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Seminar in Health Care Waste Management

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Seminar in Health Care Waste Management

  1. 1. 6/13/2016 1 WELCOME TO SEMINAR
  2. 2. 6/13/2016 2
  3. 3. 6/13/2016 3 Discovered during a waste audit: a leg destined for disposal via the municipal system (Nakarmi/HECAF).
  4. 4. 6/13/2016 4
  5. 5. Contd… One extreme case from Brazil demonstrated a carcinogenic impact on the general population from an unintended exposure to radioactive waste from a health-care facility. While moving to a new site, a radiotherapy institute left a sealed radioactive source in equipment at its old premises. An individual who gained access to these premises removed the sealed source, took it home and broke open the casing to reveal the radioactive material. As a consequence, 249 people were exposed, of whom several died or suffered severe health problems, (International Agency for Research on Cancer (IARC,1988). 6/13/2016 5
  6. 6. 6/13/2016 6 HEALTHCARE WASTE MANAGEMENT Pabitra Sharma
  7. 7. General objective At the end of the session the participants will be able to explain Health care waste management. 6/13/2016 7
  8. 8. Specific Objectives • define waste. • define health care waste. • state the types of health care waste. • identify sources of health care waste. • explain impact of health care waste. • state the types of infection by Health Care Waste. • list the principles of health care waste management. • explain the steps of health care waste management. 6/13/2016 8
  9. 9. Specific Objectives Cont.. identify different organization in health care waste management. identify the legislation regarding Health Care Waste Management in Nepal. 6/13/2016 9
  10. 10. Waste Definition • Waste (also known as rubbish, trash, refuse, garbage, junk, litter) is unwanted or useless materials. • “Substances or objects which are disposed of or are intended to be disposed of or are required to be disposed of by the provisions of the law,” (Basel Convention,2003). 6/13/2016 10
  11. 11. Health Care Waste (HCW) Health-care waste includes all the waste generated by health-care establishments, research facilities, and laboratories. In addition, it includes the waste originating from “minor” or “scattered” source such as that produced in the course of health care undertaken in the home (dialysis, insulin injections, etc.), (WHO,1999). 6/13/2016 11
  12. 12. HCW Contd.. Medical waste means the hazardous waste produced and discharged from hospitals, clinics, pharmacies, dispensaries, blood banks, pathology laboratories, veterinary institutions and health research centers, (Solid Waste Management Act, 2011,Nepal). 6/13/2016 12
  13. 13. HCW Contd.. HCW 80% general/ non hazardous 15% hazardous (10% infective waste 5% non- infectious but hazardous1% is sharp 6/13/2016 13
  14. 14. 6/13/2016 14 Classifications of waste
  15. 15. Categorization of HCW a) Based on UNEP/SBC/WHO (United Nation Environment Programme/Secretariat Basal Convention,2004) 1. Non-risk HCW. 2. HCW requiring special attention. 3. Infectious and highly infectious waste. 4. Other hazardous waste. 5. Radioactive waste . 156/13/2016
  16. 16. 1) Non risk HCW Non-risk health care waste (Comparable to the domestic waste) 1.1. Recyclable HCW - paper, card board, non- contaminated plastic or metal, cans or glass 1.2 . Biodegradable HCW – waste that can be composted 1.3. Other non-risk HCW – clay equipment. 6/13/2016 16
  17. 17. HCW which needs special attention for disposal 2.1. Human anatomical waste -human body parts, organs and tissues 2.2. Sharp Waste- 2.3. Pharmaceutical waste - Non- hazardous pharmacological waste- Normal saline, Dextrin or Cough syrup etc. 6/13/2016 17 2. Health care waste requiring special attention
  18. 18. HCW with special attention contd.. - Potentially hazardous pharmaceutical waste- Date expired medicine. - Hazardous pharmaceutical waste- unidentifiable pharmaceuticals as well as heavy metal containing disinfectants 6/13/2016 18
  19. 19. Contd… 6/13/2016 19 A dog finds some pathological waste on a Kathmandu street (Nakarmi/HECAF).
