in research, industry,medicine, manufacturing, agriculture, consumergoods and services. Thecommon concern is that in all these uses, care must be taken to ensure thateveryone is protectedfrom the potential hazards of radiation.EFFECTS OFBIO-MEDICALW T S A ESHARPS HANDLING AND DISPOSALSharps consist of needles, syringes, scalpels, blades, glass etc., whichhave the capability to injure by piercing the skin. Asthese sharps are used inpatient care, there is every chance that infection can spread through this typeof injury. Nursescan get a sharp injury before and after using a sharp on apatient. Further, sharps discarded without any specialcontainment orsegregation can injure and transmit disease to those who collect waste(including safai karamcharis,municipal sweepers and ragpickers). Therehave been reports that waste collected from the hospitals are resold,thiscreates an additional occupational and community health hazard.MEDICAL WASTE INCINERATIONAcid gases include nitrogen oxide, which has been shown to cause acidrain formation and affect the respiratory andcardiovascular system. As largeamounts of plastic are incinerated hydrochloric acid is produced. This acidattacks therespiratory system, skin, eyes and lungs with side effects such ascoughing, nausea and vomiting.Heavy metals are releasedduring incineration of medical waste. Mercury,when incinerated, vaporizes and spreads easily in the environment. Leadandcadmium present in the plastics also accumulates in the ash.Acute and chronic exposure to lead can cause metabolic,neurological andneuro-psychological disorders. It has been associated with decreasedintelligence and impairedneurobehavioral development in children.Cadmium has been identified as a carcinogen and is linked to toxic effectsonreproduction, development, liver and nervous system.PLASCTICS IN HELTHCAREDisposal of PVC via incineration leads to the formation of dioxin andfurans. Dioxin and furans are nwanted by-productsof incineration withcarcinogenic and endocrine-disrupting properties. They are toxic at levels aslow as 0.006 picogramsper Kg of body weight.MERCURYHEALTHHAZARD:When products containing mercury are incinerated, the mercurybecomes airborne and eventually settles in waterbodiesfrom, where via bio-magnification in the food chain and bioaccumulation, it reaches humans. If itis flushed, it enterswaterbodies directly, and if it is thrown in bins it couldenter the body of animals via skin or inhalation, or permeate intothe groundcausing soil and groundwater poisoning. This metalaccumulates in the muscle tissues.Three major types ofmercury are found in the environment – methylmercury, mercury (zero), mercury (two). Out of these, methyl mercury isthemost toxic; it bio accumulates and has the capability to interfere with celldivision and cross the placental barrier. Italso binds to DNA and interfereswith the copying of chromosomes and production of proteins. Pregnantwomen andchildren are most vulnerable to the effects of mercury. TheMinamata disaster in Japan is an example of mercury-poisoning via bio-magnification and bioaccumulation. Mercuryexposure can lead topneumonitis, bronchitis, muscle tremors, irritability, personality changes,gingivitis and forms ofnerve damage
  6. 6. GLUTARALDEHYDE/ CIDEXAqueous solution is not flammable. However, after the waterevaporates the remaining material will burn. During a fire,toxicdecomposition products such as carbon monoxide and carbon dioxide can begenerated.RADIOACTIVE WASTEAccidents due to improper disposal of nuclear therapeutic materialfrom unsafe operation of x-ray apparatus, improperhandling of radio-isotopic solutions like spills and left over doses, or inadequate control of radiotherapy have beenreported world over with a large number of personssuffering from the results of exposure. In Brazil while moving, aradiotherapyinstitute a left over sealed radiotherapy source resulted in an exposure to 249people of whom several eitherdied or suffered severe health problemsInternational atomic Energy Agency, 1988). In a similar incidence four peoplediedfrom acute radiation syndrome and 28 suffered serious radiation burns(Brazil, 1988)Collection andTet e tf i- ramnoBoMedicalWasteThe fight against hospital infection demands the cooperation