Zamokuhle orientation sept 2014

ORIENTATION TRAINING FOR ISIKHOVA
CONTAINERS – HEALTH CARE RISK WASTE
HANDLING
Isikhova Kelniksher Trading cc (Zamokuhle) 1

ZAMOKUHLE PRIVATE HOSPITAL
ORIENTATION TRAINING
 1. Key Outcome :
 The main objective of this session is to inform
participants of waste classifications and the different
containers to be used for Health Care Risk Waste, with
specific reference to the containers as supplied to
Zamokuhle Private Hospital by Isikhova Kelniksher
Trading cc

ZAMOKUHLE PRIVATE HOSPITAL
ORIENTATION TRAINING
 Learning outcomes
 1.1 At the end of this session participants should be
able to :
 (i)identify and quantify the safe containerization
methods for the four main health care waste streams
 (ii) be aware of the “cradle to grave” life cycle of waste

GENERAL WASTE
 Between 75% to 90% of waste generated in health care
facilities is general waste and it is similar to household
waste
 Segregation of materials that can be reused or recycled
will greatly reduce the impact burden of the general
waste stream
 General waste consists of cardboard, damaged
containers, discarded flowers, food, bags, tins, paper,
non-clinical glass, wrappings, plastic bottles and
building rubble

Handling and containerisation
General waste
 General waste containers must be available at the
point where the waste is generated for ease of use
 The liners are closed using plastic cable ties, or tied,
and stored in an intermediate storage to await
collection by the internal transporters

Onsite storage
General waste
 A large skip is provided for the collection of general
waste. When full, the skip is removed by the local
municipality or contractor using the special truck for
the size of skip provided

HCGW
Black/Clear liners /
Containers
Intermediate
Storage
Central Storage
Municipal waste
collection system
Private
contractor
(recycling)
Disposal by landfill
2.5 Summary diagram of cradle to grave management of HCGW

3 Health Care Risk Waste
 The four main Health Care Risk Waste streams are :
 3.1 Infectious waste
 3.2 Sharps
 3.3 Anatomical (pathological) waste
 3.4 Pharmaceutical waste (including expired
medication)

3.1 INFECTIOUS WASTE
 This category forms the largest component of health
care risk waste generated in health care facilities.
Infectious waste basically consists of discarded
materials arising from activities performed on people,
which could potentially transmit infectious agents to
people.

3.1.1 Safety, Health and Environment Hazards
 Infectious waste may contain any one of a great variety
of pathogenic micro-organisms (bacteria and viruses)
from body fluids such as blood, urine, faeces, saliva,
sputum, etc. Pathogens in infectious waste may enter
the human body by a number of routes :
 Through a puncture, abrasion or cut in the skin
 Through the mucous membrane (eg lining of mouth
and nose)
 By inhalation (through breathing) and
 Through ingestion (eating and drinking)

3.1.2 Handling and Containerization
 The separation of infectious waste must be done at
point of generation of the waste. Suitable containers,
in accordance with specifications for the containment
of infectious waste, must be used with the red colour
coded liners of the correct size and thickness for the
size of the container. All containers used for infectious
waste should be marked with a recognized sign

The four circled symbol is the international symbol
for bio-hazardous waste

The skull and crossbones is sometimes used to indicate that the
waste is dangerous (NOT Orlando Pirates)

3.1.2 Handling and Containerization
 To encourage segregation at source, smaller reusable
containers such as pedal bins with liners are placed as
close to the point of generation as possible
 When they are ¾ full, the liners are closed by tying
with plastic cable ties and placed at the intermediate
storage areas
 Suitable latex gloves must always be used when
handling infectious waste

Different waste containers used for
infectious waste
Plastic pedal bin used with a red liner

Different waste containers used for
infectious waste
Reusable red wheelie bin for infectious waste

3.1.3 On-site / Internal transport and storage
 Contact with the infectious waste must be kept to a
minimum
 Once the bags or containers are sealed, they should be
removed from the intermediate storage area by the
facility’s internal transport personnel using dedicated
wheelie bins or trolleys that are easy to use and do not
damage the bags or containers
 The principle of not touching the waste again must be
upheld

3.1.3 On-site / Internal transport and storage
 Contact with the infectious waste must be kept to a
minimum
 Once the bags or containers are sealed, they should be
removed from the intermediate storage area by the
facility’s internal transport personnel
 Dedicated wheelie bins or trolleys must be easy to use
and not damage the bags or containers.
 The principle of not touching the waste again must be
upheld

3.1.4 Treatment and/or disposal
 Incineration was the commonly used method in
Gauteng until recently for the total destruction of
these wastes.
 New non-burn technologies such as autoclaving,
microwaving and electro thermal deactivation are now
also being used

HCRW - Infectious Waste
Red liners /
Containers/Pedal bins
Intermediate Storage
Central Storage
Licensed / Permitted
service provider
Non-burn technology
(eg Autoclaving,
Electro thermal
deactivation)
Burn technology
(eg incineration)
Residue : Hazardous
Waste Landfill
Isikhova Kelniksher Trading cc (Zamokuhle)
22

3.2 SHARPS
 Sharps are items that could cause cuts or puncture wounds,
including:
 needles
 hypodermic needles
 scalpel and other blades
 knives
 infusion sets
 saws
 broken glass
 nails
 Whether or not they are infected, such items are usually
considered as highly hazardous health care waste

 As hypodermic needles carry traces of contaminated
blood, the hazards, as indicated for exposure to
infectious waste, also apply to sharps
 Sharps, however, may not only cause cuts and
punctures but may also infect these wounds if they are
contaminated with the pathogens.
 Sharps are considered as a very hazardous waste class
because of this double risk of injury