  20. 20. Contd…. In China, 21 dead babies were found in a lake; some had hospital identity tags and one was wrapped in plastic and labeled “medical waste,” (human right and medical waste, 2011). 6/13/2016 20
  21. 21. HCW Require Attention Contd.. 2.4 Cytotoxic pharmaceutical waste - alkylated substances, antimetabolites, antibiotics, plant alkaloids, hormones, and others. 2.5. Blood and body fluids waste human or animal blood, secretions and excretions. E.g dressing material, s􏰂wabs, syringes without needle, infusion equipment. 6/13/2016 21
  22. 22. 3. Infectious and highly infectious Waste 3.1. Infectious waste- potential of transmitting infectious agents to humans or animals. E.g isolation wards, dialysis wards or centers for patients infected with hepatitis viruses (yellow dialysis); pathology departments; operating theatres etc. 3.2. Highly infectious waste- All microbiological cultures and 􏰂laboratory waste. 6/13/2016 22
  23. 23. 4. Other Hazardous Waste Include chemicals, heavy metals, pressurized containers, discarded gaseous, liquid and solid generated during diagnostic and experimental 􏰂,disinfecting procedures, cleaning processes and house-keeping with features of, o Toxic o Corrosive acids o Flammable o Reactive, explosive, shock sensitive o Cytotoxic or genotoxic properties 6/13/2016 23
  24. 24. 5. Radioactive Waste • Include materials contaminated with radio􏰂 nuclides, which arise from the medical or research use of radio-nuclide. • Sealed radiation source, liquid and gaseous material contaminated 􏰂with radionuclide, excreta of patients etc. 6/13/2016 24
  25. 25. WHO Classification a) Hazardous health-care waste • Sharps waste • Infectious waste • Pathological waste • Pharmaceutical waste, • cytotoxic waste • Chemical waste • Radioactive waste b) Non-hazardous or general health-care waste 6/13/2016 25(WHO,2014)
  26. 26. Categorizations According to BMW Schedule ,2011 • Category 1- Human Anatomical • Category 2- Animal • Category 3- Microbiology/Biotechnology • Category 4- Sharp • Category 5- Discarded Medication and Cytotoxic 6/13/2016 26
  27. 27. BMW Categorization Contd.. • Category 6- Soiled Water • Category 7- Solid Waste • Category 8- Liquid Waste • Category 9- Incinerator Ash • Category 10- Chemical Waste 6/13/2016 27
  28. 28. Categorization in Nepal Based on UNEP/SBS/WHO 1) Non risk HCW • Biodegradable • Non-biodegradable 6/13/2016 28NHCWM Guideline,2014
  29. 29. Categorization Contd.. 2) Risk health care wastes • Pathological Waste • Infectious waste Sharp Waste • Cytotoxic Waste • Pharmaceutical Waste • Other hazardous Waste 6/13/2016 29NHCWM Guideline,2014
  30. 30. Categorization by NHRC • Non hazardous waste/ general waste • Hazardous/ contaminated waste • Sharp( infected or not infected) 6/13/2016 30
  31. 31. Research Worldwide, an estimated 16 billion injections are administered every year. Not all needles and syringes are disposed of safely, creating a risk of injury and infection and opportunities for reuse. 6/13/2016 31 " I am Committed for Safe Injection". (BMWS,2011)
