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Hari Prasad Kafle
Lecturer, SHAS, FST
Pokhara University
Health Care Waste
 Health care waste includes all waste generated
by health care establishment, research facilities
and l...
Health Care Waste
 75-90% health care waste are non risk waste
as compared to household waste.
 10-25% health care waste...
Health Care Waste
Hospital
Waste
Medical
waste
Infectious
waste
Health Care Waste
 Hospital waste: are waste generated from health
care facilities including cafeteria, office and
constr...
Bio-medical Waste
 “Bio-Medical Waste" means any waste, which
is generated during the diagnosis, treatment or
immunizatio...
Bio-medical Waste
 It includes infectious and non-infectious waste.
 Infectious waste includes pathological waste,
cotto...
Classification of Health Care Waste
Classification of Health Care Waste
Waste
Category
Description and example
Infectious
waste
Waste suspected to contain pat...
Classification of Health Care Waste
Waste
Category
Description and example
Pharmaceuti
cal waste
Waste containing pharmace...
Classification of Health Care Waste
Waste
Category
Description and example
Chemical waste Waste containing chemical
substa...
Classification of Health Care Waste
Waste
Category
Description and example
Pressurized
containers
Gas cylinders; gas cartr...
Classification of Health Care Waste
Waste
Category
Description and example
Gases
waste
Gaseous waste generated during
burn...
Classification of Health Care Waste
Waste
Category
Description and example
Liquid
waste
Waste in liquid form. Waste such a...
Sources of Health Care Waste
 Government hospitals
 Private hospitals
 Nursing homes
 Private clinics
 Dentists clini...
Sources of Health care waste
 Blood bank and collection centers
 Animal houses
 Slaughter houses
 Laboratories
 Resea...
Composition of Health care waste
 80% general health care waste (which may be
dealt with by the normal domestic and urban...
Risk Groups
 Medical doctors, nurses, health care auxiliaries
and hospital maintenance personnel
 Patients in health car...
Risk Groups
 Workers in waste disposal facilities such as
land fills or incinerators
 Waste pickers (scavenger);
 Waste...
Thank You!
Health hazards from health care waste
 Exposure to hazardous health-care waste can
resulting disease or injury because:
...
Health hazards from health care waste
1. Hazards from infectious waste and sharps
 HIV, hepatitis B &C, microbial resista...
Health hazards from health care waste
4. Hazards from radioactive waste
 Headache, dizziness, vomiting,
unconsciousness a...
Infection caused by health-care waste
Type of
infection
Causative
organism
Transmission
vehicles
Gastro enteric
infections...
Infection caused by health-care waste
Type of
infection
Causative organism Transmission
vehicles
Ocular
infections
Herpes ...
Infection caused by health-care waste
Type of
infection
Causative organism Transmission
vehicles
Meningitis Neisseria
meni...
Infection caused by health-care waste
Type of
infection
Causative organism Transmission
vehicles
Bacteraemia Staphylococcu...
Health care waste generation in Nepal
Studies are carried out on:
 92 governmental hospitals ( 67 under MOHP, 3
community...
Health care waste generation in Nepal
 Medical waste composition: 23% infectious,
3% sharp, 12% saline bottles and remain...
Health care waste generation in Nepal
 On an average , a 150 bed hospital have about
50-100 thermometer breakage in a mon...
Composition of hospital waste in India
 Paper : 15 %
 Plastics: 10%
 Rags: 15%
 Metal including sharps: 1
 Infectious...
Medical Waste Generation in Asia
Estimates of medical waste generation in some countries
Medical Waste Generation in Asia
Medical Waste Generation in Asia
 0.33 million tons/year in India
 0.25 million tons/year in Pakistan
 (100 ton/day fro...
Management of health care waste
Effective waste management needs:
 National Policy, Strategy, plan, guidelines and
SOP;
...
Management of health care waste
 Application of local available technology and
also according to resource; envelop;
 Inv...
WHO Waste management Cycle
Waste
minimization
Waste identification
Waste
Segregation
Waste handling
Waste treatment &
disp...
Waste Minimization
 Care full management prevents the
accumulation of large quantity of waste.
 Health care service prov...
Waste Minimization
Some policies of waste minimization are-
1. Source reduction- Purchasing and supplies
materials which a...
