Waste management

July 27, 2014 Capital Hospital 1
Capital Hospital
Islamabad

Dr. Asif Tauseef
Dr. Rizwan Elahi Chohan
A Freelance
Sensitization Program

Healthcare waste
(infectious and toxic agents)
a grave threat to human
health and environment if
not disposed off properly
can result in outbreak of
deadly diseases like AIDS,
cancer and hepatitis
Food for thought

Ray of
hope
 Unluckily, proper hospital
waste management is almost
non- existent in the country.
 In private sector hospital
waste management program:
Shalamar Hospital Lahore
United Christian Hospital Lahore
 An integrated network of 80
healthcare facilities is linked
with this system.

Objective
s
 Raising awareness of the participants towards
seriousness and urgency of the issue,
 Imparting basic knowledge about:
 Types & magnitude of hospital waste,
 Risks associated with hospital waste,
 Healthcare waste management planning,
 Waste minimization, recycling and reuse,
 Handling, storage & transportation of HCW,
 HWM treatment options and facilities,
 Application of treatment & disposal of HCW,
 Linkages & coordination required to sustain
a HWM system,

“Hospital waste management (HWM)
means the management of waste
produced by hospitals using such
techniques that will help to check the
spread of diseases through it by
disposing off its waste through scientific
means.”
Definition

 Waste management is a major
problem on the globe,
 Pakistan is also facing this
problem.
 Around 2.5 million tons of
medical waste is annually
produced from all sorts of health
care facilities in the country,
having bad effect on the
environment by contaminating
our land, air and water resources.
Overview

 In Pakistan, hospital wastes are simply
mixed with the municipal waste in
collecting bins at roadsides for their
disposal.
 No systemic measures are taken for the
proper management of hospital waste.
Improper disposal of
HCW

 According to a report, the rate of
generation of healthcare waste in Punjab is
1.8 KG/ day/ bed.
 The province houses 250 hospitals with a
total capacity of 41,000 beds.
In
Punjab…

Two major categories of healthcare waste:
 Non- risk or non- hazardous waste- 85%
includes paper and cardboard, packaging,
food waste and aerosols, comparable to
normal domestic garbage, presents no
greater risk,
 Risk or hazardous waste- 15%
comprises of infectious waste, pathological
waste, sharps, pharmaceutical waste,
genotoxic waste, chemical waste and
radioactive waste,
Types of HCW

This includes:
 Cultures from laboratory work,
 Waste from surgery and autopsies,
 Waste from infected patients,
 Waste from infected hemodialysis
patients,
 Infected animals from laboratories,
 Any material having been in contact
with patients,
Infectious
waste

This includes:
 Tissues,
 Organs,
 Body parts,
 Fetuses,
 Blood and body fluids,
 Lab culture,
Pathological
waste

 Needles,
 Syringes,
 Scalpels,
 Infusion sets,
 Saws & knives,
 Blades,
 Broken glass,
 Any other items that could cut or puncture,
Contaminated
Sharps

This includes:
 Expired or unused
pharmaceutical products,
 Spilled or contaminated pharmaceutical
products,
 Surplus drugs, vaccines or sera,
 Discarded items used in the handling of
pharmaceuticals, e.g. bottles, boxes,
gloves, masks, tubes or vials,
Pharmaceutical
waste

 Cytotoxic drugs & outdated material
causing mutagenic and teratogenic
effects, like Daunomycin, Chlorambucil,
Cyclophosphamide etc,
 Vomitus, feces or urine from patients
treated with cytotoxic drugs.
 Contaminated used material from
preparation & administration of drugs
such as syringes, vials and ampoules
etc,
Genotoxic
waste

 X-ray developing,
 Chemotherapy,
 Anaesthesia,
 Sterilization,
 Laboratory solvents & Chemicals,
 Broken mercury containing equipment,
 Cadmium waste, mainly from discarded
batteries,
Chemical waste

Liquid, solid & gaseous wastes contaminated
with radio-nucleotides are generated from:
 In vitro analysis of body tissue/ fluids,
 In vivo body organ imaging and tumor
localization,
 Investigations/ therapeutic
procedures regarding human
Body organs and systems,
Radioactive
waste

Radio-isotopes decay by emitting radiations
eventually become inert (non-radioactive)
Thus
Containers of radioactive wastes are isolated
in temporary collection areas with minimum
exposure to individuals until the waste has
decayed to the point that it can be disposed
of in a designated labeled container.
What
happens…

Hospital waste
stream

These may be through:
 A puncture, abrasion or cut in the skin,
 The mucus membranes,
 Direct inhalation,
 Oral ingestion,
Health impacts of
HCW

 Reuse of disposable syringes is a common
practice in Pakistan. People pick up used
syringes from the hospital waste and sell
them, leading to spread of diseases,
 The hospital staff should dispose the
syringes off properly by cutting the needles
of the syringes with the cutter to prevent their
reuse,
A common
practice

 Doctors & nurses,
 Patients,
 Hospital support staff,
 Waste collection and
disposal staff,
 General public,
Who is at
risk?