  32. 32. 6/13/2016 32 Production of HCW
  33. 33. Production of HCW A) Globally • Developed countries - 1- 5kg/bed/day • Developing countries - 1-2/kg/day - The waste generation rate (kg/bed/day) hospital USA - 4.5 , Netherlands 2.7 and France 2.5. 6/13/2016 33 (WHO,2014)
  34. 34. - Average HCW - 1-4.5 kg/bed/day in Latin American countries( e.g Chile, Brazil Argentina and Venezuela ) - Hazardous waste - 5% in Denmark , 28% in USA (Monreal, 1991). 6/13/2016 34 Production Contd…
  35. 35. B) Production of Waste in South East Region (by 2001) Country Waste(kg/bed/day) Annual waste Bangladesh 0.8-1.67 93,0755 tons Bhutan 0.27 73 tons India 1.0- 2.0 0.33 million tons Maldives NA 146 tons Nepal 0.5 2,018 tons Pakistan 1.63-3.69 0.25 million tons Srilanka 0.36 6,600 tons WHO,2001 6/13/2016 35
  36. 36. Production Contd… C) In Nepal • Kathmandu Metropolitan City have organized a study on biomedical waste in hospital located Kathmandu - (Results- 1.72kg waste/ day / patients) - Out of which26% waste was infectious and hazardous. 6/13/2016 36
  37. 37. Production in Nepal Contd… • Estimated at 0.533 kg/bed /day Out of which  0.256 kg/bed/ day is general  0.147 kg/bed/day -biodegradable waste,  0.120 kg/bed-day- infectious waste sharps  0.009 kg/bed-day - hazardous chemical/pharmaceutical waste. (UNEP, 2012) 6/13/2016 37
  38. 38. Hospital No Total bed HCW / ton HCWR (ton) Government, teaching including MoHP 92 6601 3080 905.54 Government hospital under other ministry 3 1036 Private hospital 157 9207 7192.49 2115.44 Private teaching hospital 14 8626 Mission hospital 8 612 246 72 Country hospital 274 26082 105119 3093 Source: MoHP Poster Presentation in first HCWM International Workshop, Nepal; 2012 Total health care facilities with bed and corresponding waste generation 6/13/2016 38
  39. 39. Contd… Assessment study at Civil Service Hospital(CSH), Kathmandu Waste generation - 64.58 kg per day, with occupancy rate of 55.65% (1.73 kg per bed per day). - Pre-separation scenario (71% is risk waste and 29% is non-risk). Post-separation scenario (25% risk and non- risk is around 29%) (CSH,2011). 6/13/2016 39
  40. 40. Production in Nepal Contd… Hospitals Average productio ns (kg/d) General (kg/d) Hazardou s (kg/d) Sharp (kg/d) Patan 594.0 kg 377 (63.5%) 165 (27.8%) 52 (8.8%) Koshi Zonal 441.14 kg 302 (68.4%) 125 (28.4%) 14 (3.1%) National kidney center 28 kg 14 (50%) , 5 (17%) 9 ( 33%) 6/13/2016 (JHNRC,vol 11,2013) Out of 24 health care institution, from only 3 HCI information available
  41. 41. • Enayetullah et al., (2011) stated average HCW generation in Pokhara city is est. - 1.22 kg/bed. - From outdoor facility is est. 0.34kg/day • From all HCF facilities (Pokhara) - 2.8 ton/day (22% HCWs is hazardous and infectious and the rest general waste. ) 6/13/2016 (JHNRC,vol 11,2013) Contd….
