Hospital waste manish
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The document discusses hospital waste management. It defines healthcare waste and hazardous healthcare waste. Most healthcare waste poses similar risks as household waste, but used sharps and needles must be properly disposed of to prevent injury or disease spread. The document provides guidelines for safely disposing of different types of hazardous waste produced in hospitals, such as infectious waste, chemicals, pharmaceuticals, and radioactive materials. Priority should be given to properly disposing of used sharps and infectious waste.
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Hospital waste manish
- 2. Learning Objectives • Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority • Learn ways to minimise waste • Know the criteria for safe management of sharps 5: Managing Medical Waste Slide 2
- 3. Definitions of Waste Health care waste • All types of waste from all health care activities Hazardous health care waste • Waste that presents a health hazard of some kind • Note: Most health care waste is no more hazardous than household waste 5: Managing Medical Waste Slide 3
- 4. Types of Hazards to Consider • Flammable • Toxic - mutagenic, cytotoxic, teratogenic, etc • Reactive • Allergen, contact sensitiser • Explosive • Infectious • Radioactive • Corrosive • Caustic • Alcohol • Cancer chemotherapy, tar-based products • Sulphuric acid, chlorine powder • Glutaraldehyde • Picric acid, fertiliser, ammonia • TB cultures • Barium enema, X-rays • Bleach • Lye 5: Managing Medical Waste Slide 4
- 5. Hazardous Health Care Waste Infectious hazard: • Anatomic waste • Laboratory cultures • Sharps • Live viruses Corrosive, teratogenic, reproductive hazard: • Heavy metals • Pesticides • Cleaning products • Pressurised containers • Mercury • Cancer therapy 5: Managing Medical Waste Slide 5
- 6. Is Health Care Waste an Important Source of Infectious Disease? Yes! • IF needles and syringes are scavenged and re-used, then many diseases can be spread • Keep used sharps and syringes out of public access No! • Most medical waste does not have more germs than household waste • It causes visual pollution, generates fear, but unless re- use of sharps occurs, medical waste causes little disease 5: Managing Medical Waste Slide 6
- 7. Then Why does this Waste Matter? • Sharps injuries may harm workers and communities • Medical waste potentially impacts patients, workers, community, and economy because of the volume and permanence of waste 5: Managing Medical Waste Slide 7
- 8. . Health care waste may: • Contain infectious organisms, including drug resistant ones • Place cancer causing agents into air or ground water • Cause radiation-related illnesses • Contribute to global warming harm atmosphere (CFC containing refrigerant gas) • Cause injury (sharps, explosion) • Cause congenital defects or stillbirth, prematurity, infertility 5: Managing Medical Waste Slide 8
- 9. Which Waste to Address First? • IC Committees should START with infectious waste, especially used sharps and microbiological culture waste 5: Managing Medical Waste Slide 9
- 10. How to Safely Dispose of Infectious Sharps • Do not recap sharps before disposal • Dispose of sharps at the point of use in a leak proof puncture proof container • Avoid handling, emptying or transferring used sharps between containers • Autoclave highly infectious waste before disposal • Control public access to syringes and medical equipment • Shred, encapsulate and bury according to national legislation 5: Managing Medical Waste Slide 10
- 11. For Non-Infectious Hazardous Waste, the Risks Depend on: • Severity of acute or chronic exposure – Duration of exposure – Frequency of exposure – Concentration agent (1% versus 50%) – Individual vulnerability including pregnancy, weight – Route of exposure (skin, respiratory, oral, etc.) – Steps taken to protect (PPE, relieved from immediate contact etc.)5: Managing Medical Waste Slide 11
- 12. Who is at Risk? • Doctors - anesthesiologists, pathologists • Nurses - oncology nurses, OT, ER • Hospital support staff - X-ray assistants, pharmacy, morgue, and lab staff • Cleaning staff - those cleaning sewage lines • General public - those using sharps found in the waste 5: Managing Medical Waste Slide 12
- 13. Common Hazards • Anesthetic gases • Glutaraldehyde • Formaldehyde/formalin • Cancer therapeutic agents • Ethylene Oxide • Radiation • Asbestos • Blood contaminated sharps • Bleach • Solvents (xylene, toluene, acetone, ethanol) • Pesticides, fungicides • Heavy metals (mercury, chronium, cobalt, cadmium, arsenic, lead) • Latex • Strychnine and cyanide 5: Managing Medical Waste Slide 13
- 14. Steps to Manage Hazardous Wastes before Disposal1. Know what hazards you have 2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists 5: Managing Medical Waste Slide 14 **Use mercury-free thermometers
- 15. Steps to Manage Hazardous Wastes (cont’d) 3. Limit use and access to trained persons with personal protective gear 5: Managing Medical Waste Slide 15
- 16. Use Engineering Controls such as Ventilation, Hoods for Select Hazards 5: Managing Medical Waste Slide 16
- 17. Get Rid of Unnecessary Stuff • Don’t accumulate unneeded products • Don’t let peroxides and oxidising agents turn into bombs 5: Managing Medical Waste Slide 17 Photo of bomb robot called into hospital to dispose of picric acid.