Waste Minimization
Some policies of waste minimization are-
3. Encourage use of Recyclable products- Use
materials that ca...
Waste Segregation
 The key of effective waste management is the
waste segregation.
 The waste should be segregated on th...
Waste Segregation
 If waste is properly segregated, small amount
are needed for disposal instead of large
quantity of was...
Waste Segregation
 Segregation of medical waste should always be
the responsibility of waste producer and waste
should be...
Waste Identification
 An appropriate way of identifying the waste is
by sorting the waste into different COLOR
CODE.
 Co...
WHO recommended Color Code
for developing countries
Waste Handling
 Waste handling means the links between
packing, storage and transportation of medical
waste from every ar...
Waste Collection
 Waste should not accumulate at the point of
birthplace.
 The designated personnel should collect the
w...
Guidelines for waste collection
 Collectors must wear protective materials.
 Collection of waste in colored bag or color...
Guidelines for waste collection
 No container should be used if damaged or
licked.
 All bins should be covered with lid ...
Guidelines for waste collection
 During collection each containers should be
replaced with a new one.
 Collection of Sha...
Waste collection materials
 Character of the materials depends upon the type
of generated medical waste.
 Its better tha...
Placement of color bins
 Appropriate container should be placed at all
important location where particular wastes are
gen...
Placement of color bins
 General waste (Black color bin) could be
placed at landing area of the staircase, in the
straigh...
Labeling
 Waste container should be labeled with some
basic information’s: about its waste category,
weight of the waste ...
Security
 Security of medical waste throughout its
lifecycle is significantly a challenge, as
because there is chance of ...
Health and safety
 To ensure the health and safety of the cleaner
in waste management through continuous
monitoring is im...
Health and Safety
c. Immunization of the worker under
occupational safety program especially
against Hepatitis-B virus and...
Personal hygiene
 In medical waste management personal
hygiene is very important.
 The working place should be provided ...
Response to injury and exposure
 Service providers should be trained to deal
with injury and exposure.
 This program may...
Emergency response
 Should be prepare for accident and or unexpected
situation.
 Should be trained to manage common emer...
In-house transportation
 Means transportation of waste from the site of
origin or collection to temporary storage area
wi...
In-house transportation
 A consignment note should accompany the
waste during transportation.
 The trolley or handcart s...
Temporary in-house storage
 The store will be a room or area or building
within the health care facility depending upon
t...
Selection criteria for Temporary in-
house storage area
 Should be properly located to prevent access of
unauthorized per...
Selection criteria for Temporary in-
house storage area
 Should be sufficient space for washing and
cleaning.
 Should be...
Record keeping
 Accurate record keeping is needed for effective
medical waste management.
 Record keeping might give som...
Record keeping
c.Assess the cost directly related with the man
and materials
d.Assess the cost related with waste treatmen...
Thank you!
Transportation for out house
management
 Means collection of stored waste from the
health care facilities to the final di...
Strategy of medical waste
management
 Development of awareness among the service
providers by sensitization;
 Proper cap...
Strategy of medical waste
management
 Supply of logistics like different color bin,
needle crusher, service gloves, boot,...
Key consideration for the better
management of medical waste
 Strongly believes the need of alternative
approach of MWM.
...
Key consideration for the better
management of medical waste
 Committed and well motivated hospital staff
can adopts an e...
Disposal & Treatment Methods Suitable
for Different Categories of Medical Waste
Technology or
method
Infecti
ous
waste
Ana...
Disposal & Treatment Methods Suitable
for Different Categories of Medical Waste
Technology
or method
Infectio
us
waste
Ana...
Disposal & Treatment Methods Suitable
for Different Categories of Medical Waste
Technology
or method
Infectio
us
waste
Ana...
Disposal & Treatment Methods Suitable
for Different Categories of Medical Waste
Technology
or method
Infecti
ous
waste
Ana...
Technologies for Treatment and
Final Disposal
 Incineration
 Chemical disinfection
 Render inert
Incineration
 Description: A high temperature dry oxidation
process that reduces organic and combustible
waste to inorgan...
Incineration
 Disadvantages:
 If not operated effectively may pollute atmosphere
 High capital and operational costs. L...