  42. 42. Sources of HCW a) Major sources of health-care waste Hospitals • University hospital • General hospital • District hospital 6/13/2016 42 (SBS,2004
  43. 43. Sources Contd.. b) Medium Sources Medical centers , OPD, Mortuary/ Autopsy center, Hospices, Abortions clinics, Medical laboratories, Medical research facilities, Animal hospital, Blood bank and transfusions vices etc. 6/13/2016 43(SBS,2004)
  44. 44. Sources Contd.. c) Small Sources General medical practitioners, Convalescent homes, Nursing and remedial homes, Medical consulting rooms, Dental practitioner, Animal boarding, Tattooists, Acupuncturist, Veterinary practitioner, Pharmacies, Cosmetic piercers etc. (SBS,2004) 6/13/2016 44
  45. 45. Possible Impact 6/13/2016 45 Sanitation worker Medical paramedical staff Patients and visitors surroundings environment
  46. 46. Route of infection Hazards Ingestion Inhalatio n Mucous membranes Skin cut injury 6/13/2016 46
  47. 47. A study done by Adhikari et al., showed that 53.5% had NSI , only 46.8% had reported to concerned authority, whereas all students were aware of the fact that HIV and HBV is transmitted through needle stick injuries 6/13/2016 47 Contd…
  48. 48. • One cross-sectional study in GMC-TH showed that 70.79% health care workers had experienced Needle Stick Injury (NSI) among them - 52.5% suffered from NSI with unused needles , - 47.5% NSI from used needles and - 68.42% of NSI sufferer of used needles reported the incident (NHCW guideline, 2014) . 6/13/2016 48 Contd…
  49. 49. A study on Incidence Of NSI among PCL Nursing Students In KTM, • 46.9 % had NSI, 44.7% experienced > 1 time. • Out of total 298 injuries- 67.8 % during medication, 41% while drawing medicine, 20% recapping the needle. (International Journal of Scientific & Technology Research,2013) 6/13/2016 49 Contd…
  50. 50. A study by Sorsa et al., 1985 in Finland found an excess of spontaneous abortions during pregnancy and malformations in children of females with a history of working with anticancer agents (WHO,2014). 6/13/2016 50 Contd…
  51. 51. Waste Hazards (e.g.) Infectious waste and sharps Infection like HIV, hepatitis, resistant to antibiotic Chemical and pharmaceutical Burn, injury , intoxication even death Genotoxic Secondary neoplasma, skin eye irritation Radioactive Headache, dizziness, vomiting Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste. 6/13/2016 51 Effects of HCW
  52. 52. 6/13/2016 52 Infection By HCW Contd…
  53. 53. 6/13/2016 53 Infection By HCW Contd… (WHO,1999)
  54. 54. Samples taken from different areas of Bir Hospital • The mercury level was found to be highest in the Dental OPD/Medical ward (3.78 μg/m3) • The mercury in water highest in the floor wash sample of the Dental Ward (0.045 mg/l) • The mercury concentration in soil sample (area near maintenance) - (2.72mg/kg) 6/13/2016 54 Interim report on HCWM,Bir Hospital, 2068 Contd…
  55. 55. Survival of pathogenic microorganisms in the environment The hepatitis B virus • Is very persistent in dry air. • can survive for up to 1 week - in discarded needle, antiseptics like 70% ethanol. • Viable for 10 hours at 60 °C. 6/13/2016 55
  56. 56. Survival of microorganism Contd.. HIV Virus . - Survives for no more than 15 min if exposed to 70% ethanol and only three to seven days at ambient(20°C) temperature. - It is inactivated at 56 °C. 6/13/2016 56
  57. 57. Overview In 2010, unsafe injections were still responsible for 33, 800 new HIV infections, 1.7 million hepatitis B infections and 315,000 hepatitis C infections (WHO,2014). 6/13/2016 57
  58. 58. 6/13/2016 58
  59. 59. 6/13/2016 59 Need Health care waste management?