of allthose employed in the hospital: doctors, technicians,nursing and cleaningstaff. This is why one of the most urgent tasks is to convince, train andmonitor the personnelresponsible for refuse disposal. Unless they areconvinced of the need, trained and monitored, all efforts to improvethesituation will be doomed to failure.Hospital waste should always be collected in disposable containers whichsatisfy thefollowing requirements: they must be moisture-resistant and non-transparent; sellable in such a way as to prevent egressof micro-organisms;safe to transport; and colour-coded to distinguish them from household refusebags. The waste mustbe collected in such containers at the point where it isgenerated, and removed from the wards daily without being sortedortransferred to other containers. The containers must be carefully sealed.Generally, plastic bags are used for Type B andC waste, and plastic bucketsfor Type D waste. The material these disposable containers are made of mustbe appropriatefor the next treatment stage. If the waste is subsequentlyincinerated, for example, combustible materials with a low levelof toxicitymust be used; if it is heat-disinfected the materials must be steam-permeable.This requirement also applies,incidentalIy, to all disposable items purchasedby hospitals.The waste must be transported to a central incineration plant outside thehospital in specially designed vehicles which donot compress it. The interiorof the vehicle body must be easy to clean and it must be adequately ventilated.Generallyspeaking, hospital waste should be burnt in appropriateincinerators: this is a recognized, proven method for disposing ofall hospitalwaste. There are many different incineration systems available on the markettoday. Basically, an incinerationplant should satisfy the followingrequirements:• it should burn dry, wet and organic waste completely.• glass, plastics andmetals contained in the waste should not impair thefunction of the plant in any way.The combustion process should befully automated, and exhaust gasesshould be within the statutory limits even if there are considerable differencesin thecalorific values of the waste.It should have an automatically closing charging sluice to prevent operatingpersonnel fromcoming into contact with the combustion chamber.Plants which satisfy these requirements are now available in allsizes.Alternatively, Type C waste can be disinfected and subsequently disposed of as household refuse, or, in special cases,removed to guarded sanitary landfillsand immediately covered. Type D waste can be interred in an appropriatemanner incemeteries.A variety of methods, chemical and physical, can be used for disinfection. Todisinfect waste, however, onlythermal systems in which the waste is steam-treated at temperatures above 105°C have so far provedsuccessful.Disinfection in pressure-resistant installations involves approximately thesame amount of work as incineration,but has the disadvantage that it is notpossible to check visually whether the treatment has been a complete success.Withincineration this is of course possible. For this reason incineration is tobe preferred in countries which have no trainedinspection personnel.There are also devices on the market which shred waste and then disinfect itwith liquid chemicals.These devices are only suitable for small quantities,mostly prone to breakdowns, and there is no guarantee that the disinfectantfluid will reach all the waste. They are notsuitable for handling all the wastegenerated by a hospital.SHARPS HANDLING AND DISPOSAL:-Make needle reuse impossible:Auto disable syringes, like Solo Shotdevice, cannot be used more than once and therefore cannot carry infectionfrom onepatient to another.-Take the sharp out of sharps waste:Needle removers ―de-fang‖syringes, immediately removing the needles after injection and isolating themin securecontainers. The syringe cannot be reused, and there’s no risk of accidental needle sticks.-Keep needles away from vulnerable hands:Special stickproof containers capture used needles and other medical waste until they can bedestroyed. PATH is workingto increase access to these ―safety boxes,‖identifying low-cost options and making them available for all types ofinjections.
