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Hospital Hygiene 15 Waste M.pdf
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- 2. OBJECTIVES To be able to define hospital waste To understand the color coding in waste management To distinguish between categories of waste To understand how to sort waste based on colors of bags To differentiate between containers and how waste is separated in different ones in healthcare institutions To understand how to manage hospital waste in Lebanon: handling, storage, transportation, and elimination 2
- 3. OUTLINE What is hospital waste? • Definition • Types • Common sources What is color coding in waste management? Definition Importance Colors used Problems facing color coding system Cost What colors used for different categories of waste? How waste is separated in diverse containers? How to manage healthcare waste in Lebanon? Healthcare categories Healthcare waste management manual Hierarchy of waste management Main stages of waste management Sorting Transportation Treatment and elimination Bibliography 3
- 4. What is Biomedical/Hospital Waste? Hospital waste is any kind of infectious or potentially infectious materials. Biomedical waste is different from any kind of normal trash or general waste and is distinct from other types of hazardous waste such as chemical, radioactive, universal or industrial waste. 4
- 5. Biomedical waste can be solid or liquid blood Laboratory wastes sharps Unwanted microbiological cultures and stocks Unidentifiable body parts Human or animal tissues Used bandages and dressings Discarded gloves Medical supplies 5
- 6. Common Generators of Biomedical Waste hospitals Health clinics Nursing homes Offices of physicians dentists veterinarians laboratories Emergency medical services 6
- 7. What is Color Coding in Waste Management? Color coding exist to help you distinguish different types of waste and sort them in several categories each with a single color without damaging the environment or endangering the safety of patients or staff 7
- 8. Importance of Color Coding It is a very basic principle to insure that waste does not all go to the same place Providing different ways of handling to different kinds of waste Prevent the reuse of sharps and other waste for illegal purpose Provide more opportunities for recycling waste Protect the environment Avoiding safety hazards at your work place 8
- 9. What are the Colors Used? Yellow: Pathological wastes, infectious wastes, clinical wastes Red: Contaminated waste (recyclable) ,plastic bags White/Black : Sharp wastes, needles, blades Blue: Medical glassware, expired drugs 9
- 10. Why is Waste Colored? As much as the medical facility depend on color coding for disposing waste, waste disposal companies rely on them just the same Waste disposal companies use color coding to specify how to destroy them Coded waste end up disposed via certain processes ,they do not all go to the same place 10
- 11. Problems Facing Color Coding Waste Segregation Lack of awareness of healthcare staff Inaccurate disposal of waste items Failed means of collection, storage, and transporting Injuries from hazardous waste items Segregation of waste not taken seriously 11
- 12. Cost of Color Coding System Numbers will change based on facility’s location, volume , and frequency Mainly contracts pay 200$ to 400$ per month for waste pick up The exact number depend on your waste production quantity Some companies pay per box instead of paying monthly since more economical 12
- 13. Mixing is easy , separating is hard! Always know where to throw! 13
- 14. Clinical vs. Infectious Waste Clinical Waste Waste produced from healthcare and similar activities that may cause a risk of infection or may prove hazardous Swabs bandages, dressings, human or animal tissues, blood, etc.… Infectious Waste Waste which may cause human disease and may reasonably be suspected of harboring human pathogenic organisms, or may pose a substantial threat or potential hazard to human health or the environment when improperly treated May be biological, sharps, or even contaminated soil or water, etc.… 14
- 15. What Colour are Used for Different Types of Waste? 15
- 16. WASTE TYPE : INFECTIOUS CLASSIFICATION : HAZARDOUS COLOR CODING : ORANGE Description & Disposal Method : Infectious waste which may be treated to render safe prior to disposal or alternatively it can be incinerated . 16
- 17. WASTE TYPE :CYTOTOXIC/CYTOSTATIC CLASSIFICATION : HAZARDOUS COLOR CODING : PURPLE Description & Disposal Method : Waste consisting of , or contaminated with , cytotoxic and/or cytostatic products which requires disposal by incineration. 17
- 18. WASTE TYPE : OFFENSIVE CLASSIFICATION : NON-HAZARDOUS COLOR CODING : YELLOW & BLACK Description & Disposal Method : Non-infectious, offensive/hygiene waste which may be recycled, incinerated or deep landfilled. 18
- 19. WASTE TYPE : ANATOMICAL CLASSIFICATION : HAZARDOUS COLOR CODING : RED Description & Disposal Method : Anatomical waste which requires disposal by incineration. 19
- 20. WASTE TYPE : MEDICINAL. CLASSIFICATION : NON-HAZARDOUS. COLOR CODING : BLUE. Description & Disposal Method : Waste medicines , out of date medicines , denatured drugs , which requires disposal by incineration . 20
- 21. WASTE TYPE : DENTAL CLASSIFICATION : HAZARDOUS COLOR CODING : WHITE Description & Disposal Method : Dental amalgam & mercury including spent and out of date capsules , excess mixed amalgam & contents of amalgam separators which requires disposal by recovery or recycling . 21
- 22. WASTE TYPE :DOMESTIC . CLASSIFICATION : NON-HAZARDOUS. COLOR CODING : BLACK Description & Disposal Method : This waste should not contain any infectious materials , sharps or medicinal products , and requires disposal by landfill . 22
- 23. What Container Should I Use? There are several types of containers used in hospitals. Each of them has a certain characteristic which makes waste segregation easier. To have a better understanding of clinical waste containers, it is important to distinguish between the different types of waste. 23