Chemical disinfection
 Description: Chemicals added to the waste to
kill/inactivate the pathogens. Shredding is
usually n...
Chemical disinfection
 Disadvantages:
 Disinfectants may themselves be hazardous to
operators & pose risks in the case o...
Render inert
 Description:
 Mixing the waste with cement in order to
prevent migration of toxic substances from
waste in...
Render inert
 Disadvantages:
 Bulky and heavy final waste product to be
disposed of.
 Especially suitable for pharmaceu...
Wet thermal treatment
(including autoclaving)
 Description: Exposure of shredded waste to
high temperature, high-pressure...
Wet thermal treatment
(including autoclaving)
 Disadvantages:
 Shredder liable to mechanical failure.
 Efficiency of di...
Microwave irradiation
 Description: Waste shredded, humidified and
then irradiated by microwaves. The heat
generated dest...
Microwave irradiation
 Disadvantages:
 Relatively high capital and operating costs.
 Potential operation and maintenanc...
Landfill (Sanitary)
 Description: Landfill isolates waste from the
environment; it requires appropriate
engineering prepa...
Landfill (Sanitary)
 Disadvantages:
 If not operated properly scavengers may
access the waste and it may cause pollution...
Encapsulate
 Description: Pre-treatment involving filling
containers with waste, adding an immobilizing
material and seal...
Encapsulate
 Disadvantages:
 Not recommended as sole method for non-
sharp infectious waste.
 Bulky and heavy final was...
Thank You!
Hospital waste management
Hospital waste management
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Hospital waste management

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Hospital waste management

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Hospital waste management

  1. 1. Hari Prasad Kafle Lecturer, SHAS, FST Pokhara University
  2. 2. Health Care Waste  Health care waste includes all waste generated by health care establishment, research facilities and laboratories etc.  It also includes waste originating from minor or scattered sources e.g. health care undertaken at home (dialysis, insulin injection etc.)
  3. 3. Health Care Waste  75-90% health care waste are non risk waste as compared to household waste.  10-25% health care waste is regarded as hazardous and can create varieties of health risks.  Broadly, health care waste has been divided into three subsets: Hospital waste, Medical waste and potentially infectious waste.
  4. 4. Health Care Waste Hospital Waste Medical waste Infectious waste
  5. 5. Health Care Waste  Hospital waste: are waste generated from health care facilities including cafeteria, office and construction waste.  Medical waste (a subset of Hospital waste): waste generated as a result of patient diagnosis, treatment and immunization of human beings or animals.  Potentially infectious waste (a sub set of medical waste): that % of medical waste potential to transmit infectious disease (10-25%).
  6. 6. Bio-medical Waste  “Bio-Medical Waste" means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological.
  7. 7. Bio-medical Waste  It includes infectious and non-infectious waste.  Infectious waste includes pathological waste, cotton, dressing, used needles, syringes, scalpels, blades, glass etc.  Non-infectious waste includes general waste from the kitchen/canteen, packaging material including radioactive wastes, mercury containing instruments, PVC plastics.
  8. 8. Classification of Health Care Waste
  9. 9. Classification of Health Care Waste Waste Category Description and example Infectious waste Waste suspected to contain pathogens e.g. laboratory cultures; waste from isolation wards; tissue(swabs); material or equipment that have been contact with infected patients: excreta etc. Pathological waste Human tissue or fluids e.g. body parts; blood and other body fluids; fetuses
  10. 10. Classification of Health Care Waste Waste Category Description and example Pharmaceuti cal waste Waste containing pharmaceuticals e.g. Pharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceutical (bottles, boxes) Genotoxic waste Waste containing substances with genotoxic properties e.g. waste containing cytostatic drugs( often used in cancer therapy); genotoxic chemicals
  11. 11. Classification of Health Care Waste Waste Category Description and example Chemical waste Waste containing chemical substances e.g. laboratory reagents; film developers; disinfectants that are expired and no longer needed; solvents Waste with high contents of Heavy metals Batteries; broken thermometers; blood pressure gauze etc.
  12. 12. Classification of Health Care Waste Waste Category Description and example Pressurized containers Gas cylinders; gas cartridges; aerosol cans etc. Radio active waste Waste containing radioactive Substances e.g. unused liquid form radiotherapy or laboratory research; contaminated glass wire, packages, or absorbent paper; urine and excreta from patient treated or tested with unsealed radionuclides; sealed sources etc.