- 18. Label with Agent, Concentration and Hazard Warnings • Examples of hazard labels: 5: Managing Medical Waste Slide 18
- 19. Communicate about Workplace Hazards • Job description • Posters on doors • Labels on hazards • Give feedback on use of PPE and disposal in evaluation • Role model safe use and disposal • Contact point who is responsible 5: Managing Medical Waste Slide 19
- 20. Recycle Products When Possible 5: Managing Medical Waste Slide 20
- 21. 5: Managing Medical Waste Slide 21
- 22. Segregate Hazards at the Source • Separate sharps and infectious waste where they are used – This prevents injuries that can occur when people sort the trash after it is disposed • Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members 5: Managing Medical Waste Slide 22
- 23. Have Written Policies on Waste Disposal • Sharps and infectious waste • Chemotherapy (cancer) • Heavy metals (batteries) • Chemicals Post brief, colorful instructions on walls to remind workers 5: Managing Medical Waste Slide 23
- 24. . Minimise the Handling of Wastes • Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly 5: Managing Medical Waste Slide 24
- 25. 12. Conduct Walk-Around Interviews • Ask about the hazardous substances staff work with, how they dispose of them, and what they need to be able to dispose of them properly • Have a no-blame philosophy that strives to solve problems, NOT to assign blame 5: Managing Medical Waste Slide 25
- 26. . • Waste management methods 5: Managing Medical Waste Slide 26
- 27. Options for Specific Types of Waste • Pharmaceutical • Cytotoxic • Other chemical wastes • Heavy metals • Pressurised containers • Radiation • Infectious 5: Managing Medical Waste Slide 27
- 28. Pharmaceutical Waste Small amounts: • Disperse in landfill sites, encapsulate or bury on site • Discharge to sewer • Incinerate Large amounts • Incinerate at high temperatures or encapsulate • LANDFILL IS NOT RECOMMENDED 5: Managing Medical Waste Slide 28
- 29. Cytotoxic Waste • NEVER LANDFILL or DISPOSE TO SEWER Disposal Options: • Return to supplier • Incinerate at high temperature • Chemical degradation 5: Managing Medical Waste Slide 29
- 30. Chemical Waste - Further Recommendations • Keep different hazardous chemicals separate • Do not dispose into the sewers or street • Do not encapsulate large amounts of disinfectants as they are corrosive and flammable • Do not bury large amounts of chemicals 5: Managing Medical Waste Slide 30
- 31. Wastes with Heavy Metals • Wastes with mercury, cadmium, lead, arsenic, strychnine, are poisonous (e.g., thermometers, batteries, lead paints, dyes) • Never incinerate or burn • Never dispose of in municipal landfills Best solution: Avoid purchase OR • Recycle in specialised cottage industry or export to countries with specialised facilities • Encapsulation 5: Managing Medical Waste Slide 31
- 32. Pressurised Gas Containers • NEVER INCINERATE • Return undamaged gas cylinders and cartridges to the manufacturer for reuse • Damaged containers: empty completely and crush, landfill 5: Managing Medical Waste Slide 32
- 33. Radioactive Waste Use requires a national strategy including: • Appropriate legislation • A competent regulatory organisation • Trained radiation protection officer to monitor exposures • Return to the manufacturer Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme 5: Managing Medical Waste Slide 33
- 34. Simple Chemical Disinfection • Requires shredding of waste • May introduce strong chemicals into the environment (chorine bleach turns into dioxin when burned) • Efficiency varies • Only the surface is disinfected • Does not disinfect human tissue • Special disposal required to avoid pollution 5: Managing Medical Waste Slide 34
- 35. Waste Disposal Options Include • Disinfection – Autoclaving/ Microwaving, treatment, shredding • Land Disposal • Burial • Encapsulation • Incineration • Inertisation • Managed Land-fill • On-site disposal 5: Managing Medical Waste Slide 35
- 36. Infectious Waste: Autoclaving • Pressure and temperature • Holding time • Sterility indicators • Type of waste • Followed by shredding / burial / recycled 5: Managing Medical Waste Slide 36
- 37. Commercial Disinfection Systems Shred waste, treat chemically, encapsulate Possible advantages: • Encapsulated residue can be placed in landfill • Environmentally friendly • Easy to operate Possible disadvantages: • Requires specialised operators • May be expensive 5: Managing Medical Waste Slide 37
- 38. Burying Inside Hospital Premises Apply the following rules: • Access to the site restricted and controlled If waste is retained on site, ensure rapid burial to isolate from animal or human contact • Only hazardous HC Waste to be buried Management controls on what is dumped • Each deposit covered with soil • Site lined with low permeable material-concrete • Groundwater pollution must be avoided Not recommended for untreated hazardous waste 5: Managing Medical Waste Slide 38