  7. 7. Using a needle cutter/destroyer:1. Place used needle in the cutter/destroyer.2. Cut/destroy the needle and the nozzle of syringe in the destroyer/cutter.3.Separate syringe’s barrel and plunger and put in liquid disinfectant.4. After every shift empty the contents of needlecontainer/destroyer intoliquid disinfectant, removethrough pouring out contents through a sieve.MEDICAL WASTE INCINERATIONDue to poor operation and maintenance, these incinerators do notdestroy the waste, need a lot of fuel to run, and are oftenout of order. There isa lot of difference between the theory and practice of incinerator operation.This is true around theworld. The problem of medical waste needs asystematic approach, with investments in training of staff, segregation,wasteminimisation and safe technologies, as also centralised facilities. Merelyinvesting in unsafe incinerators cannot solveit.PLASCTICS IN HELTH CAREDo’s and Don’ts:Ensure1. That the used product is mutilated.2. That the used product is treated prior to disposal.3. SegregationDo not1. Reuse plastic equipment.2. Mix plastic equipment with other waste.3. Burn plastic waste.Alternatives to mercury based instrumentsDigital instruments are available as substitutes to the mercury containinginstruments. Costs: The cost of the bloodpressure instruments ranges fromRs 2000 to 7000 and the cost of thermometers ranges from Rs 200 to 300Why are the alternative technologies better ?These less harmful, non-toxic substitutes pose no environmental or healthhazards and last for a longer duration. The lifespan of the mercuryinstruments, on the other hand, is short because of their fragility. Eventhough the initial investmentcost of the alternative technologies is high, theassets associated with them are lifelong.GLUTARALDEHYDE/ CIDEXIdentify All Usage Locations:All departments that use glutaraldehyde mustbe identified and included in the safety program. Eliminate as manyusagelocations as possible and centralize usage to minimize the number of employees involved with the handling ofglutaraldehydeMonitor Exposure Levels: Measurement of glutaraldehyde exposure levelsmust be conducted in all usage locations.Training: An in-depth education and training program should be conductedfor all employees who work with hazardous chemicals.Use Personal Protective Equipment: All employees who work withglutaraldehyde must be provided appropriate personal protective equipment.Thisequipment includes proper eye/face protection, chemical protectivegloves, and protective clothing.Engineering controls: Rooms in which glutaraldehyde is used should have aminimum of 10 air exchange rates per hour.General roomventilation: A neutralizing agent will, over time, chemicallyinactivate the glutaraldehydeSAFETY MEASURES:A chain is as strong as the weakest link in it, thus, not even one person in thehospital should be missed while training isgiven. The entire staff is involvedin waste management at some point or the other, including administrators,storespersonnel and other, seemingly uninvolved, departments. To ensurethat the waste is carried responsibly from cradle tograve, and to see that allthe material required for waste management is available to the staff, it isimportant to involveeveryone, including:• Doctors• Administrators• Nurses• Technicians• Ward Boys and safai karamcharisINFECTION CONTROL1. Universal Precautions:All the healthcare workers being exposed directlyor indirectly to infectious diseases must take Universal Precautions toreducethe chance of spread of infection.2. Sterilization and cleaning: Ensure that the hospital has adequateprocedures for the routine, cleaning, and disinfection of environmentalsurfaces,beds, bed rails, bedside equipment, and other frequently touchedsurfaces, and ensure that these procedures are beingfollowed. Routinemicrobiology tests for air and water contamination should be carried out inall parts of the hospital.Sterilize and disinfect instruments that enter tissue,or through which blood flows, before and after use. Sterilize devices oritemsthat touchintact mucus membranes. In all the autoclave cycles, spore strips need to beplaced to check the efficacy ofthe machine. Recommended chemicaldisinfectants should be used for the storage of instruments and fumigation of rooms.All the rooms must have proper ventilation.3. Managing Body Fluid Spillages: Urine, Vomit & Faeces : All spillages of body fluids (urine, vomit or faeces) should be dealt with immediately.Gloves(ideally disposable) should be worn, spillage should bemopped up with absorbent toilet tissue or paper towels: thisshould bedisposed of into the waste bin meant for soiled waste. Pour 10 percenthypochlorite solution and leave it for 15min. Clean the area with a swab. Forspillages outside (e.g. in the playground) sluice the area with water. Do notforget towash the gloves and then wash your hands after you have taken thegloves off.