  13. 13. Classification of Health Care Waste Waste Category Description and example Gases waste Gaseous waste generated during burning of health care waste. Either open burning or drum incinerator or incinerator produce several gaseous pollutants: CO2, H2O, HCL, HF, SO2, NO etc
  14. 14. Classification of Health Care Waste Waste Category Description and example Liquid waste Waste in liquid form. Waste such as infected urine, expired blood, body fluids and fluids coming from wound. Waste water coming from different wards and laboratories. Incineration Ash Could be highly toxic (both bottom ash and Fly ash). Contains high concentrated toxic chemicals and other heavy metals including dioxin and furans.
  15. 15. Sources of Health Care Waste  Government hospitals  Private hospitals  Nursing homes  Private clinics  Dentists clinic  Dispensaries  Primary Health Centers  Medical research and training institutions
  16. 16. Sources of Health care waste  Blood bank and collection centers  Animal houses  Slaughter houses  Laboratories  Research organizations  Vaccination centers  Bio-technology institution and product units
  17. 17. Composition of Health care waste  80% general health care waste (which may be dealt with by the normal domestic and urban waste management system).  15% pathological and infectious waste.  1% sharp waste.  3% chemical or pharmaceutical waste.  <1 % special waste, such as radio active or cytotoxic waste , pressurized container or broken thermometer & used batteries.
  18. 18. Risk Groups  Medical doctors, nurses, health care auxiliaries and hospital maintenance personnel  Patients in health care establishments.  Visitors to health care establishments.  Workers in support services allied to health care establishments such as laundries, waste handling and transportation.
  19. 19. Risk Groups  Workers in waste disposal facilities such as land fills or incinerators  Waste pickers (scavenger);  Waste recyclers;  Drug addicts (who scavenge for used needles and disposed medicines); and  The entire community.
  20. 20. Thank You!
  21. 21. Health hazards from health care waste  Exposure to hazardous health-care waste can resulting disease or injury because:  It contains infectious agents.  It is genototic.  It contains toxic chemicals or pharmaceuticals.  It is radioactive.  It contains sharp.  It contains carcinogenic agents and gaseous chemicals.
  22. 22. Health hazards from health care waste 1. Hazards from infectious waste and sharps  HIV, hepatitis B &C, microbial resistance 2. Hazards from chemical and pharmaceutical waste  Intoxication, burn, poisoning, shock due to inhalation 3. Hazards from genotoxic waste  Gentoxic effects, affects genetic materials
  23. 23. Health hazards from health care waste 4. Hazards from radioactive waste  Headache, dizziness, vomiting, unconsciousness and also genotoxic effects. 5. Public sensitivity  General public is very sensitive to visual impact of health care waste particularly anatomical waste.
  24. 24. Infection caused by health-care waste Type of infection Causative organism Transmission vehicles Gastro enteric infections Entero bacteria: e.g. salmonella, Shigella spp., Vibrio cholera, helminthes. Faeces and or vomit Respiratory infection M. tuberculosis, measles virus, streptococcus pneumoniae Inhaled secretions; saliva
  25. 25. Infection caused by health-care waste Type of infection Causative organism Transmission vehicles Ocular infections Herpes virus Eye secretions Genital infections Neisseria gonorrhoeae, herpes virus Genital secretions Skin infections Streptococcus spp. Pus Anthrax Bacillus anthracis Skin secretions
  26. 26. Infection caused by health-care waste Type of infection Causative organism Transmission vehicles Meningitis Neisseria meningitidis Cerebro-spinal fluid AIDS Human deficiency virus (HIV) Blood, sexual secretions Hemorrhagic fever Junín, Lasssa, Ebola and Marburg viruses all body products and secretions Septicemia Staphylococcus spp. Blood
  27. 27. Infection caused by health-care waste Type of infection Causative organism Transmission vehicles Bacteraemia Staphylococcus spp., enterobacter, Klebsiella and streptococcus spp. Blood Candidaemia Candida albicans Blood Viral hepatitis A Hepatitis A virus Faeces Viral hepatitis B & C Staphylococcus spp. Blood and body fluids
  28. 28. Health care waste generation in Nepal Studies are carried out on:  92 governmental hospitals ( 67 under MOHP, 3 community hospital, 8 teaching hospitals, 14 NGO’s hospitals)  74 private health facilities/ nursing homes  16 eye hospitals
  29. 29. Health care waste generation in Nepal  Medical waste composition: 23% infectious, 3% sharp, 12% saline bottles and remaining 62% non infections.  Infectious waste generation rate 0.48kg/person/day.  Total medical waste generation rate 1.7kg/person/day.  Average incinarable waste: 396.77gm/day/bed.