  60. 60. Guiding Principles of HCWM • The “Polluer Pays” Principle • The “Precautionary” Principle - (adopted under the Rio Declaration on Environment and Development (UNEP, 1972) ) • The “Duty of Care” Principle • The “Proximity” Principle • The “Prior Informed Consent Principle” 6/13/2016 60
  61. 61. Steps for the Waste Management • Waste Minimization • Waste Segregation • Waste Collection and Storage • Waste Transportation • Waste Treatment and Disposal (Solid Waste Management Act, 2011 ) 6/13/2016 61
  62. 62. Waste Minimization • Waste minimization is defined as the prevention of waste production and or its reduction at a source. 6/13/2016 62
  63. 63. Waste Minimization Contd.. Waste minimization can be achieved through: • Avoidence • Reduction - Product Substitution - Product Changes - Procedural Changes • Re-Use • Recycling 6/13/2016 63
  64. 64. Waste Segregation • Waste segregation refers to the process of separation of waste at the point of generation and keeping them apart during handling, collection, interim storage and transportation. • Segregation of the waste at source is the key principle of successful and safe waste minimization and is the most important step for a successful management of HCW. 6/13/2016 64
  65. 65. Color Coding in Segregation Types of Waste WHO HCWG, 2014 Symbol Non-risk waste Biodegradables Black Green Non-risk waste Recyclable Dark blue Other non-risk HCW Light blue Pathological waste (Danger! Pathological waste Yellow with biohazard symbol. Red Hazardous Sharps Danger! contaminated sharps Do not open yellow with sharp Red 6/13/2016 65
  66. 66. Types of Waste WHO HCWG, 2014 Symbol Pharmaceuticals (cytotoxic) Danger! Hazardous Infectious waste Brown, With symbol Red Danger! Hazardous Infectious waste Brown Danger! Highly infectious waste . Yellow Brown Other hazardous waste Danger! To be discarded by au- thorized staff only 6/13/2016 66 Color Coding contd..
  67. 67. Segregation contd… Types of waste WHO HCWG, 2014 Symbol Radioactive Waste (Danger! Radioactive waste ) radiation symbol Black 6/13/2016 67
  68. 68. Color Coding (BMW) Colour Category Yellow 1,2,5,5 Red 3,4,7 ( earlier soiled water are in red) Blue 8 Black Municipal waste 6/13/2016 68
  69. 69. • The study conducted by MoHP help from WHO concluded that HCWM is poor and 38.7% hospitals adopted correct segregation of HCWs, HCW were disposed at Okharpauwa dumping site without any pre-treatment. (MoHP,2012) 6/13/2016 69
  70. 70. Waste Collection and Storage • In order to avoid accumulation of the waste, it must be collected and transported to a central storage area within the HCF on a regular basis before being treated or removed • This area must be marked with warning sign. 6/13/2016 70
  71. 71. Collection Contd.. • Bags should be fill not more than 3/4th • Label of ward • Types of waste • Symbol properly • Weight • Record register 6/13/2016 71
  72. 72. Storage Contd… • Waste security and restriction of access to authorized persons • Easy access for waste collection vehicle, water. • Protection from sun, rain, strong winds and floods. • Temperature - ( Cold area)– max- 72 hour(winter), 48 hour (summer) - Hot area max-48 hr(winter), 24 hr(summer) 6/13/2016 72
  73. 73. Storage Contd.. • Anatomical Waste - : 3° C to 8° C. • Infectious waste (if store > week) 3° C to 8° C • Cytotoxic waste store separately. • Radioactive waste should be stored in containers (lead shielding) with labeling. • Chemical waste 6/13/2016 73
  74. 74. Waste Transport • Suggested collection frequency on room to room basis is once every shift. • No bags should be removed unless they are labeled with their point of production. • The bags or containers should be replaced immediately with new ones of the same type. 6/13/2016 74
  75. 75. Transportation Contd.. Follow the guideline strictly in both: • On-site transport • Off-site transport 6/13/2016 75
  76. 76. 6/13/2016 76