Safety, Health and Environment Hazards
 The principle concerns relate to infections such as HIV
and Hepatitis B and C
 Medical staff, nurses and doctors are at the greatest
risk of infection from needle prick injuries during
 administration of the medications
 handling of the sharps prior to disposal into the
containers
 and from needles not correctly disposed of

Safety, Health and Environment Hazards
 Others at risk are :
 Other hospital workers
 waste management operators outside health-care
establishments
 waste reclaimers on waste disposal sites when the
sharps are not properly segregated and contained

Handling and Containerization at point of
Generation
 When disposing of a syringe, for example, the
packaging should be placed in the general waste bin
and the used syringe in the sharps container
 In most circumstances the needle should not be
removed from the syringe because of the risk of injury
 If removal of the needle is required, such as for
vacutainers, special care must be taken

Handling and Containerization at point of
Generation
 The sharps containers must be securely placed as close
as possible to the point of generation such as in wall
mounted brackets at the bed sites (ICU and Casualty)
or on the dressing trolley
 When ¾ full, the container must be securely closed
and placed in the intermediate storage area for
collection
 The containers must be tamper-proof when closed and
sealed

Examples of Sharps Containers
30
A horizontal loading sharps container helps needles to lie flat
inside the container

Examples of Sharps Containers
31
A 20 litre round sharps container

HCRW – Sharps
Sharps Container ONLY
Intermediate Storage
Central Storage
Licensed / Permitted
service provider
Non-burn technology
(eg Autoclaving,
Electrothermal
deactivation)
Burn technology
(eg incineration)
Residue : Hazardous Waste
Landfill
3.2.5 Summary diagram of cradle to grave management of sharps
33

3.3 ANATOMICAL / PATHOLOGICAL WASTE
Anatomical waste consists of
 Tissue
 Organs
 body parts
 placentas
 non-viable human foetuses
 animal carcasses
 blood
 and body fluids
 It is also known as pathological waste

 Aside from general psychological and/or ethical effects
of recognizable body parts to sensitive groups, the
health hazards from anatomical waste are considered
greater than general infectious waste
 This is because of the volume and size of body tissue
 The hazards discussed under infectious waste also
apply to this waste stream

3.3.2 Handling and Containerization at Point of
Generation
 Anatomical waste must be placed in disposable leak-
proof red containers as soon as possible at the site
where it is generated
 A tamper-proof container with a tightly-fitting two-
stage lid/closing device is the preferred option for
anatomical waste
 The first stage device is to prevent odours escaping
while it is in use
 The second stage is to prevent the container from
being opened again

A 10 Litre Pathalogical/Anatomical waste container
(Specican)

3.3.3 On-site/Internal transport and storage
 Anatomical waste should be removed from the point of
generation (maternity or theatre for example) in the
specially marked containers and taken to the cold storage
area as soon as possible
 In a health-care facility, the intermediate storage should
have a dedicated freezer in a secure place that is only
accessible to trained personnel
 The mortuary of a hospital can be used to store anatomical
waste in the absence of a dedicated freezer
 A separate waste manifest is normally used to control
movement of anatomical waste when collected by an
external transporter

3.3.4 Treatment and/or disposal
 As required by the Human Tissue Act no 65 of 1983,
pathological waste must always be incinerated
completely, in an appropriate and licensed facility

HCRW - Pathological Waste
Specially marked red disposable leak
proof containers
Cold storage area eg mortuary
Licensed / Permitted service provider
Incineration Only
(Human Tissue Act 65 of 1983)
Residue : Hazardous Waste Landfill
3.3.5 Summary diagram of cradle to grave management of Pathological Waste
40

3.4 PHARMACEUTICAL WASTE
 Pharmaceutical waste includes
 expired, unused, spilled and contaminated
pharmaceutical products, drugs, vaccines, and sera
that are no longer required and need to be disposed of
appropriately
 discarded items used in the handling of
pharmaceuticals, such as bottles or boxes with
residues, gloves, masks, connecting tubing and drug
vials

3.4.1 Handling and Containerization at point
of Generation
 Large quantities of unused, obsolete or expired
pharmaceuticals stored in hospital wards or
departments should be returned to the pharmacy for
disposal
 Spilled or contaminated drugs or packaging containing
drug residues should not be returned because of the
risk of contaminating the pharmacy
 This waste should be deposited in a rigid, leak-proof
container or directly into the sharps container at the
point of generation

4. SPECIFICATIONS FOR CONTAINERS AND LINERS
 The service provider is contracted to supply all the equipment
requirements for the containment and removal of the waste from
the facility
 Strict regulations govern the types of equipment to be used by
specifying
 minimum requirements for the manufacture of the equipment
 the type of materials used in its manufacture
 Thicknesses
 Sizes
 maximum weight
 how it is transported
 the final treatment and disposal methods

SPECIFICATIONS FOR CONTAINERS AND LINERS
 In general terms containers must be leak-proof or
leak-resistant, tamperproof, puncture-resistant and
manufactured without heavy metals or PVC
components
 The thickness of a liner is measured in microns

CONTROL OF DISPOSABLE STOCK
 The whole waste management system will collapse if
disposable items such as reusable containers, sharps
containers or liners run out
 It is crucial that strict control is kept over all items for
both health care risk waste and health care general
waste
 Sufficient quantities of receptacles must be available
for the quantities of waste anticipated to be generated
between ordering routines

CONTROL OF DISPOSABLE STOCK
 If containers are ordered monthly, for example, there
should be sufficient stock for approx a six week period
to cover for ‘peaks’ and ‘valleys’ in the generation of
waste and to ensure that there are no shortages should
there be a ‘spike’ in demand

QUESTIONS ?

Zamokuhle orientation sept 2014

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