  30. 30. Health care waste generation in Nepal  On an average , a 150 bed hospital have about 50-100 thermometer breakage in a months and each thermometer contain 0.5-1 gram mercury.  On an average 1 gram mercury has been used for dental restoration in 4 patients.  Source: MOHP 2009, Ale Devika 2005, NHRC 2002, ENPHO 2000, CEPHED 2006, 2008.
  31. 31. Composition of hospital waste in India  Paper : 15 %  Plastics: 10%  Rags: 15%  Metal including sharps: 1  Infectious waste: 1.5%  Glass: 4%  General waste: 53.3 % Source: National Environmental Engineering Research Institute 1997.
  32. 32. Medical Waste Generation in Asia Estimates of medical waste generation in some countries
  33. 33. Medical Waste Generation in Asia
  34. 34. Medical Waste Generation in Asia  0.33 million tons/year in India  0.25 million tons/year in Pakistan  (100 ton/day from Karachi alone)  2,000 tons/day in china  60,000 tons/year in Vietnam  255 tons/day in Dhaka alone  47 tons/day in Metro Manila  (11 tons/day illegally dumped)  Source: Healthcare waste composition in developing Asian countries (WHO,1999)
  35. 35. Management of health care waste Effective waste management needs:  National Policy, Strategy, plan, guidelines and SOP;  Legislation/Rules for waste management;  Political commitment;  Committed manpower;  Good management;  Proper budgetary allocation;
  36. 36. Management of health care waste  Application of local available technology and also according to resource; envelop;  Involvement of NGOs;  Community participation;  Proper capacity development of the service providers;  Development of information system in relation to MWM as a part of MIS;  Supportive supervision and monitoring.
  37. 37. WHO Waste management Cycle Waste minimization Waste identification Waste Segregation Waste handling Waste treatment & disposal Record keeping Training Supervision and monitoring
  38. 38. Waste Minimization  Care full management prevents the accumulation of large quantity of waste.  Health care service providers and institutions administrator can play important role in reduction of waste volume.  Waste minimization is directly proportional with waste management cost and related risk.  Institution can adopt many policies and practices that might reduce the waste volume.
  39. 39. Waste Minimization Some policies of waste minimization are- 1. Source reduction- Purchasing and supplies materials which are less wasteful and or generate less medical waste. 2. Stock management- Frequent auditing; use oldest stock first and checking the expired date of products during receiving and supplies of goods.
  40. 40. Waste Minimization Some policies of waste minimization are- 3. Encourage use of Recyclable products- Use materials that can be recycled both off-site or on-site. 4. Control at institution level- Centralized purchase and monitoring the receipt and supply procedure of medical goods.
  41. 41. Waste Segregation  The key of effective waste management is the waste segregation.  The waste should be segregated on the basis of the category of waste.  The whole waste management depends upon effective waste segregation, because incorrect segregation creates lot of hassles in the down stream of waste management.
  42. 42. Waste Segregation  If waste is properly segregated, small amount are needed for disposal instead of large quantity of waste, ultimately related manpower, related cost, related risk lowered.  If segregation is not properly done, small quantity of hazardous waste has a chance to mix with large volume of non-hazardous waste making the whole volume into hazardous waste.
  43. 43. Waste Segregation  Segregation of medical waste should always be the responsibility of waste producer and waste should be segregated at the point just after its generation.  Once waste is segregated, staffs should never attempt to correct of wrong segregation by placing/transferring items from one container to another.
  44. 44. Waste Identification  An appropriate way of identifying the waste is by sorting the waste into different COLOR CODE.  Color code is easy for identification and thereby easy for safe handling, transportation and waste treatment.  The color code varies from country to country, due to socioeconomic status, literacy rate, availability of local resources, countries classification of waste etc.