 Breeding flies from rotting garbage,
 Mosquitoes,
 Dogs, cats and rats mostly living in or
around the refuse,
Who transmits
disease

Potential health effects of hazardous waste
are:
 Hepatitis B & C,
 AIDS,
 Gastro- enteric infections,
 Respiratory infections,
 Blood stream infections,
 Skin infections,
 Radioactive effects,
 Intoxication,
Public Health risks of
HCW

Serious concern about infection with
HIV & hep. B and C in sanitary workers
strong evidence of transmission, while
dealing healthcare risk waste,
 The virus is transmitted through reuse of
contaminated syringes,
 Shared use of disposable syringes by
drug addicts,
HCW & communicable
diseases

Appropriate measures should be taken for
proper segregation, collection and disposal
of healthcare waste through:
 Suitable training,
 Clear standards,
 Tough enforcement,
What is the
solution?

Waste Management
Plan

 Non- risk waste: 85%
Dumped in suitable black container or
a container lined with black plastic
bag, and marked “NON- RISK WASTE.”
 Risk waste: 15%
Dumped in suitable yellow container or
a container lined with yellow plastic
bag, and marked “DANGER! RISK WASTE.”
Identificati
on

Waste Management includes:
 Waste minimization and re-use,
 Waste segregation,
 Waste collection,
 Waste transportation,
 Waste storage,
 Waste disposal,
Waste
Management

Waste minimization includes any source
reduction or recycling activity by the waste
generator to reduce:
the quantity, or
the toxicity of the hazardous waste,
thus minimizing present & future threats to
human health and its environment.
Waste
minimization

 Risk waste should be separated from non-
risk waste at source, i.e. ward bedside,
operating theatre, laboratory etc,
 All disposable supplies like syringes,
needles, drips and infusion bags should be
cut or broken, rendering them non-reusable
at source,
 Sharps including the cut or broken syringes
and needles should be placed in high
density plastic containers resistant to
penetration or leakage,
Waste
segregation

 All sanitary staff and sweepers
should, when handling waste,
wear face masks, aprons, boots
and heavy duty gloves,
 Waste should be collected at
least daily, but more often if
necessary,
 All bags must be appropriately
labeled,
 All the removed bags are
immediately replaced with the
new ones of the same type,
Waste
collection

 Infectious waste must be contained in double
disposable plastic bags that are impervious to
moisture.
 The bags must be strong enough to prevent
ripping, tearing or bursting during normal use and
handling.
 All disposal bags must be yellow and
conspicuously labeled "Infectious Waste" or
"Biohazard" with the international symbol.
Waste
marking

 Sealed plastic bags should be carefully
loaded by hand onto the trolley,
 Yellow bagged risk waste and black
bagged non- risk waste should be collected
on separate trolleys painted in their
corresponding colors,
 The collected waste should not be left even
temporarily anywhere other than at the
designated central storage facility,
 The transportation of waste is properly
documented,
Waste
transportation

A central storage facility for risk waste:
 Be located within the hospital premises
close to the incinerator,
 Be large enough to contain all the risk
waste produced by the hospital,
 No material other than yellow bagged
waste should be stored there.
 No waste should be stored at the
central storage facility for more than 24
hours,
Waste
storage

Various garbage treatment techniques
available are:
 Steam autoclaving,
 Chemical treatment,
 Microwave radiation,
 Infrared radiation/ Gamma radiation,
 Incinerators,
 Deep burial or Landfill,
HCW treatment
techniques

It is a most widely used technique and is most
efficient alternative medical waste treatment
technology. This jointly operates with a shredder
and a compactor to reduce waste volume. The
effects of heat from saturated steam and
increased pressure decontaminate medical waste
by inactivating and destroying microorganisms.
Steam
autoclaving

An anti- microbial chemical such as sodium
hypochlorite, chlorine dioxide or peracetic
acid decontaminates the medical waste at
ambient temperature.
Chemical
treatment

Micro waving is an expensive system.
Medical waste enters this system by batch
or continuous mode where it is wetted with
steam or water followed by irradiation to
decontaminating temperatures.
Microwave
radiation

Pathological waste, i.e. body parts, organs,
fetuses, research animals etc. should be
disposed off either by crematoria (burning of
the body), or deep burial.
Pathological waste
disposal

