Healthcare waste management dr. sanjay dalsania hospitech india_03 march 2013

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Healthcare waste management dr. sanjay dalsania hospitech india_03 march 2013

  1. 1. MAJOR (DR) SANJAY DALSANIAChief Quality OfficerApollo Hospitals, AhmedabadHEALTHCARE WASTE MANAGEMENTStepping Towards Quality Improvement & Safety“THE APOLLO WAY”
  2. 2. HEALTHCARE WASTE HAZARDS• Infectious & pathological• Sharp injuries• Hazardous chemicals• Radioactive• Cytotoxic & Genotoxic
  3. 3. DISEASE TRANSMISSION• Air borne• Direct contact / sharp injuries (through broken skin)• Diseases:• Hepatitis-B• AIDS• Tetanus• Diseases of GI tract & respiratory system• Skin diseases & many more
  4. 4. WHO ARE AT RISK?• Doctors• Nursing staff• Ward staff• Housekeepers• Patients & visitors• Community• Environment
  5. 5. HEALTHCARE WASTE MANAGEMENT• Structure• Processes• Outcomes
  6. 6. POLICY• To outline the SoPs to manage various types ofwastes• To avoid nosocomial infections• To encourage safe working practices• To ensure environmental conservation
  7. 7. GOLDEN RULES• Segregation at the source• No mixing• No storage beyond 48 hours• PPE & Universal precautions
  8. 8. WASTE CLASSIFICATION• Clinical waste• Sharps waste• Chemical waste• Pharmaceutical waste• Laboratory waste• Radio-active waste• Cytotoxic /genotoxic waste• Confidential waste• Food & domestic (general) waste
  9. 9. HEALTHCARE WASTE MANAGEMENTStep-ISEGREGATIONTRANSPORTATION TO CENTARLSTORAGE SITECOLLECTIONTREATMENT & DISPOSALStep-IVStep-IIIStep-IILOCAL STORAGETRANSPORTATION TO FINALDISPOSAL SITEStep-VStep-VIIn-houseOutsourced
  10. 10. HEALTHCARE WASTE MANAGEMENTType of WasteNon-infectious Waste(80-85%)Infectious Waste(15-20%)
  11. 11. SEGREGATION• Responsibility of all staff.• At the source of generation itself.• Clear identification & sorting.• Display of segregation guidelines.• Color coding and labeling .
  12. 12. SEGREGATION
  13. 13. SEGREGATION
  14. 14. INFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTEREDCATHETERS, TUBINGS, CANNULAE, SYRINGES, PLASTIC IVBOTTLES, USED GLOVES, IV SETS, INFECTED PLASTIC WASTE,SPECIMEN CONTAINERS, WASTE GENERATED FROMLABORATORY, CULTURE OF MICRO ORGANISMS, USED ORDISCARDED BAGS OF BLOOD/BLOOD PRODUCTS, VACCINESINFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTEYELLOWHUMAN TISSUES, ORGANS, BODYPARTS, ITEMS CONTAININGBLOOD AND BODY FUID (COTTON), SOILED DRESSING, SOILEDPLASTERS CASTS, BEDDINGS, DISCARDED MEDICINE,DISCRDED CYTOTOXIC DRUGSINFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTEBLUEGLASS WARE ITEMS, NEEDLES, SYRINGES, SCALPELS, BLADES,USED AND UNUSED SHARPSINFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTEBLACKRADIOACTIVE AND CHEMOTHERAPY WASTES
  15. 15. SEGREGATION GUIDELINESCOLOUR WASTE DESCRIPTIONYELLOWHuman tissues, organs, body parts, items contaminated by blood/bodyfluids, soiled cotton & dressing, soiled plaster casts, discarded medicines,discarded cytotoxic drugsREDCatheters, tubings, cannulae, syringes, plastic IV bottles & sets, used gloves,infected plastics, specimen containers, lab waste, microbiology cultures,used or discarded bags of blood/blood products, vaccinesBLUE Glass items, needles, syringes, scalpels, blades, used and unused sharpsBLACK Radioactive and chemotherapy wastageGREENGeneral waste, non-infected plastic materials & papers, disposables,cardboards, metal containers, office waste, food waste
  16. 16. SEGREGATION• Allow to fill the bag/bin up to 3/4thlevel.• Hub cutters for needles.• Other sharps: puncture proof auto-locked containers.