  45. 45. WHO recommended Color Code for developing countries
  46. 46. Waste Handling  Waste handling means the links between packing, storage and transportation of medical waste from every area of the institution by designated individual.
  47. 47. Waste Collection  Waste should not accumulate at the point of birthplace.  The designated personnel should collect the waste containers by a routine program through the designated route as a part of the waste management plan.
  48. 48. Guidelines for waste collection  Collectors must wear protective materials.  Collection of waste in colored bag or colored covered bins.  Content of the container should not exceed three quarter of its capacity.  If bag is used for waste collection, tie the neck tightly.  Avoid throwing, dragging over floor or holding the bottom of the containers.
  49. 49. Guidelines for waste collection  No container should be used if damaged or licked.  All bins should be covered with lid during collection and transportation of waste.  Waste should not be collected more the ¾ of containers capacity.  No container should be transported without labeling.
  50. 50. Guidelines for waste collection  During collection each containers should be replaced with a new one.  Collection of Sharp medical waste under maximum precaution.  If there is spillage of waste from the container (gently collect the waste into a bin, soak the area with 2% Lysol solution, wait for 30 minutes, then wash and wipe.
  51. 51. Waste collection materials  Character of the materials depends upon the type of generated medical waste.  Its better that the materials should be domestic in origin, so that sustainability of supply could be ensured.  The commonly used materials are Colored waste containers or bins, puncture proof container, heavy duty gloves, rubber service gum boots, hand tray, Balcha, waste carrying trolley, rubber apron etc.
  52. 52. Placement of color bins  Appropriate container should be placed at all important location where particular wastes are generated.  Instruction on waste identification should be pasted over the containers.
  53. 53. Placement of color bins  General waste (Black color bin) could be placed at landing area of the staircase, in the straight long corridor bin could be placed at 50 meter distance, yellow colored bin could be placed out side of the toilet in female ward for collection of sanitary napkins.  During replacement of the bin, same colored another bin should be placed at the site.
  54. 54. Labeling  Waste container should be labeled with some basic information’s: about its waste category, weight of the waste materials, date of collection, and site of waste production.  These information could be written on preprinted labels with irremovable or water resistance ink.  All waste should be labeled and marked with international symbol especially during transportation.
  55. 55. Security  Security of medical waste throughout its lifecycle is significantly a challenge, as because there is chance of scavenging in every point of its lifecycle.  Scavenging of medical waste especially at the generation site and disposal site must be recognized as threats to institutional infection control program, quality of patient care and community health hazard.
  56. 56. Health and safety  To ensure the health and safety of the cleaner in waste management through continuous monitoring is important.  An appropriate health and safety program includes a. Training of the worker about related risk. b. Timely issue and encourage wearing personal protective materials.
  57. 57. Health and Safety c. Immunization of the worker under occupational safety program especially against Hepatitis-B virus and Tetanus. d. Ensure reporting and post exposure prophylactic treatment. e. Ensure periodical medical checkup system. f. Medical surveillance.
  58. 58. Personal hygiene  In medical waste management personal hygiene is very important.  The working place should be provided with continuous water supply and soap/detergent.  Hand washing should be ensured on arrival for work, before meal, before living the working area and whenever is necessary.
  59. 59. Response to injury and exposure  Service providers should be trained to deal with injury and exposure.  This program may include  In case of accident immediate reporting to the designated authority.  Identify items involved in accident.  Immediate first aid measure  Giving medical attention as soon as possible.  Record keeping.
  60. 60. Emergency response  Should be prepare for accident and or unexpected situation.  Should be trained to manage common emergencies, necessary equipment should be in hand and ready at all times.  Some common emergencies are  Accidental spillage  Equipment failure  Accidental tear or breakage of containers.  Explosion and or fire.
  61. 61. In-house transportation  Means transportation of waste from the site of origin or collection to temporary storage area within the institution.  Waste should be transported by designated trolley, through the designated route according to time schedule given by the institutional authority.
  62. 62. In-house transportation  A consignment note should accompany the waste during transportation.  The trolley or handcart should be easy to clean, loading and unloading, leak proof body, should not be used in any other case other then waste transportation.
