Hospital Waste Management

Hospital Waste; & its Management: 

Hospital Waste; & its Management Presented By: Mithalesh Verma , MBA,SSITM,Bhilai

Definition: 

Definition According to bio medical waste(management & handling) rules, 1998 of India, ”bio-medical waste means any waste, which is generated during the diagnosis, treatment or immunization of human-beings or animals, or in research activities pertaining thereto or in the production or testing of biological. About 75-80% waste produced by health providers is “non-risk”. And remaining 10-25% are hazardous and may create various health risk.

Classification of health care waste: 

Classification of health care waste Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients . Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It is hazardous waste.

PowerPoint Presentation: 

Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have been returned from wards, have been spilled, are outdated, or contaminated. General waste: Largely composed of domestic or house hold type waste. It is non-hazardous to human beings, e.g. kitchen waste, packaging material, paper, wrappers, plastics

PowerPoint Presentation: 

Chemical waste: This comprises discarded solid, liquid and gaseous chemicals e.g. cleaning, house keeping, and disinfecting product. Genotoxic waste: waste containing cytostatic drugs , genotoxic chemicals.

PowerPoint Presentation: 

Sources of hospital waste Government hospitals Private hospitals Nursing homes Clinics. Physician’s clinics/ offices. Dentist’s office/clinics Dispensaries mortuaries Primary health centers Community health centers subcenters Vaccinating center and Immunization center. bio-technology institutions & Production units. etc And all these waste generated are covered under Bio-medical waste rules(BMW). Medical research and training Establishments. Laboratories Rearch centers

Distribution of health care waste in India: 

Distribution of health care waste in India 80% general health care wastes(food waste,sweeping from hospital premises). 15% pathological & infectious wastes. 1% sharps waste 3%chemical and pharmacological wastes About 1% special wastes such as radioactive or cytotoxic waste,pressurised containers,broken thermometer etc. India contribuate about 1.5 kg of waste/bed/day. (The World Day observed by ISEB on June 5, 1999 at NBRI, Lucknow ) Environment ).

Composition of hospital waste in india(as-per national environmental engineering research institute 1997: 

Composition of hospital waste in india (as-per national environmental engineering research institute 1997 materials Papers Plastics Rags Metals(sharps etc) Infectious waste Glasses General waste Percentage(wet weight basis) 15% 10% 15% 1% 1.5% 4% 53.5% By weight Plastic 14% Combustible Dry cellu-blostic solid 45% Wet cellu-blostic solid 18% Non-combustible 20%

PowerPoint Presentation: 

Health Care Waste sharps, medical devices, pharmaceuticals, chemicals. In- and out-patients Visitors Workers (waste handlers) Medical staff Workers (support services) General public Health Care Waste can affect all of us !!! Persons at risk..

IMPACT ON HEALTH : 

IMPACT ON HEALTH Impact on patient’s health: hospital acquired infection from contaminated hospital environment Impact on employees: Potential hazards including: - physical injuries from chemical spillage. - bacterial and viral infections as TB, hepatitis and AIDs. Arise from improper handling and disposal of hospital waste.

According to WHO(2004) injections with contaminated syringes caused: : 

According to WHO(2004) injections with contaminated syringes caused: One needle stick injury carries the following risk: Risk of HBV 6-30% i.e.21million heptitis b virus infection. Risk of HCV 0-7% ie 2 million hep c virus infection. risk of HIV 0.3% ie 260000 hiv infection.

PowerPoint Presentation: 

Impact on environment: Risk of pollution of, air, water and soil from mismanagement of different hospital waste .

Colour Coding and type Of container for disposal of biomedical waste : 

Colour Coding and type Of container for disposal of biomedical waste Colour coding Type of container Waste category treatment yellow Plastic bag Cat.1, cat.2,cat.3,cat.6 Incineretion and deep burial red Disinfected container/plastic bag Cat.3,cat.6,cat.7 Autoclaving/microwaving/chemical treatment Blue/white/ traslucent Plastic bag/ punture proof container Cat.4,cat.7 Autoclaving/microwaving/chemical treatment & destruction/shredding black Plastic bag Cat.5,cat.9,cat.10 & solid Disposal in secured landfill.

PowerPoint Presentation: 

Approach for hospital waste management Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India). 1. Segregation of waste Segregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labor rooms, treatment rooms etc. The biomedical waste should be segregated as per categories mentioned in the rules.

PowerPoint Presentation: 

2. Collection of bio-medical waste Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At ordinary room temperature the collected waste should not be stored for more than 24 hours.

PowerPoint Presentation: 

Type of container and colour code for collection of bio-medical waste. Category Waste class Type of container Colour 1. Human anatomical waste Plastic Yellow 2. Animal waste -do- -do- 3. Microbiology and Biotechnology waste -do- Yellow/Red 4. Waste sharp Plastic bag puncture proof containers Blue/White Translucent 5. Discarded medicines and Cytotoxic waste Plastic bags Black 6. Solid (biomedical waste) -do- Yellow 7. Solid (plastic) Plastic bag puncture proof containers Blue/White Translucent 8. Incineration waste Plastic bag Black 9. Chemical waste (solid) -do- -do-

PowerPoint Presentation: 

3. Transportation desiccated containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment. Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage . The wheeled containers should be so designed that the waste can be easily loaded, remains secured during transportation, does not have any sharp edges and is easy to clean and disinfect. Hazardous biomedical waste needing transport to a long distance should be kept in containers and should have proper labels. The transport is done through desiccated vehicles specially constructed for the purpose having fully enclosed body.