  77. 77. Treatment and Disposal HCW can be treated and disposed through the following techniques: i) Biological procedure ii) Autoclave iii) Chemical disinfection iv) Encapsulation 6/13/2016 77 HCWM,Guideline, 2014
  78. 78. Treatment and Disposal Contd.. v) Sanitary landfill vi) Burial vii) Septic/concrete vault viii) Incineration ix) Inertization 6/13/2016 78
  79. 79. Biological Procedure • Biological process uses an enzyme mixture to decontaminate HCW. • The technology requires regulation of temperature, pH, enzyme level and other variables. • Composting falls in this category . 6/13/2016 79
  80. 80. Vermicomposting The possible option is the vermicomposting. In this process, the earthworm of species Eisnia foetida is used for the composting process. 6/13/2016 80 Biological Procedure Contd…
  81. 81. Biological Procedure Contd.. • The Chainpur sub health post has been generating bio-gas from placentas. • In Bir Hospital Infected gauze and cotton waste are disinfected using autoclaved then adopt the process of vermicomposting. Health care Foundation Nepal(HECAF),2071) 6/13/2016 81
  82. 82. Autoclave • Autoclave is a process of steam sterilization under pressure. • Autoclaves are commonly used for the treatment of highly infectious waste, such as microbial cultures or sharps, Large volume of blood. 6/13/2016 82
  83. 83. Autoclave Contd… For effective inactivation of vegetative micro- organisms, most bacterial spores in a small amount of waste 􏰂about 5-8 kg􏰂 - 60 minute cycle at 121°C (minimum) and 1 bar (100k.pa)(WHO, 1999). 6/13/2016 83
  84. 84. Autoclave Contd… The effectiveness depends on time, temperature, pressure, load size, stacking, configuration and packing density, types and integrity of bags or containers used, physical properties of the materials, amount of residual air and the moisture content in the waste (UNEP, 2012). 6/13/2016 84
  85. 85. Chemical Disinfection • Chemical disinfections are usually applied for the treatment of infectious and highly infectious HCW. • Aldehydes, chlorine compounds, phenolic compounds are added to HCW to kill or inactivate pathogens. • Preferred treatment for liquid infectious wastes, but can also be used in treating solid waste too. 6/13/2016 85
  86. 86. Chemical Disinfection Contd.. • Useful in treating blood, urine, stools and sewage. • Chemical systems use heated alkali to destroy tissues, organs, body parts and other anatomical waste . • Chemotherapy waste including bulk cytotoxic agents can be treated by chemical decomposition. 6/13/2016 86
  87. 87. Chemical Disinfection Contd… • Sodium Hypochlorite (5%) – 100ml/lit- for 24 hour (for Cytotoxic Waste) • Calcium Hypochlorite (70% chlorine) 7g/lit- • Alkaline hydrolysis -process that converts animal carcasses, human body parts and tissues into a decontaminated aqueous solution. - (Later the contents are heated to between 110 °C and 127 °C for 6-8 hours). 6/13/2016 87
  88. 88. Chemical Disinfection Contd… • Lime milk (calcium oxide) used in liquid wastes with high organic content (e.g. stool or vomit during a cholera outbreak) • lime milk in a ratio of 1:2,for 6 hours. Urine - 1:1 for 2 hours(Robert Koch Institute, 2003). • Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use. 6/13/2016 88
  89. 89. Encapsulation • Involves the filling of the containers with waste, adding an immobilizing material and sealing the container • When containers are three quarters filled with sharps, pharmaceuticals and chemical waste, an immobilizing agent poured on it. • It is particularly suitable for sharps and pharmaceutical waste. 6/13/2016 89
  90. 90. Encapsulation Contd… The following are typical proportions (by weight) for the mixture for encapsulation • 65% pharmaceutical waste • 15% lime • 15% cement • 5% water. (WHO,2014) 6/13/2016 90