- 24. What Container Should I Use? Waste is divided into : Non-Infected Infected Non-Infected waste container type is a plastic container and it should have a secured land filling. Example of disposed waste: General waste such as food, scrap material, etc. 24
- 25. What Container Should I Use? Infected waste is further divided into four container types: Soiled waste plastic bag /disinfectant container with a deep burial Anatomical waste container with a deep burial Infected plastic bag/puncture proof container that is re-cycler Sharps plastic bag/puncture proof container with a sharp pit 25
- 26. What Container Should I Use? Soiled plastic containers and anatomical containers have: Yellow plastic bag, plastic bucket, or cardboard box Example of waste: cotton swab, dressing material, placenta, organ, infected tissue, etc. Infected plastic containers have: Cardboard or plastic boxes which should be puncture-proof and leak-proof Example of waste: syringe needles, BP blades, etc. 26
- 27. What Container Should I Use? Sharp plastic bags have: Puncture, tamper-proof, leak-proof containers Example of waste: metal sharps like needles, blades or syringe with fixed needles, etc. 27
- 28. What Container Should I Use? Some wastes are considered to be hazardous since they are highly dangerous for humans. Example of hazardous waste: Cytotoxic drugs and chemical waste. The materials used to make hazardous waste containers can vary. For example, some may be made of steel while others are made of heavy lined plastics. 28
- 29. Healthcare Waste in Lebanon Lebanese law and World Health Organization define healthcare waste as the waste produced by the healthcare institutions. 29
- 31. Healthcare Waste Categories Infectious Healthcare Waste is defined by WHO (World Health Organization) as a waste which contains pathogens (bacteria, parasites, virus, fungus) in relative quantities or concentrations sufficient to cause illness for sensitive hosts. Practically, it is a waste which contains blood, secretions or excretions presenting a risk of contamination. The average quantity of Infectious Healthcare Waste produced in Lebanon is of 0.50 kg/occupied bed per day, which represents an average of 0.87 kg/occupied bed per day, if we consider that the average level of occupation is 60%. Therefore the estimated total quantity of healthcare waste is 4kg/occupied bed per day 31
- 32. Healthcare Waste Management Manual A manual about waste management should be elaborated by the person in charge of waste management and should include: The current situation Possibility of minimization, re-usage, recycling and purchasing policy Sorting, collection, storage and transportation Identification and evaluation of options of treatment and elimination Protection measures Training Cost estimation Auditing and follow up Organizational chart related to waste management Names and phone numbers of people who have to be contacted in emergency situation cases 32
- 33. Hierarchy of Waste Management 33
- 34. Main Stages of the Waste Management 34
- 35. Waste Sorting Sorting at source is a crucial stage that conditions the successive stages of collection, storage and elimination of waste. The sorting consists of a clear identification of the different waste categories and their separation in containers, or plastic bags. The sorting allows: To prevent the propagation of potentially infectious germs To insure the security of people (the healthcare staff, the staff in charge of the waste transportation, patients and the community To respect hygiene rules To eliminate each waste type through the appropriate network, with respect to regulations To reduce the economic impact of a bad waste management of HCRW or of the treatment of HCRW. Bags are closed once they are two-thirds full, then put in a suitable bin Bags are never emptied, nor piled, nor carried against someone’s body. They are manipulated from the top, with gloves 35
- 36. Transportation and Storage of Waste Intra-hospital transportation Transportation of waste from one place to another, inside the hospital Done during periods of low activity, not less than twice daily Prior to collection and treatment, waste is stored on 2 levels: Intermediate storage rooms Central storage room During their manipulation and their transportation, bags of waste should never be: Transported by hand Carried against the body Placed on the ground The transportation of waste is done in a provided elevator, equipped with a device restricting its access Transportation of hazardous materials outside the hospital must comply with national law and international agreements. The transporter must have an official document; at the end of the transport, he must complete his part and return the document to the producer of waste. 36
- 37. Treatment and Elimination The choice of techniques for treatment and elimination depends on numerous parameters like the quantity and types of waste produced, the legislation, etc. In Lebanon, healthcare facilities in most cases use a service provider providing a solution including transportation, sterilization treatment, and disposal of IHCW outside the hospital. The Arcenciel association manages since 2003 the National Network of Collection and Treatment of IHCW. The appropriate treatment technique is sterilization by autoclaving. 37
- 38. Treatment and Elimination Incineration At high temperature (850 ° C), it is one of the only technologies capable of correctly processing and significantly reducing the volume and weight of all types of IHCW Autoclaving Thermal process where a low temperature is used in order to put saturated steam under pressure with direct contact to waste during an adequate time period for sterilization in order to reach a temperature of 134 °C, which is sufficient to destroy the Geobacillus stearothermophilus, the most thermo-resistant bacteria. 38