The Team• The medical officer in-charge will be the overall supervisor of the waste management programme,& composes his team as follows-⁻ Team Leader -Waste Management coordinator ( Medical officer I/c of the hospital)⁻ Memberso The second M.O.o Senior Staff Nurseo FDAo SDAo Senior Group ‘D’ Workero Low level Group ‘D’ Worker
Hospital Waste Management Structure Head of Hospital Head Of Depts. , Advisers on House infection Keeping, control Admi Waste management officer Matron & Support Staff Senior Staff Hospital Attendents & ancillary workers
Workers Health Safety• The production, segregation, transportation, treatment and disposal of health care waste involve the handling of potentially hazardous material.• Protection against personal injury is therefore essential for all workers who are at risk.
Protective clothing• Helmets• Face masks• Eye protectors• Industrial aprons• Leg protectors• Disposable gloves• Coveralls
Personal hygiene• For reducing the risks from handling health care waste.• Convenient washing facilities should be available.IMMUNIZATION• Viral hepatitis B & tetanus immunization is commonly recommended.
Cytotoxic safety• Written procedures that specify safe working methods for each process.• Data sheets based on suppliers specifications, to provide information on potential hazards.• Established procedures for emergency response in case of spillage or other occupational accident.• Appropriate education and training for all personnel involved in the handling of cytotoxic drugs.
Training & Supervision• All health care establishments should have written policies on waste handling procedures• The people responsible for implementing these policies should be clearly identified.• The waste handling procedure should be made known & readily available to all personnel concerned, not only those at the senior level.• Basic training in waste handling procedure should be given to all new personnel in service. Training for all personnel should form part of a training programme.
The Basic content of training programmes shouldinclude information on• The hazards of health care waste.• The methids of preventing the transmission of nosocomial infections related to waste handling.• The safety procedures for dealing with chemical, pharmaceutiocal & radioactive waste & sharps• Proper waste segregation, handling packaging, transport & disposal.
In case of emergency• Action & notification to supervisiors in case of accident.• These programmes should be periodically reviewed & updated as necessary• Good supervision is essential for the maintenance of efficient & safe waste handling operations.• The selection and training of supervisory personnel plays a fundamental role in IN-House Waste Management• Information on health care waste management policy & methods should also given to support staff, maintenance personnel from external organization, such as transport firms, who may be involved in handling the waste
Effects of improper hospital wastemanagement• Collection, reuse or resale of the single-use products without adequate treatment results in spread of infection• Infections to waste handlers, especially the rag pickers & pourakarmikaas• Improper burning or sub standard incineration of these plastics release dioxins and furans which are carcinogenic in nature• Improper landfilling or dumping them results in leaching & contamination of soil & surronding water bodies.
IMPROPER HOSPITAL WASTE MANAGEMENT ARE DUE TO :• Improper handling; Unsafe actions: handling without personal protective equipment (PPE),• Poor storage (e.g. high temperature conditions combined with prolonged storage time before treatment),• Manual Transportation for longer distances.• Use of uncovered containers instead of closed plastic bags• Exposure times beyond acceptable limits and• Lack of adequate worker and equipment decontamination process/procedures
Legislative Framework• The Gov of India put forward a legislation on 20th July 1998 under section 6 ,8 ,25 of the Environment protection Act, 1986.• The rule defines Adminstrative Medical Officer of Health Care facilities as Biomedical Waste generators & fix responsibilities on them for developing an effective waste disposal mechanism for the waste they generate
• The rule spells out Treatment & disposal options for various categories of Bio- medical waste• The standards for various treatment and disposal technologies have been stipulated• The rules have also fixed time scale for implementation & disposal technology• At State level the State Pollution Control Board is the regulatory body, which monitors the proper implementation of the rules.
Summary of Bio-Medical rules• The rules apply to all persons who generate, collect, receive, store, transport, treat, dispose & handle bio – medical waste in any form• The defination of Biomedical waste• Facilty for treatment is one which is authorized by prescribed authority to deal with all aspects of bio- medical wastes• Every ‘Generator/Occupier’ has a responsibility to take steps to ensure proper waste disposal without any adverse effect on human health & enviorment• Bio medical waste shall be segregated, at source, collected in color coded containers & transported for treatment & disposal within 48 hrs of its generation
Type of Waste Color of the box Categories involved Type of ContainerHuman anatomical Cat 1, Cat 2, Plastic bagwaste, animal waste,microbiology and Cat 3 & Cat 6biotech. waste & soiled YellowwasteMicrobial and biotech Cat 3, Cat 6 & Disinfectedwaste & solid waste Red Cat 7 container/plastic bagWaste Sharps Cat 4, Cat 7 Plastic bag White /Puncture proof containerDiscarded medicines Cat 5, Cat 9 & Plastic bagand cytotoxic drugs, Blackincinerator ash & Cat 10 (solid)chemical waste
• Cytotoxic waste should be collected in strong leak proof containers clearly marked “CYTOTOXIC WASTES ”• Heavy metal waste collected separately• Staff instructions Should be adequate & followable
The Persisting Problem• Lack of segregation practices, mixing of hospital wastes with general waste makes whole waste stream hazardous;• Mushrooming of clinics often unregistered aggravating the problem; (typical Indian problem). How to cover them in the existing legislation.• Open burning by clinics, dispensaries & some hospitals;• Incinerators are old and poorly maintained;• Poor legislative measures/standards, poor implementation;• Public ignorance of the law• Informal sectors largely involved in recycling and reusing medical waste items.
The Ray Of Hope The Scope of improvement• source reduction has higher potential to be implemented in health care waste management.• Benefits of source reduction: Resources conservation; Reduction of collection, transportation, and disposal costs; Decreased pollution control liability, Reduce Regulatory & compliance costs• Segregation and handling of generated waste Segregation reduces the volume & toxicity of waste stream; Proper procurement practices such changing the products & materials can help to reduce the harm (Hg based thermometer can be substituted by electronic sensing devices) Increasing awareness of hospital staffs, employee training in hazardous materials management and waste minimization