  63. 63. Temporary in-house storage  The store will be a room or area or building within the health care facility depending upon the quantity and quality of waste production and frequency of waste collection.  Normally waste should not be stored more then 24 hours.
  64. 64. Selection criteria for Temporary in- house storage area  Should be properly located to prevent access of unauthorized person.  Should have an easy access for workers and collection vehicle.  Should be away from food preparation, processing and food store.  Provided with sufficient light and sufficient water supply.  Should be inaccessible for scavenger, animal and rodents.
  65. 65. Selection criteria for Temporary in- house storage area  Should be sufficient space for washing and cleaning.  Should be equipped with sand, cleaning equipments and fire fitting equipments and reagents.  Floor should be elevated and impervious with proper drainage facility.  There should be weighting and recording facility.  The room should be properly ventilated.
  66. 66. Record keeping  Accurate record keeping is needed for effective medical waste management.  Record keeping might give some important information’s, which are needed for: a. Assess the recurrent expenditure b. Assess the quality and quantity of generated waste
  67. 67. Record keeping c.Assess the cost directly related with the man and materials d.Assess the cost related with waste treatment and disposal method e.Assess the risk involved with generated waste, amount and nature of accident, amount of damage, measure taken against accident etc. f. Assess the failures, problem and obstacle in waste management for better compliance of the program.
  68. 68. Thank you!
  69. 69. Transportation for out house management  Means collection of stored waste from the health care facilities to the final disposal site.   Collection of waste from different institute should be in a covered Van.  The driver area should be totally separated from waste carrying area.
  70. 70. Strategy of medical waste management  Development of awareness among the service providers by sensitization;  Proper capacity development of the service providers by providing training;  Development of in-house management of waste;  Development and adoption of option for the final disposal of waste depending upon the situation, type of hospital, amount of waste production;
  71. 71. Strategy of medical waste management  Supply of logistics like different color bin, needle crusher, service gloves, boot, mask etc;  Establishment of accountability framework;  Formation of “Local waste management committee” and plan for implementation;  Refresher training program for service providers;  Effective Monitoring and supervision.
  72. 72. Key consideration for the better management of medical waste  Strongly believes the need of alternative approach of MWM.  Hospitals will bear the responsibility of safe management of its generated waste.  Need for attitude change of service providers, patients and community people.  Service providers can contribute positively in reducing waste volume and segregation.
  73. 73. Key consideration for the better management of medical waste  Committed and well motivated hospital staff can adopts an effective strategy for proper MWM.  Government should take positive steps in making guideline Legislation and policy on HWM with ensuring monitoring and supervision.
  74. 74. Disposal & Treatment Methods Suitable for Different Categories of Medical Waste Technology or method Infecti ous waste Anato mical waste Shar ps Pharma ceutical waste Cytotoxi c waste Chemica l waste Radioactive waste Rotary kiln Yes Yes Yes Yes Yes Yes Low-level infectious waste Pyrolytic incinerator Yes Yes Yes Small quantiti es No Small quantiti es Low-level infectious waste Single-chamber incinerator Yes Yes Yes No No No Low-level infectious waste Drum or brick incinerator Yes Yes Yes No No No No
  75. 75. Disposal & Treatment Methods Suitable for Different Categories of Medical Waste Technology or method Infectio us waste Anatomi cal waste Sharp s Pharmaceu tical waste Cytotoxic waste Chemical waste Radioactiv e waste Chemical disinfection Yes No Yes No No No No Wet thermal treatment Yes No Yes No No No No Microwave irradiation Yes No Yes No No No No Encapsulati on No No Yes Yes Small quantitie s Small quantitie s No
  76. 76. Disposal & Treatment Methods Suitable for Different Categories of Medical Waste Technology or method Infectio us waste Anatomi cal waste Sharp s Pharmaceu tical waste Cytotoxic waste Chemical waste Radioactiv e waste Safe burial on hospital premises Yes Yes Yes Small quantities No Small quantitie s No Sanitary landfill Yes No No Small quantities No No No Discharge to sewer No No No Small quantities No No Low-level liquid waste
  77. 77. Disposal & Treatment Methods Suitable for Different Categories of Medical Waste Technology or method Infecti ous waste Anatom ical waste Sharp s Pharmace utical waste Cytotoxi c waste Chemical waste Radioactive waste Inertization No No No Yes Yes No No Other methods Return expired drugs to supplier Return expired drugs to supplier Return unused chemicals to supplier Decay by storage
  78. 78. Technologies for Treatment and Final Disposal  Incineration  Chemical disinfection  Render inert
  79. 79. Incineration  Description: A high temperature dry oxidation process that reduces organic and combustible waste to inorganic matter. Many different types of incinerator ranging from the sophisticated to the basic; however, basic incinerators often cause serious emissions problems.  Advantages:  Requires no pre-treatment.  Good disinfection efficiency.
