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Hospital Waste Management
- 2. HOSPITALW ASTE • Hospital/Health Care waste includes all the waste generated by health care facilities, research facilities and laboratories. In addition, it includes the waste originating from minor or scattered sources such as that produced in the course of health care undertaken in the home. • According to Bio medical waste rule, 1998 “Bio medical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities.
- 3. SOURCES OF HEALTH CARE WASTE Government hospitals Private hospitals Nursing home Physician’s office/ clinics Dispensaries Primary health center Medical research and training establishment Mortuary Blood bank and collection center Animal house Slaughter house Laboratories Research organization Vaccinating center Bio technology institute
- 4. TYPES OF HOSPITALWASTE WASTE CATEGORY DESCRIPTION 1. INFECTIOUS WASTE Waste suspected to contain pathogens. Eg: laboratory culture, waste from isolation ward, any instrument or material that have been in contact with infected persons or animals 2. PATHOLOGICAL WASTE Pathological waste consists of tissues, organs, body parts, human fetus 3. PHARMACEUTICAL WASTE Waste containing pharmaceutical. Eg: pharmaceuticals that are expired or no longer needed, medicine bottle or box or strips 4. SHARPS Sharps are items that could cause cuts or puncture wound, including needles, scalpel, knives, blades, broken glass, nail, etc 5. GENOTOXIC WASTE Waste containing substance with genotoxic properities.eg: cytostatic drugs, genotoxic chemicals
- 5. WASTE CATEGORY DESCRIPTION 6. CHEMICAL WASTE Waste containing chemical substance. Eg: laboratory reagents , disinfectants that are no longer needed 7. WASTE WITH HIGH CONTENT OF HEAVY METAL batteries, broken thermometer, blood pressure equipments, etc 8. PRESSURIZED CONTAINERS Gas cylinders, aerosol cans, etc 9. RADIOACTIVE WASTE waste containing radio active substance. Eg: unused liquid from radiotherapy or laboratory research, contaminated glassware urine or excreta from patients treated or tested with unsealed radionuclide
- 6. HAZARDS OFHEALTH CARE WASTE Exposure to health care waste can result disease or injury due to following characteristics: • It contain infectious agents • It contain toxic or hazardous chemicals or pharmaceuticals • It contain sharp • It is genotoxic • It is radioactive Health Problems • Infectious diseases such as HIV/AIDs, Hepatitis B and C, contagious diseases such as scabies. • Poisoning due to chemical and pharmaceutical waste • Genetic problems • Cancer due to accidental or unnecessary exposure to radiology emissions. • Injuries due to sharp wastes.
- 7. Situation of Health Care Waste Management in Nepal Health care waste management is a major problem in Nepal. Only about 20% of the waste produce in hospital are hazardous but, the practice of mixing hazardous waste with ordinary waste makes the whole waste hazardous and difficult to manage. Some hospital possess their own incineration while other do not have their own. However good practice of segregation of waste at the point of generation is beginning. MANAGEMENT OF HOSPITALW ASTE 1. Separation of waste/ Segregation 2. Using incinerators
- 8. In our context, following basic steps are considered essential for the proper waste management: • Waste minimization • Waste segregation • Waste collection and storage • Waste transportation • Waste treatment and disposal
- 9. Waste Minimization • Waste minimization is defined as the prevention of waste production and/or its reduction. Waste minimization can be achieved through: • Waste reduction at source (product substitution, product change, procedural change): Reduction involves measures that either completely eliminate use of a material or generate less waste. Examples are improving house-keeping, reviewing purchasing policies without compromising work standards or environmental outcomes.
- 10. Giving preference to recyclable and reusable items: Medical and other equipments used in HCF may be reused provided that it is designed for the purpose and will withstand the sterilization process; some examples are scalpels, glass bottles and containers. Some of the materials which can be recycled are given below: • Glass • Plastics • Aluminium cans • Paper and card board • Iron
- 11. 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 must take place at the bed site, at the operation theater, at ward, at laboratory, wherever it is generated. Non-risk waste (e.g. paper, glass, plastic, iron) can be recycled. Non-risk biodegradable organic wastes (i.e. food waste, garden waste) can be composted. • Infectious waste must never be mixed with non-infectious waste to keep the volume of infectious waste as low as possible.
- 12. Recommended color-code for the container, labeling and international signs for segregation of HCW
- 15. Note: If the container with the recommended color is not available, any colored container can be used to segregate wastes with proper labeling and hazardous sign as shown in the above table.
- 16. 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. • All the collected HCWs should be stored in waste storage area until transported to a designated off-site treatment facility. This area must be marked with warning sign. • Storage facilities for waste should be suitably established within the HCF; however, these areas should be located away from patient rooms, laboratories, hospital function/operation rooms or any public access area. The storage facility should be lockable, hygienic and appropriately sign- posted. • Bio-degradable general and hazardous waste should not be stored longer and should be removed within 24 hours to minimize microbial growth, putrefaction and odors.