 Incineration of solid medical waste can
significantly reduce the quantity of waste
that must be disposed in landfills,
It should only be used when the
incinerator units are in good working
condition, are retrofitted with pollution
control devices, and are properly operated
and maintained.
 When waste containing plastic is burnt,
Dioxin is produced which can cause
cancer, birth defects, hearing deficits, and
behavioral alterations in infants.
Incinerati
on

General Features:
 It should be housed in a building to
protect it from rain,
 Has two chambers, i.e. primary (800C) &
secondary (1200C for 2 seconds),
 Average stack height is 40 feet, or 10 feet
higher than the nearest building,
 Should be specifically designed to destroy
all types of medical waste,
Incinerato
r

A modal
incinerator
A complete system often includes a waste
heat boiler for energy recovery, followed by
an air pollution control system to remove acid
gas.

 Landfills should be located at sites with
minimal risk of pollution of ground water and
rivers,
 Access to the site should be restricted to
authorized personnel only,
 Risk waste should be buried in a separate
area of landfill under a layer of earth,
 The landfill should be regularly monitored
for groundwater contamination and air
pollution,
Landfill
s

 Yellow-bagged waste should be inactivated or
rendered safe before final disposal. Finally it
should be disposed off by burning in an
incinerator or by burial in a landfill,
 All risk-waste delivered to an incinerator should
be burned within 24 hours,
 Ash/ residue from incinerator should be sent to
designated landfill site,
 Radioactive waste should either be buried in a
landfill or incinerated after proper decay,
 Sharps should be disposed off by encapsulation
or any other method of disposal,
Waste disposal

 Prevent or minimize,
 Re-use or recycle,
 Incinerate with heat recovery,
 Use alternative to incineration,
 Landfill the residues,
Waste hierarchy

Infectious waste is to be disposed of in four
ways:
 Incineration in a controlled-air, multi-
chambered incinerator that provides
complete combustion,
 Burial in a Class I or Class II disposal site as
regulated by the state,
 Discharge to a sewage system if the
waste is liquid or semi-liquid, and
 Sterilization in a steam sterilizer.
Disposal
plan

 Disposal of liquid medical waste like blood and
body fluids, ground pathological tissues, dialysate,
and some laboratory fluids in sewer systems should
only be followed when the sewage is treated at a
treatment facility to render the waste non-infectious.
 Contaminated sharps are landfilled or
incinerated. These sharps are not compacted prior
to landfilling as the waste often contains residual
fluids.
 Landfilling is used for the final disposal of many
types of solid medical waste, including treated
glassware, containerized sharps, boxed animal
carcasses, packaged blood-soaked materials,
incinerator ash, and treated, boxed cultures and
stocks.
Remember
…

“Every hospital shall stand responsible
for the proper management of the waste
generated by it till its final disposal in
accordance with the provisions of the
Healthcare Waste Management
Guidelines.”
Responsibility of waste
management

Keeping your Hospital
&
is
in our own hands

 Wash hands and other body parts
thoroughly with soap & water which have
been contaminated with blood or other
body fluids,
 Cover all open wounds & lesions on hands
and arms with a waterproof dressing,
 Wear mask while handling a patient for
your own safety,
 Wear good quality, durable gloves, and
dispose them off after use,
Preventing
risks…
Contd.

 If gloves are not disposable, they should
be properly sterilized before reuse,
 Heavy duty gloves should be used when
working with sharps to avoid accidental
injuries,
 Disposable syringes should be used for
injections and drawing samples of blood,
 Proper disposal of he syringes should be
carried out,
 Needle should neither be recapped nor
removed from the syringe,
Preventing
risks…

Our hospital incinerator
facility
 Unit was installed in
early eighties,
 Effectively meeting
hospital’s healthcare
waste disposal needs
to a larger extent.

Hospital
incinerator
Made in Hungary

Incinerator
kiln

Garbage at
random

Waste collection in
hospital

Birds hovering on waste
bin

Our future at
stake
Deadly
Waste Bins

Oh God, protect us from deadly
diseases

Good waste management in hospital depends
on:
 A dedicated waste management team,
 Good administration,
 Careful planning,
 Sound organization,
 Underpinning legislation,
 Adequate financing,
 Full participation by trained staff,
Healthcare waste
management

 Create an awareness among
healthcare providers regarding
hazards of hospital waste,
 Constitute a team for HCW
management,
 Ensure appropriate handling,
collection and disposal of
waste, both non- risk & risk,
 Monitor periodically,
Doctor’s
responsibilities

Save Environment!

Waste management

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