hospital design

1. Hospital Waste
Management
by/
Mahmoud shakria
Outlines:-
- Introduction
- Definitions of waste and hospital waste
- Classificationof hazards waste
- Importance of safe waste management
- Sources of healthcare wastes
- HealthHazards of health-care waste
- Treatment and disposal technology for wastes
- Strategy AdoptedFor Hospital waste Management
- Dos and DONTs of Health Care Waste

2. INTRODUCTION
Hospitals generated large volume wastes as a by-product of a variety health
services and procedure carried out such as surgery, dressing of wounds, dialysis,
deliveries, laboratory and dental procedures, etc.
Such a waste may be infectious or non-infectious. If such waste is not properly
collected, transported and disposed off, it not only results in causation of
hospital acquired infection( Nosocomial infections) but also poses a major public
health hazard by causing pollution of air, water and soil.
Persons who are constantly exposed to these wastes especially waste-sharps,
are nurses, rag pickers cleaners, laundry staff, etc . who are always risk of getting
fatal disease like Hepatitis B, C, and HIV through injuries by contaminated
needles and sharps as an occupational hazard. Also indiscriminate dumping
‫اإلغراا‬‫العشرااي‬ of the hospital wastes into backyards ‫السرحاح‬‫الخلفير‬‫للمنرحل‬ or into
open municipal pits ‫افرا‬‫البلدير‬ , become breeding places for diseases (mosquitoes,
flies, rodents and microbes .(
Epidemics can result from the contamination of drinking water and food
sources with these infectious wastes, which are washed by rains. open burning of
infectious wastes, especially plastic will result in emission ‫انبعحث‬ of noxious gasses,
which may produce CA. Further, there is scope of re-use of syringes, needles,
polythene bags, catheters, etc .
Definitions of waste andhospital waste:
Waste: Everything is made for a defined purpose. “ Anything which is not
intended further use termed as waste.”
Any waste generated by out of hospitals can be said to be “hospital waste”.
Any waste generated by consequent to health care activity including those at
home is “Health Care Waste.”

3. Classificationof hazards waste
1. Infectious waste(suspect to contain pathogen)e.g. Lab culture, waste from I.W,
tissue swab, etc.
2. Pathological waste: (containing human tissue or fluid)e.g. Body parts , blood
and other fluids, etc
3. Sharps(sharp materials)
4. Pharmaceutical waste(containing pharmaceutical
5. Geno-toxic waste, e.g. containing cyto-toxic dugs ‫األداير‬‫السرحم‬‫للخاليرح‬ , geno-toxic
chemicals ‫المااد‬‫الكيميحيي‬‫السحم‬‫الجيني‬ .
6. Chemical waste, e.g. lab. Reagent‫,الكحشف‬ film developer
7. Waste with heavy metal- broken thermometer
8. Pressurized containers-aerosol cans, gas cylinder
9.Radioactive material - unused liquid from radiotherapy, excreta from pt.
treated with unsealed radio-nucleotide.
Safe Waste Management PracticesHelps (Importance of safe waste
management):
To reduce the infectious/hazards nature of waste.
To reduce Volume of the waste.
To prevent misuse or abuse of waste.
To ensure occupational safety and health.
To recycle the wastes so that it can be serve as another utility item.
To maintain order and cleanliness in the hospital.
To maintain a healthy environment for pts, staff,and public.
To prevent spread of infectious diseases.
To project good impression of the management.
To attract more clientele.
To Generate revenue ‫ليحدة‬‫الدخ‬ for the institution.

4. Sources of healthcare wastes:
Governmental Hospital and private hospital.
Nursing home care.
Physician’s and Dentist’s clinics.
Dispensaries ‫مستاصفح‬ .
Medical research and training instruments.
Mortuaries
Blood banks
Lab's
Vaccine center, etc
HealthHazards of health-care waste:
Exposure of health-care waste can result in disease or injury due to one or more
of the following factors:
It contain infectious agent,
It contain toxic or chemical hazards,
It contain sharps,
It is radioactive.
All individual who exposed to such hazards material are potentially at risks,
including who generate the waste or who handle the waste:
The main groups who exposed:
1. Dr. and nurse, hospital maintenance personnel,
2. Pts. in health-care establishment,
3. Workers who facilities waste disposal
4. Visitors