  17. 17. SEGREGATION
  18. 18. SEGREGATION• Thumb Rule: Mutilate disposable and plastic itemsand empty the glass vials & bottles before throwingin waste bins.• Proper segregation:• Facilitates further collection, handling, storage &disposal of waste.• Minimizes the cost of handling and disposal ofwaste.
  19. 19. COLLECTION• Scheduled collection by Housekeeping Staff.• 2 hourly in ICUs• 4 hourly in wards/other clinical areas• Thumb Rule: Tie on the top. Do not compress thebag. Lift the bag from the top. Do not support thebottom of the bag with the other hand.• Regular washing & disinfection. Checklist forwashing/disinfection.• Use of PPE while collecting waste.
  20. 20. COLLECTION
  21. 21. LOCAL STORAGE• Temporary storage:• Colour coded containers / big polythene bags• Labelling• Local collection points (closed dirty utility rooms)• Away from patient areas• No mixing of infectious and non-infectious waste.• Thumb Rule: Waste from local storage must betransported to central collection site within twohours of collection.
  22. 22. LOCAL STORAGE
  23. 23. TRANSPORTATION TO CENTRALSTORAGE SITE• From local storage areas to central storage area:• Closed air-tight color-coded container trolleys• Scheduled time interval• Pre-defined waste route• Well demarcated dirty utility lift• Thumb Rule: No crossing over with food trolleys orsterile areas.
  24. 24. TRANSPORTATION TO CENTRALSTORAGE SITE• Scheduling & separate routes for waste trolleys &food trolleys.• Regular washing & disinfection of container trolleys.Checklist for washing/disinfection.• Use of PPE while transporting waste.
  25. 25. CENTRAL STORAGE AREA• Away from clinical areas, kitchen, stores & public routes.• Restricted entry.• Adequately lit & ventilated rooms with impervious floor.• Color-coded self-closing doors.• Facility of washing area.• Provision of First Aid Kit.• Availability of PPE.• Fire extinguishers.• Regular washing and disinfection. Checklist.
  26. 26. CENTRAL STORAGE AREA
  27. 27. TRANSPORTATION TO FINALDISPOSAL SITE• Daily.• Outsourced to Government authorized CBWTF(Common Biomedical Waste Treatment Facility).• In a closed cart/vehicle with smooth & impermeablesurfaces.• Thumb Rule: No waste should be kept stored in thehospital beyond the period of 48 hours.
  28. 28. TRANSPORTATION TO FINALDISPOSAL SITE• Weighing of waste to monitor the wastevolume/bed.• PPE while handling the waste. Immunizedpersonnel.• Once a month, visit by Infection Control Coordinatorto the disposal site.• General/food waste – municipal vehicle.
  29. 29. TREATMENT & DISPOSALWasteCategoryWaste Category TypeTreatment & DisposalOptionCategory-1Human Anatomical Waste(human tissues, organs, body parts )Incineration/deep burialCategory-2Animal Waste(animal tissues, organs, body parts carcasses,bleeding parts, fluid, blood and experimentalanimals used in research, waste generated byveterinary hospitals, colleges, discharge fromhospitals, animal houses)Incineration/deep burialCategory-3Microbiology & Biotechnology Wastes(Wastes from laboratory cultures, stocks orspecimens of micro-organisms live orattenuated vaccines, human and animal cellculture used in research and infectious agentsfrom research and industrial laboratories,wastes from production of biologicals, toxins,dishes and devices used for transfer ofcultures)local autoclaving/micro-waving/incineration
  30. 30. TREATMENT & DISPOSALWasteCategoryWaste Category TypeTreatment & DisposalOptionCategory-4Waste sharps(needles, syringes, scalpels, blades, glass etc.that may cause puncture and cuts. Thisincludes both used and unused sharps)disinfection (chemicaltreatment)/autoclaving/microwaving and mutilation/shreddingCategory-5Discarded Medicines and Cytotoxic drugs(wastes comprising of outdated, contaminatedand discarded medicines)incineration/destruction anddrugs disposal in secured landfillsCategory-6Soiled Waste(Items contaminated with blood, and bodyfluids including cotton, dressings, soiledplaster casts, lines beddings, other materialcontaminated with blood)Incineration/autoclaving/micro-wavingCategory-7Solid Waste(wastes generated from disposable itemsother than the waste [sharps] such as tubing,catheters, intravenous sets etc.)disinfection by chemicaltreatment/autoclaving/microwaving andmutilation/shredding
  31. 31. TREATMENT & DISPOSALWasteCategoryWaste Category TypeTreatment & DisposalOptionCategory-8Liquid Waste(waste generated from laboratory andwashing, cleaning, house-keeping anddisinfecting activities)disinfection by chemicaltreatment and discharge intodrainsCategory-9Incineration Ash(ash from incineration of any bio-medicalwaste)disposal in municipal landfillCategory-10Chemical Waste(chemicals used in production of biologicals,chemicals used in disinfection, as insecticidesetc.)Chemical treatment anddischarge into drains for liquidsand secured landfill for solids• Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemicalreagent. It must be ensured that chemical treatment ensures disinfection.• Mutilation/shredding must be such so as to prevent unauthorized reuse.