  91. 91. Sanitary landfill • Sanitary landfill is an engineered method, designed and constructed to keep the waste isolated from the environment • It shouldn't contaminate the soil, surface, and ground water and should limit air pollution, smells and direct contact with public. 6/13/2016 91
  92. 92. Sanitary landfill Contd.. • Disposing of certain types of HCW (infectious waste and small quantities of pharmaceutical waste) is acceptable • 􏰂Should be at least 50 m away from water sources. 6/13/2016 92
  93. 93. Burial • Hazardous waste can be buried in a special pit. • Especially in remote locations, in temporary refugee encampments. • Pit should be 􏰂2-5m deep and 1-2􏰂m wide. • The bottom of the pit should be at least 2 m above the water level. 6/13/2016 93
  94. 94. Burial Contd… • In outbreak of an especially virulent infection (as Ebola virus),lime and soil cover may be added. • About 50m 􏰂􏰂meters a􏰂way from any 􏰂water body such as rivers or lakes􏰂. • After each waste load, it should be covered 􏰂with a 􏰂􏰂􏰂􏰂􏰂 10-30 cm thick soil layer.􏰂 6/13/2016 94
  95. 95. Burial Contd.. • 􏰂large quantities 􏰂higher than 􏰂1 kg􏰂 of chemical 􏰂pharmaceutical waste should not be buried. • When the level of the waste reaches 􏰂􏰂 to 30- 50 􏰂􏰂 cm to the surface of the ground, fill the pit 􏰂with dirt, seal 􏰂with concrete and dig another pit 6/13/2016 95
  96. 96. Septic / concrete vault • This method can be used for the disposal of used sharps and syringes • Dig a pit 1􏰂􏰂m x 1􏰂m x 􏰂􏰂􏰂1.8m depth􏰂 • The site must be isolated and at least 􏰂􏰂􏰂500 feet aw􏰂ay from the ground water sources • Deposit the collected safety boxes filled with used sharps and needles inside the septic/concrete vault 6/13/2016 96
  97. 97. Incineration • Incineration converts combustible materials into non-combustible residue or ash. • Incinerators can be oil,􏰂fired or electrically powered or a combination of both 6/13/2016 97
  98. 98. Incineration Contd… • Gases are ventilated through the incinerator stacks, and the residue or ash is disposed in a sanitary landfill • In case of cytotoxic drug- 1200 °C ( but prefer Autoclave) 6/13/2016 98
  99. 99. Incineration contd.. • When 􏰂incinerated at lo􏰂w temperatures or w􏰂 hen plastics that contain polyvinyl chloride 􏰂 PVC􏰂 are incinerated, dioxins, furans and toxic gases may be produced • This happens if 􏰂waste are incinerated at temperatures < 800°C or wastes are not completely incinerated􏰂 6/13/2016 99
  100. 100. Wastes that Should Never be Incinerated • Pressurized gas containers • 􏰂large amounts of reactive chemical 􏰂waste • 􏰂Radioactive waste • 􏰂Silver salts or radiographic waste • 􏰂Halogenated plastics 􏰂e􏰂g􏰂 PVC􏰂 • 􏰂Mercury or cadmium • 􏰂Ampoules of heavy metals 6/13/2016 100
  101. 101. Inertization • Inertization is usually suitable disposal method for the pharmaceuticals and incinerated ash 􏰀with heavy metal content (􏰂WHO,1999). 􏰂􏰂 􏰂􏰂􏰂 • HCW is mixed with cement􏰂􏰂􏰂, lime, cement and 􏰂􏰂water􏰂. • The formed mixture is allowed to set into cubes or pellets ,the waste must be grinded.6/13/2016 101
  102. 102. Treatment for Radioactive waste • “Decay in storage”, which is the safe storage of waste a general rule is to store the waste for at least 10 times the half-life of the longest lived radionuclide in the waste • Return to supplier • long-term storage at an authorized radioactive waste disposal site. 6/13/2016 102
  103. 103. Treatment of liquid waste/water • Liquid wastes including hazardous chemicals and laboratory wastes have not been addressed in almost all institutions􏰂 • HCFs like Western Regional Hospital, Bir Hospital, Civil Service Hospital, Manipal Teaching Hospital, Shahid Gangalal National Heart Centre and some other HCFs are practicing HCWM system. 6/13/2016 103
  104. 104. Contd… A study (Center for Public Health and Environmental Development (CEPHED), 2012) showed • 90.32% hospitals - not practice environment sound waste treatment. • 61.29% hospitals have very poor source separation • 80.65% hospitals not practise separate waste collection • 67.42% hospitals have very poor transportation. ( NHCWMG,2014) 6/13/2016 104