PowerPoint Presentation: 

4. Treatment of hospital waste Treatment of waste is required: to disinfect the waste so that it is no longer the source of infection. to reduce the volume of the waste. make waste unrecognizable for aesthetic reasons. make recycled items unusable 4.1 General waste The 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the responsibility of the local authority

PowerPoint Presentation: 

.2 bio-medical waste: 15% of hospital waste · Deep burial: The waste under category 1 and 2 only can be accorded deep burial and only in cities having less than 5 lakh population. · Autoclave and microwave treatment Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998.. The waste under category 3,4,6,7 can be treated by these techniques.. · Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps (needles, blades, glass etc) should be shredded but only after chemical treatment/microwaving/autoclaving. Needle destroyers can be used for disposal of needles directly without chemical treatment. · Secured landfill:: The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste should be treated by this option. · Incineration: The waste under category 1,2,3,5,6 can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of chlorinated plastics should not be incinerated. However, it may be noted that depending upon the option chosen, correct colour of the bag needs to be used.

PowerPoint Presentation: 

Safety measures 5.1   All the generators of bio--medical waste should adopt universal precautions and appropriate safety measures while doing therapeutic and diagnostic activities and also while handling the bio-medical waste. 5.2   It should be ensured that: drivers, collectors and other handlers are aware of the nature and risk of the waste. protective gears provided and instructions regarding their use are given. workers are protected by vaccination against tetanus and hepatitis B.

PowerPoint Presentation: 

PROPER HANDLING MEANS: Wearing gloves. Transporting contaminated solids in cover containers to disposal site. Disposal of all sharps in puncture-resistant containers. Washing hands after disposal of infectious waste.

HOSPITAL WASTE MANAGEMENT Waste management system must include: : 

HOSPITAL WASTE MANAGEMENT Waste management system must include: Definition of responsibilities for waste management. Allocation of sufficient human and financial recourses. Inclusion of health care waste management into the training curricula of all health care personnel. Waste minimizing as much as possible at the site of origin. Segregation of waste into hazardous and non hazardous in all steps of waste disposal. implementation of safety handling of waste.

PowerPoint Presentation: 

Training each and every hospital must have well planned awareness and training programme for all category of personnel including administrators (medical, paramedical and administrative). all the medical professionals must be made aware of Bio-medical Waste (Management and Handling) Rules 1998. institute awards for safe hospital waste management and universal precaution practices. training should be conducted to all categories of staff in appropriate language/medium and in an acceptable manner.

PowerPoint Presentation: 

Management and administration Heads of each hospital will have to take authorization for generation of waste from appropriate authorities as notified by the concerned State. Government, well in time and to get it renewed as per time schedule laid down in the rules. Each hospital should constitute a hospital waste management committee, chaired by the head of the Institute and having wide representation from all major departments . This committee should be responsible for making Hospital specific action plan for hospital waste management and its supervision, monitoring and implementation . The annual reports, accident reports, as required under BMW rules should be submitted to the concerned authorities as per BMW rules format

PowerPoint Presentation: 

. 8. Measures for waste minimization As far as possible, purchase of reusable items made of glass and metal should be encouraged. Select non PVC plastic items. Adopt procedures and policies for proper management of waste generated . Establish effective and sound recycling policy for plastic recycling and get in touch with authorized manufactures.

PowerPoint Presentation: 

9. Coordination between. hospital and outside agencies ·         Municipal authority : As quite a large percentage of waste (in India upto 85%), generated in Indian hospitals, belong to general category (non-toxic and non-hazardous) , hospital should have constant interaction with municipal authorities so that this category of waste is regularly taken out of the hospital premises for land fill or other treatment. ·         Co-ordination with Pollution Control Boards: Search for better methods technology, provision of facilities for testing, approval of certain models for hospital use in conformity with standards

PowerPoint Presentation: 

·         To search for cost effective and environmental friendly technology for treatment of bio-medical and hazardous waste. Also, to search for suitable materials to be used as containers for bio-medical waste requiring incineration/autoclaving/ microwaving. ·         Development of non-PVC plastics as a substitute for plastic which is used in the manufacture of disposable items.

PowerPoint Presentation: 

recommendations System approach involving the handling, storage, transport, treatment and disposal of waste. Training for all to be aware of the potential risks of mishandling waste. Segregation of waste into hazardous and non hazardous and using appropriate packing and labels. Reducing the quantity of waste at source as far as practicable.

PowerPoint Presentation: 

Incineration of pathological waste. Storage of radioactive waste until their radioactivity decays. Comprehensive waste disposal plans. Information on performance. Legislation should be restricted to basic principles.