  32. 32. TREATMENT & DISPOSAL• Thumb Rule: Disinfect and mutilate the wastebefore its final disposal.• Syringes: cut, disinfected & disposal into sharps pit.• Infected plastics: disinfected/autoclaved, shreddedand sent for final disposal into municipal dumps.• General waste: disposal to municipal waste dumpswithout any treatment.
  33. 33. ACCIDENTS & INCIDENTS• Structured procedures for risk management.• Immediate first-aid measures & post-exposureprophylaxis.• Reporting to Emergency Department or Staff Clinicat earliest.
  34. 34. ACCIDENTS & INCIDENTS• Prompt reporting to Quality/Infection Control Dept:• Inappropriate segregation• Leakage & spillage• Damaged containers• Splashes & Sharp Injuries• Mixing of general waste with biomedical waste• Excessive accumulation
  35. 35. ACCIDENTS & INCIDENTS• Retention of the item and identification of possibleinfection.• Investigation and RCA• CAPA to prevent recurrences.
  36. 36. PERSONAL PROTECTION• Disposable gloves & heavy-duty gloves• Industrial apron / leg protectors• Face shields & protective glasses• Sturdy industrial boots• Helmets & strong industrial PPE in high risk areas.• Masks & respiratory protectors for protectionagainst toxic dust.• Standard PPE (approved by BARC) for protectionagainst radioactive wastes.
  37. 37. PERSONAL PROTECTION
  38. 38. PERSONAL PROTECTION• Protective equipment - cleaning & maintenance.• Periodic/surprise checking.• Hepatitis-B and tetanus vaccination.• Washing facilities at storage & disposal areas.• Insistence on hand washing practices.
  39. 39. STAFF SAFETY• Pre-employment & annual health check• Vaccination & online monitoring of immune status• Training on occupational safety• Display of SoPs at all working areas• Provision of required PPE and periodic inspection• Spillage Kits, Mercury Kits• HAZMAT Kits• First Aid Kits• Fire Fighting Equipment
  40. 40. EDUCATION & TRAINING• Training on induction, a part of orientation program.• Focused group training at regular intervals byInfection Control Dept.• Training on colour coding, labelling, route markingetc.• Training on special problems related to sharpdisposal.• Awareness about the occupational risks.• Re-training on revision of policies & procedures.
  41. 41. EDUCATION & TRAINING• Training on personal safety, safe procedures, use ofprotective clothing/equipment and how-to-deal-withspillage and other incidents at work area.• Training on appropriate cleaning and disinfectionprocedures.• Hand Hygiene, First Aid, BLS & Fire Safety Training.• Post-training assessment & competency evaluation.• Mock Drills.
  42. 42. QUALITY ASSURANCE• Process Audits• Planned & surprise• Cross-departmental• Waste Audits• Segregation• Labeling• Departmental Waste Volume/Day
  43. 43. QUALITY ASSURANCE• Biomedical Waste Management – permanentagenda in monthly Infection Control CommitteeMeetings.• “Quality Watch”• Adherence to cleaning checklists• Needle Stick Injuries• Incident Reports• Hospital Acquired Infection Rates• Hand Hygiene Compliance
  44. 44. END

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