- 39. Disposal to Land by Encapsulation • Fill metal or plastic containers to 3/4, add: – plastic foam – bituminous sand – cement mortar – clay material • When dry, label and seal containers and landfill • May be used for sharps, chemicals, drugs etc. 5: Managing Medical Waste Slide 39
- 40. Incineration Combustible waste turned to ash at temps >800 C • Reduces volume and weight • Residues are transferred to final disposal site • Treatment efficiency depends on incineration temperature and type of incinerator • Not all wastes can be incinerated • Costs vary greatly according to type of incinerator • Produces combustion gases 5: Managing Medical Waste Slide 40
- 41. Do not Incinerate Do not incinerate the following: • Plastics especially halogenated plastics (e.g. PVC) • Pressurised gas containers • Large amounts of reactive chemical waste • Radioactive waste • Silver salts or radiographic waste • Mercury or cadmium • Ampoules of heavy metals 5: Managing Medical Waste Slide 41
- 42. Advantages of Incineration of HC Waste: • Good disinfection efficiency • Drastic reduction of weight and volume • Good for chemical + pharmaceutical waste 5: Managing Medical Waste Slide 42
- 43. Land-fill in Municipal Landfills If hazardous health-care waste cannot be treated or disposed elsewhere: • Designate a site for hazardous HC Waste • Limit access to this place • Bury the waste rapidly to avoid human or animal contact • Investigate more suitable treatment methods 5: Managing Medical Waste Slide 43
- 44. Because no Disposal Method is Easy or Completely Safe… Prevention is best! • Eliminate purchase by buying safer alternatives • Recycle • Use smallest quantities possible, use with engineering controls and Personal Protective Equipment • Segregate hazards into separate waste streams at source • Supervise disposal using best available ecologic option 5: Managing Medical Waste Slide 44
- 45. More Free References • http://www.healthcarewaste.org, Health Care Waste Management at a Glance • “First, do no harm.” WHO/V&B/02.26 – Available at www.healthcarewaste.org/linked/onlinedocs/4-bd-704 . Contains information about the disposal options for sharps 5: Managing Medical Waste Slide 45
Editor's Notes
- Can you give additional examples? Are there other types of hazards?
- Waste generated per day ranges from 0.2 kg to 10 kg
- Note to facilitators: Refer participants to Handout 5.1 How to Dispose of Infectious Sharps in the Participant’s Manual Minimise unnecessary injections to reduce the number of sharps. Most injections are unnecessary! Do not recap sharps before disposal. Dispose of sharps at the point of use in a leak proof puncture proof container for sharps only. Avoid handling, emptying or transferring used sharps between containers since needlestick occur then. Autoclave highly infectious waste such as lab cultures from laboratories before disposal. Control public access to syringes and medical equipment to prevent re-use. Shred, encapsulate and bury according to national legislation.
- 1. The first step is to know what hazards you have. Keep an inventory, perhaps though the purchasing office who can track what comes in. They will need assistance. 2. Don’t purchase hazards when alternatives exist. When a new thermometer is purchased, purchase an alcohol or digital thermometer.
- Who is responsible at your work place regarding hazards? Has this role been assigned?
- Examples of labels for plastic: Type 1 and 2 are commonly recycleable. Other symbols: nickel cadmium batteries, paper, food and organic waste for gardening, CFC labels for refrigerant gas. Type 1 - PETE Polyethylene Terephthalate (PET) Soda & water containers, some waterproof packaging. Type 2 - HDPE High-Density Polyethylene Some syringes, Milk, detergent & oil bottles. Toys and plastic bags. Type 3 - V Vinyl/Polyvinyl Chloride (PVC) Some syringes. food wrap, vegetable oil bottles, blister packages. Type 4 - LDPE Low-Density Polyethylene Many plastic bags. Shrink wrap, garment bags. Type 5 - PP Polypropylene Refrigerated containers, some bags, most bottle tops, some carpets, some food wrap. Type 6 - PS Polystyrene Throwaway utensils, meat packing, protective packing. Type 7 - OTHER Usually layered or mixed plastic. No recycling potential - must be landfilled.
- Once the waste Is separated (i.e. sharps), staff should not go through the waste by hand to remove things. Staff should not combine sacks of waste that have been separated.
- Questions for discussion: What are alternatives to incineration for disposal of infectious waste? Are any of these solutions economically viable? If not, what recommendations would you have?