  105. 105. HCWM in Chitwan • Effective segregation of waste at source. • Used to transport and disposed by contractor. • Most hospital are using Incinerators/ burial method for needle/sharp waste management. • Planning to produce biogas from placenta, and leftover food( Already started in Pithuwa hospital) • Planning / under construction of waste water treatment plant 6/13/2016 105
  106. 106. 6/13/2016 106 HCWM Team
  107. 107. Past to Current Legislation for addressing Health Care Waste Management - The Constitution of Kingdom of Nepal, 1990 The state shall give priority to protection of the environment and also to the prevention of its further damage. 6/13/2016 107
  108. 108. Past to Current Legislation for addressing Health Care Waste Management • Solid Waste Management and Resource Mobilization Act, 1987 • The Town Development Act, 1988 • The Labor Act, 1991 • Industrial Enterprise Act, 1992 • The Environment Protection Act, 1997 • The Local Self- Governance Act, 1999 (fine anyone up to Rs. 15000.00 for haphazard dumping of solid waste.) 6/13/2016 108
  109. 109. Past to Current Legislation for addressing Health Care Waste Management • The three year Interim Plan of Nepal Government (2064/65- 2066/67) - mentioned the programs for Health Care Waste Management. • Interim Constitution of Nepal, (2063) 2007 (with amendment): right of healthy environment for all. 6/13/2016 109
  110. 110. Past to Current Legislation for addressing Health Care Waste Management • Health Care Waste Management Guidelines, (2008/9, DoHS) • Urban Environmental Management Guidelines, (2011) • Second Long Term Health Plan, 2054-74 (1997- 2017) • Solid Waste Management Act, (2011) (Fine of Rs 50, 000 to 100, 000 for the first time and the penalty will be double for the repetition 6/13/2016 110
  111. 111. Organization in HCWM • Center for Public Health and Environmental Development • Epidemiology and disease Control Division • Ministry of Environment • Ministry of Health and Population • Ministry of Science, Technology and Environment • United Nations Development Programme 1116/13/2016
  112. 112. Organization in HCWM Contd.. • United Nations Environment Programme • Ministry of Urban Development • Private Hospital Association • WHO • UN • Health Care Foundation Nepal 6/13/2016 112
  113. 113. Bir hospital in HCWM • Health Care Foundation Nepal (HECAF) has been working in the field of health care waste management since 1999 • when it installed the first non-burn medical waste management system in the National Kidney Centre • Waste is segregated at source and infectious materials are disinfected in an autoclave. 6/13/2016 113
  114. 114. Health and Safety Practices in HCWM • Infection Prevention • Personal hygiene and hand hygiene • Worker’s Protection/training • Protective clothing • Immunization • Injection safety / awaeness • Response to injury and exposure 6/13/2016 114
  115. 115. Conclusion Everyday large amount of HCW generate having different characteristic. To overcome from this need to proper manage of HCW as well as treatment of waste. 6/13/2016 115
  116. 116. Reference Ananth, P., Prashanthini, A., and Visvanathan, V.C., (2010). Healthcare waste management in Asia. Bir Hospital, (2011). Interim Report of Health Care Waste Management System In Bir Hospital, Kathmandu. WHO. CEPHED, (2012). Waste Management: Environmental Health Condition of Hospitals in Nepal CDC, (1988). Guideline for Handwashinng and Environmental Control. CSH, (2013) Health Care Waste Management Policy. Civil Service Hospital. Minbhawan, Kathmandu Enayetullah et al., (2011) Feasibility Study for the Establishment and Operation of Common/Central Treatment Facility (CTF) for Hospital in Pokhara City. Joshi,H.D., (2013). Health Care Waste Management Practice in Nepal. JNHRC. 6/13/2016 116
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