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A General Procedure for Assessing and Improving of Medical Waste Management Dr. Said Ali El-Quliti Professor, Dept. of Industrial Engineering, King Abdulaziz University, Jeddah, and Professor, Operations Research and Decision Support Dept., Faculty of Computers and Information, Cairo University
A General Procedure forAssessing and Improving ofMedical Waste Management Agenda
Agenda1- Hazardous Medical Waste.2- Types of Hazardous Medical Waste.3- Dangers of Medical Wastes.4- Disposal Methods for Medical Wastes.5- General Guidelines (How to Deal with Medical Wastes).6- Assessing the Medical Waste Management Systems. 6.1 Data Collected 6.2 Assessed Parameters: • Typology of Respondents. • Estimated Healthcare Wastes. • Segregation and Classification of Medical Wastes. • Medical Waste Storage Tools. • Disposal Methods for Medical Wastes. • Hours Spent in Management of Medical Wastes. • Cleanliness of Health Facilities. • Knowledge of Health Workers on Medical Wastes. 6.3 Final Evaluation of the System.
1- Hazardous Medical Waste• Medical Solid Waste are similar to household wastes.• Hazardous waste, represents 20% of medical waste.The UN, the World Bank and the WorldHealth Organization (WHO) define medicalwaste as hazardous if:toxic, infectious, incendiary, or cause allergies
2- Types of Hazardous Medical Wastea) Pathological, infectious or contaminated wastes,b) Hazardous chemical wastes,c) Radioactive wastes.
a) Pathological, infectious orcontaminated wastesPathological Waste• Remnants of delivery rooms.• Human organs and tissues.• Eradicated tumors.• Blood and body fluids.
Infectious Waste• Infectious germs (bacteria - Viruses - parasites - fungi): bacteriological farms, viral laboratories and remnants of experimental animals.• Waste of isolation patients (infectious diseases).• Remnants of dialysis room.• Remnants of the operating rooms: Masks and shoe covers, gloves and so on.• Remnants of the dental injection, cups, gloves and so on.• Contaminated instruments such as the esterification of all kinds - medical dressing, gauze and cotton - Transmission of blood instruments.• Gypsum, and leftover tools contaminated with patients body fluids and secretions.
Contaminated WastesCause wounds, scratches or holes.Such as:Syringes,Scalpels,instruments of medical solutions,broken glass,ampoule,Slides,… and so on.
b) Hazardous Chemical Wastes• Resulting from medical activities:1. Formaldehyde.2. Waste chemical substances used in X-rays.3. Organic solvents such as methylene chloride - chloroform.4. Organic chemical wastes such as some disinfectants and detergents.5. Inorganic chemical wastes, such as acids and alkalis: sulfuric, hydrochloric and nitric acids.6. Highly toxic heavy elements: – Mercury compounds: produced from broken medical instruments such as thermometers, damaged blood pressure measuring devices, and the remnants of dental fillings. – Ray films Waste (raw or used films)
c) Radioactive wastesInclude wastes containing radioactivematerials, such as:• Radium needles - 226, and• Cobalt tablets- 60 .
3- Dangers of Medical Wastes• They are filled with microbes and viruses transmitting diseases, especially those that are transmitted by blood.• A reason for the breeding of insects, flies and rodents, and the expansion of diseases to wider areas.• The plastic materials (needles, syringes and bottles) when burning leads to the emission of carcinogenic substances such as dioxin.• The wrong way to deal with medical wastes may lead to infection with dangerous diseases as AIDS and Hepatitis transmitted by blood.
4- Disposal Methods for Medical Wastes4-1 Sanitary Landfill4-2 Burning4-3 Sterilization a) Sterilization by Steam and High Temperatures b) Infrared (or Ultraviolet) radiation Sterilization System4-4 Disposal of Radioactive Waste
4-1 Sanitary LandfillAn earth pit isolated from ground waterto protect it from pollution.The base is equipped with a network for waterdischarging resulting from rain anddecomposition of organic materials.A layer of gravel and sand is placed overthe network to facilitate entry of water intothe drainage network.Waste is primary treated, distributed on the baseof the hole and pressed to reach the amount of 0.8 -1.0 tons per m2.
Sanitary Landfill (Cont’d.)Advantages:1 - Low cost and ease of application, no high-tech.2 - Absorb massive amounts of solid wastes.3 - Replanting the area with trees.4 - Access to methane.Disadvantages:1 - Leakage of air pollutant gases: methane, carbon dioxide.2 - Possibility of contamination of water sources by waste water resulting from landfill.
4-2 Burning• Able to treat many types of medical waste, except: Radioactive materials, mercury and compressed containers.• The best way is to burn at a temperature of 1200 ° C for two seconds only.• Avoid burning in bad incinerators or burn randomly, this leads to the formation of dangerous dioxin.
Burning Method Disadvantages:• Incineration is not a solution to the problem, it is a simple transfer of pollutants from waste itself to the smoke and ash.• The ash contaminates soil and groundwater.