  8. 8. 4. Patient Placement: A separate room is important to preventdirect/indirect contact transmission when the patient is with highlytransmissiblemicroorganisms, or the patient has poor hygienic habits.5. Immunization programmes: Since hospital personnel are at risk of exposure to preventable diseases, maintenance of immunity is anessential.Optimal use of immunizing agents will not only safeguard the health of personnel but also protect patients frombecoming infected by personnel. Themost efficient use of vaccines withhigh risk groups is to immunize personnelbeforethey enter high-risk situations.HANDLE MERCURY WITH CARE:-NEVER TOUCH MERCURY WITH BARE HANDS.-WEAR ALL PROTECTIVE GEARS.-GATHER MERCURY USING STIFFPAPER AND SUCK IT IN THESYRINGE WITHOUT THE NEEDLE-POUR CONTENTS OF THE SYRINGE IN A BOTTLE CONTAININGWTR AE-PUT SCOTCH TAPE AROUND THE BOTTLE KEEP THESYRINGEFOR FURTHER USERADIOACTIVE WASTEFacilities and procedures described in the rules:(a) Collection:It is mandatory to mention the facilities available e.g.polythene lined waste bins for collection of solid wastes, andcorrosionresistant cardboards or delay tanks for collection of liquid wastes.(b) Transfer:it is important to state the type of container employed duringtransfer of waste/sourcese.g. cardboards, sturdy polythenebags, radio-graphy camera(d) Disposal:Identify the disposal methods for solid, liquid and gaseouswastes briefly such as for:i). Solids: Burial pits, municipaldumping site or waste management agencye.g. BRIT etc.ii). Liquids: Sanitary sewerage system, soak-pit, wastemanagement agencyetc.iii). Gaseous wastes: Incineration facility, fume hood etc.Safety Clothing:A set of safety clothing and equipment for waste handlerswas identified and provided. It included cap, eye protectiongoggles, mask,apron, gloves and boots. Disposable caps and masks were used. Gloves andaprons selected were ofnonpermeable material to prevent contact with blood& body fluids. However gloves selected were malleable enough topermitfinger movement.Handling, segregation, mutilation, disinfection, storage, transportation andfinal disposal are vitalsteps for safeand scientific management of biomedialwaste in any establishment. The key to minimisation and effectivemanagement of biomedical waste is segregation(separation) andidentification of the waste. The most appropriate way of identifying thecategories of biomedical waste isby sorting the waste into colour codedplastic bags or containers.C SSU Y. .. AYNOIA AET D IH LAI S L NK . S HP : TStrategy:1. Already existing bins were used.2. Hard plastic bins were purchased instead of cheap alternatives or pedalbins, as thehospital,going by their experience, wanted to go in for bins which would last longer.3. Initially, changing of bags was doneon a regular basis. In case of infectiousand plastic waste, bags were changed once a day, and for general waste, bagswerechanged twice daily. The cost of this exercise was coming to almost Rs.100 daily. The hospital has now decided toexperiment with plastic reductionin its waste stream. Thus, only the infectious waste bags are replaced daily,the bagsmeant for disinfected plastics and general waste are retained till thebag remains intact and clean.4. The plastic bagspurchased by the hospital are cheaper alternatives to theexpensive bags available.5. The hospital purchased extra stock inaddition to its present needs, as donefor other items, to prevent any slack in the system.6. To minimize the use of chemicaldisinfectant in the wards, two bins havebeen provided, one for disinfection of plastics and one for disinfectedplastics.After each shift, or when the bin with disinfectant is full, the contents aretransferred to the other bin (min.residence period of any item in disinfectantis 2hrs)Strategy adopted:1. To reduce the load of plastics, the hospital is planning to go in for clothlining. This would cost them 1-2 Rs. / bag.2.Microbiological studies in the hospital’s laboratory have shown that 10%bleach is effective for two days, thus a newsolution is prepared everyalternate day.CONCLUSIONInadequate waste collection, handling and disposal promotesthe spread of infection in hospitals is and can thusundermine doctors effortsto heal their patients. Moreover, it can cause infection outside the hospital. Soproper disposalof hospital waste is in everyones interest.To achieve this, clear guidelines must be issued; organizational measuresarenecessary; hospital personnel must be trained, convinced of the need forappropriate disposal method and monitored,waste must be collected indisposable containers at the place where it is generated and transportedwithout being
  9. 9. transferred or compacted. Special waste must be burned inincinerators which are technologically up to date.Healthworkers shouldn’t have to be afraid that saving another’s life willendanger their own. Nor should communities pay forbetter health care withmedical waste they aren’t yet able to manage.Hospital waste management should be with a view tominimize risk tohealthcare workers, and cause minimum damage to the environment 1.CONCLUSIONInadequate waste collection, handling and disposal promotesthe spread of infection in hospitals is and can thusundermine doctors effortsto heal their patients. Moreover, it can cause infection outside the hospital. Soproper disposalof hospital waste is in everyones interest.To achieve this, clear guidelines must be issued; organizational measuresarenecessary; hospital personnel must be trained, convinced of the need forappropriate disposal method and monitored,waste must be collected indisposable containers at the place where it is generated and transportedwithout beingtransferred or compacted. Special waste must be burned inincinerators which are technologically up to date.Healthworkers shouldn’t have to be afraid that saving another’s life willendanger their own. Nor should communities pay forbetter health care withmedical waste they aren’t yet able to manage.Hospital waste management should be with a view tominimize risk tohealthcare workers, and cause minimum damage to the environment 2. 3.
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