  80. 80. Incineration  Disadvantages:  If not operated effectively may pollute atmosphere  High capital and operational costs. Low cost incineration is possible by using a drum or brick incinerator, however, these present large emission problems and are not as effective in the destruction of hazards.  Suitable condition:  >60% combustible  Moisture content < 30%.  Not suitable for pressurized gas canisters, reactive chemical waste, PVC, wastes with high heavy metal content, photographic or radiography wastes.
  81. 81. Chemical disinfection  Description: Chemicals added to the waste to kill/inactivate the pathogens. Shredding is usually necessary before disinfection, as only the surface of intact solid waste will be treated. The waste is then disposed of in a conventional way, e.g. landfill.  Advantages:  Efficient disinfection when operated well.  Some chemical disinfectants are low cost.  Shredding reduces volume of waste.
  82. 82. Chemical disinfection  Disadvantages:  Disinfectants may themselves be hazardous to operators & pose risks in the case of leakage and subsequent disposal.  Needs highly trained operators.  Shredder liable to mechanical failure.  Suitable condition:  Best for liquid or sewage  Inadequate for pharmaceutical, chemical and some types of infectious waste.
  83. 83. Render inert  Description:  Mixing the waste with cement in order to prevent migration of toxic substances from waste into ground water etc.  Advantages:  Relatively low cost.  Low-technology
  84. 84. Render inert  Disadvantages:  Bulky and heavy final waste product to be disposed of.  Especially suitable for pharmaceuticals.  Suitable condition  Not suitable for infectious waste.
  85. 85. Wet thermal treatment (including autoclaving)  Description: Exposure of shredded waste to high temperature, high-pressure steam. If temperature and contact time is sufficient, most micro-organisms are inactivated. Waste can subsequently be disposed of as municipal waste.  Advantages:  Relatively low capital and operating costs.  Low environmental impact.
  86. 86. Wet thermal treatment (including autoclaving)  Disadvantages:  Shredder liable to mechanical failure.  Efficiency of disinfection very sensitive to operational conditions.  Suitable condition  Not suitable for anatomical, pharmaceutical or chemical wastes.
  87. 87. Microwave irradiation  Description: Waste shredded, humidified and then irradiated by microwaves. The heat generated destroys micro-organisms.  Advantages:  Very efficient disinfection when operated well. Environmentally sound. Reduction in volume of waste.
  88. 88. Microwave irradiation  Disadvantages:  Relatively high capital and operating costs.  Potential operation and maintenance problems.  Suitable condition  Not suitable for pharmaceutical or chemical wastes  Not suitable for large metal objects.
  89. 89. Landfill (Sanitary)  Description: Landfill isolates waste from the environment; it requires appropriate engineering preparation, staff to control operations, organized deposition and covering of waste. Waste may be pre-treated (see above). Ideally, healthcare waste is separated from municipal waste.  Advantages:  Simple, low cost & safe when operated properly.
  90. 90. Landfill (Sanitary)  Disadvantages:  If not operated properly scavengers may access the waste and it may cause pollution of environment etc.  Suitable condition  Generally suitable
  91. 91. Encapsulate  Description: Pre-treatment involving filling containers with waste, adding an immobilizing material and sealing the container e.g. bituminous sand, cement mortar.  Advantages:  Preventing access to HC waste by scavengers.  Relatively simple, low cost & safe
  92. 92. Encapsulate  Disadvantages:  Not recommended as sole method for non- sharp infectious waste.  Bulky and heavy final waste product to be disposed of.  Suitable condition  Appropriate for establishments using minimal programs for disposal of sharps, chemical or pharmaceutical residue.  Source: WHO, 1999
  93. 93. Thank You!

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