4-3 SterilizationThe recent methods for safe disposal of medicalwastes. This method has become a trend in the worldSterilization ways: a) Sterilization by Steam and High Temperatures• Environmentally safe for all medical wastes except anatomical parts and animal contaminated bodies because the steam can’t penetrate.• Not suitable for handling hazardous radioactive materials, or toxic wastes.
b) Infrared (or Ultraviolet) radiation Sterilization SystemEach hospital or clinic is provided with an emptyplastic box,When filled, put into the sterilization unit, it comesout in the form of ordinary waste.
4-4 Disposal of Radioactive Wastes1. Keeping the radioactive material in an insulated and sealed bowl , then set aside to lose half-radioactive-life.2. Kept in a more compact and insulating box, and then buried in the soil.
5- General Guidelines (How to deal with medical wastes)1.Segregation of medical and non-medical wastes within the health facility until dealt with according to seriousness.
General Guidelines (Cont’d.)3- Collection of sharp and contaminated materials in small containers with lid (Yellow containers), containers are of reinforced plastic and should not be filled fully. Then send to treatment , rather than throw in the regular garbage bags. Containers should be far from beds of patients.
General Guidelines (Cont’d.)4- Location of the temporary waste collection area in health facilities away from food stores, restaurant and kitchen. Not to store medical wastes in open spaces, preferably in an enclosed ventilated space.
General Guidelines (Cont’d.)5- Use and Reformation of modern waste disposal instruments (like incinerators and sterilizers) in hospitals and regularly maintaining or replacing.
General Guidelines (Cont’d.)6- Use advanced recent methods to treat some wastes instead of burning, such as sterilization before putting them in bags and dispose.
General Guidelines (Cont’d.)7- Liquid wastes (solvents) should not be thrown in public network before primary treatment, to avoid damage of the network and the environment.
General Guidelines (Cont’d.)8- Put unusable units of blood (expired or virus infected blood) in reinforced yellow bags until properly disposed.
General Guidelines (Cont’d.)9- Expired drugs or bad stored should be returned to the supplier. Not disposed with household garbage.
General Guidelines (Cont’d.)10- Arrange awareness and training programs, on the dangers and managing of medical wastes for: workers, nursing staff and administrators of health facilities.
6- Assessing the Medical Waste Management Systems6.1 Data Collection.6.2 Assessed Parameters.6.3 Final Evaluation of the System.
6.1 Data Collection• Primary data: interviews, and observations.• Secondary data: documents.• to examine the performance of medical waste management tools in: collecting, storing, transporting and treating the medical wastes, and to examine knowledge of health workers.
6.2 Assessed Parameters:• Typology of Respondents.• Amount of Healthcare Wastes.• Segregation of Medical Wastes.• Medical Waste Storage Tools.• Disposal Methods for Medical Wastes.• Hours Spent in Management of Medical Wastes.• Cleanliness of Health Facilities.• Knowledge of Health Workers on Medical Wastes.
Amount of Healthcare WastesLevel of Health Waste Sharps Garbage fromfacility excluding (Container) wards sharpsHospital(kg/bed/day)Health Centers(kg/person/day)Dispensaries(kg/person/day)
Segregation of Medical Wastes Status for segregation of TotalHealthcare medical wasteslevel Segregated Mixed %Hospitals 100Health centers 100Dispensaries 100Total 100
Classification of Medical Wastes Status of medical Health facility waste tools Total level Color coded Not color coded %Hospitals 100Health centers 100Dispensaries 100Total 100
Medical Waste Storage Tools Plastic Metal Non Waste Safety Pit boxes Available %Functioning %
Status of Medical Waste Disposal ToolsLevel of Health Status (%)facility Good Fair BadHospitalHealth CentreDispensaries
Disposal Methods for Medical WastesLevel of Sanitary Burning Sterilization Disposal of TemporaryHealth facility Landfill Radioactive Waste Waste Collection AreaHospitalHealth CentreDispensaries
Hours Spent in Management of Medical Wastes Hours spent in management of medical wastes (%) TotalHealthfacility level 1-2 3-5 6-8 hours hours hoursHospitals 100Healthcenters 100Dispensary 100Total 100
Cleanliness of Health Facilities Cleanliness TotalHealthcare level High Moderate Poor (%)Hospital 100Health centre 100Dispensary 100Total 100
Knowledge of Health Workers on Medical Wastes Knowledge Level TotalHealthcarelevel High Moderate Poor %Hospital 100Health centre 100Dispensary 100Total 100
6.3 Final Evaluation of the System Hospital: …………………………….. Degrees Weight Marks1 Typology of Respondents.2 Estimated Healthcare Wastes.3 Segregation and Classification of Medical Wastes.4 Medical Waste Storage Tools.5 Disposal Methods for Medical Wastes.6 Hours Spent in Management of Medical Wastes.7 Cleanliness of Health Facilities.8 Knowledge of Health Workers on Medical Wastes. Total
Final Assessment of Medical Waste Management System City Evaluation Hospital Health centre Dispensary Others 1 2 3 … … …Total Final City Evaluation Recommendations for Improving