- 17. Waste Transportation • Certain recommendations should be followed by the auxiliary worker in-charge of waste collection: • Time of collection regardless of category should be at the start of every shift. In case of difficulty in the collection of waste in every shift, waste should be collected on daily basis (or as frequently as required) and transported to the designated central storage site of HCF. • No bags should be removed unless they are labeled with their point of production (hospital and ward or department) and contents. • A supply of fresh collection bags or containers should be readily available at all locations where waste is produced.
- 18. • On-site transport: Onsite transport of waste from the point of generation to an assembly storage or treatment area should be carried by wheeled trolleys, containers or carts. Wherever possible, the transport of clinical waste should be separate from general traffic. Hazardous/infectious HCW and nonrisk HCW should be transported on separate trolleys. • Off-site transport : The HCW producer is responsible for safe packaging and appropriate labeling to the waste to be transported off-site and for authorization of its destination i.e. either at the CTF(Central Treatment Facility) or at the landfill site.
- 19. Waste Treatment and Disposal • HCW can be treated and disposed through the following techniques: a. Biological procedure b. Autoclave c. Chemical disinfection d. Encapsulation e. Sanitary landfill f. Burial g. Septic/concrete vault h. Incineration i. Inertization
- 20. a. Biological Procedure/Composting • Composting is the natural, biological decomposition of organic matter by fungi, bacteria, insects, worms and other organisms. Organisms that decompose organic matter require the following basic inputs and conditions to maximize their processes and efficiency: • A suitable food source; • A suitable temperature; • Water; and • Oxygen (if decomposing aerobically)
- 21. b. Autoclave • Autoclave is a process of steam sterilization under pressure. It is a low heat process in which steam is brought into direct contact with the waste material for duration sufficient to disinfect the material. • Autoclaves are commonly used for the treatment of highly infectious waste, such as microbial cultures or sharps.
- 22. c. 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. • It is the preferred treatment for liquid infectious wastes, but can also be used in treating solid waste too. • This technique is most suitable in treating blood, urine, stools and sewage
- 23. d. Encapsulation • Encapsulation involves the filling of the containers with waste, adding an immobilizing material and sealing the container. The process uses either cubic boxes made of highdensity polyethylene or metallic drums. • When containers are three quarters filled with sharps, pharmaceuticals and chemical waste, an immobilizing agent such as plastic foam, bituminous sand, cement mortar or clay is poured into it. Material is allowed to be dried and the container is sealed and disposed safely
- 24. e. Sanitary landfill • Sanitary landfill is an engineered method, designed and constructed to keep the waste isolated from the environment. So, it shuuldn’t contaminate the soil, surface, and ground water and should limit air pollution, smells and direct contact with public
- 25. f. Burial • Hazardous waste can be buried in a special pit. Burial is recommended in those HCFs that have minimal programs for HCWM, especially in remote locations • For the purpose, the pit should be 2-5 m deep and 1-2 m wide. The bottom of the pit should be at least 2 m above the water table. After each waste load, it should be covered with a 10–30 cm thik soil layer. If coverage with soil is not possible, lime may be deposited over the waste • When the level of the waste reaches 30 to 50 cm to the surface of the ground, fill the pit with dirt, seal with concrete and dig another pit.
- 26. g. Septic/concrete vault • This method can be used for the disposal of used sharps and syringes. In this technique, the following process is applied. • Dig a pit (1m x 1m x 1.8m depth), enough to accommodate sharps and syringes for certain period without reaching the ground water level. The site must be isolated and at least 500 feet away from the ground water sources and dwelling units. • Construct concrete walls and slabs of the pit. Provide slab with opening or manhole for easy deposition of collected sharps and syringes. • Deposit the collected safety boxes filled with used sharps and needles inside the septic/concrete vault. • Install a security fence around the site.
- 27. h. Incineration • Incineration converts combustible materials into non-combustible residue or ash. Incinerators can be oil-fired or electrically powered or a combination of both. Broadly, three types of incinerators are used for treatment of HCWs: • double chambered • Single chambered • rotary kiln and • Wastes containing mercury or cadmium should never be burned or incinerated because of the risk of atmospheric pollution with toxic vapors.
- 28. Following wastes should never be incinerated: • Pressurized gas containers • Large amounts of reactive chemical waste • Radioactive waste • Silver salts or radiographic wastes • Halogenated plastics (e.g. PVC) • Mercury or cadmium • Ampoules of heavy metals
- 29. i. Inertization • Inertization is usually suitable disposal method for the pharmaceuticals and incinerated ash with heavy metal content. (WHO, 1999) • In this technique, the HCW is mixed with cement and other substances in a composition of 65% waste, 15% lime, 15% cement and 5% water. • The formed mixture is allowed to set into cubes or pellets and then these are transported to suitable storage site.
- 30. References • Health Care Waste Management Guideline 2071