5. Treatment and disposal technology for wastes:
A. Incineration ‫الحرق‬ , method of choice for most hazardous waste. But, recently
alternative method becoming popular.
- Incineration: is a high temp.(1000 o C)dry oxidation process, that reduces
organic and combustible waste ‫ماراا‬ to inorganic incombustible matter
results in significant reduction of waste vol. and wt(85-95). This process of
burning is usually select to treat waste that cannot be recycled, reused.
Incineration require no pre-treatment.
Waste types not to be Incinerated:
Pressurized gas containers,
Large amount of reactive chemical wastes,
Photographic and radioactive wastes,
Halogenated plastic such as PVC,
Waste with high Hg ‫ليبق‬ or cadmium content such as broken thermometer, used
batteries, etc,
Sealed ampoules ‫مسداد‬ or ampoules with heavy metals.
B. Chemical Disinfection ‫التطهيا‬‫الكيميحي‬ (CD) Chemical are added to waste to kill
or inactivate pathogens, its contains, disinfection rather than sterilization.
CD suitable liquid for wastes, e.g. Blood , urine, stool, etc. C. Microwave
irradiation: Water contained within waste is rapidly heated by microwaves
and infectious components are destroyed by heat conduction.
C. Land Disposal Municipal‫البلدية‬ disposal sites:
Two type –open and sanitary landfills.
Health care waste should not be deposited on and around open dumps.
- Sanitary landfill is the choice because:-
1. geographic isolation of waste,
2. Appropriate engineering preparation,
3. Staff present on the site to control operation and
4. organized deposit and daily coverage .
E. Wet and dry thermal treatment: Wet technology: Infectious to high temp.
and high pressure stream.
Screw feed technology: Non-burn, dry thermal disinfection process in which
waste is reduced by 80% in vol. and by 20-25% in wt.

6. F. Inertization : Mixing waste with cement and other substance before disposal
in order to minimize risk of toxic substances in waste to migrate in surface or
ground water.. Proportion of mixing: 65% cement, 15% lime and 5% water .
H. Categories waste: as per these rule, there are 10 categories of biomedical
waste:
Option Waste category
Cat.-1 Human anatomical waste.
Cat.-2 Animal waste-animal tissues, etc. including waste generated in vet. Hosp.
college, discharge from animal house.
Cat.-3 Microbiology and biotechnology waste.
Cat-4 Waste sharps(used and unused-needle ,
Cat. -5 Discarded medicine and cytotoxic drugs Cat.
Cat.-6 Soiled waste-contaminated with blood and body fluid-swab, dressing,
plasters, etc.
Cat-7 Solid waste-catheters, IV set, bl.bag etc.
Cat-8 Liquid waste-waste generated from lab.
Cat-9 Incineration ash.
Cat-10 Chemicals Waste wastes of disinfectants insecticides, etc.
Color coding Type of container Treatment Yellow Plastic bag Incineration /deep
burial Red Disinfected container Autoclaving/Micro /Plastic bag /chemical
Blue/White Plastic bag/ As above/destruction Puncture proof container Black
Plastic bag Disposal in secured land fill
Strategy AdoptedFor Hospital waste Management:
Waste reduction strategy.
Waste assessment strategy.
Waste recycling strategy.
Hospital waste disposal.

7. Waste reduction strategy: Objectives Reducing Waste quantity by a significant %.
Decreasing waste disposal efforts and expense. Recycling all paper and cardboard
waste Enhance hospital’s reputation in community
Waste assessment strategy: Waste assessment indicates type and amount of
waste generated in the hospital .
Hospital Waste Disposal: This is the critical part total hospital waste management,
because any failure in this aspect hazards consequence GOH has prescribed certain
procedure and guidelines as follow:
1. Collection of wastes
2. Source segregation
3. Transportation
4. Storage
5. Treatment
Dos and DONTs of Health Care Waste:
DOs
Segregate all waste at the point where they generate
Have at least 4 types of container in each area of generation
- One to collect kitchen garbage ‫قمحم‬
- Second to collect infected waste
- Third to collect all type of waste sharp
- Forth waste paper, wrapper, etc.
- Do designate a separate place to keep mop, etc.
DON’Ts
Do not consider any type of health waste in a causal manner
Do not through any type of health care waste into street bins
Do not encourage reuse of the disposables
Do not attempt to recycle and/or dispose without ensuring adequate
decontamination
Do not incinerate all kinds of waste.