Hospital waste management

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Disposal of hospital wasre

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HOSPITAL WASTE MANAGEMENT Dr. Gopalrao Jogdand M.D. Professor & Head, Department of Community Medicine, CAR Medical College:

HOSPITAL WASTE MANAGEMENT Dr. Gopalrao Jogdand M.D. Professor & Head, Department of Community Medicine, CAR Medical College

CONTENTS:

CONTENTS Introduction Categories of Biomedical waste & methods of disposal Collection & segregation Transportation & storage Disposal techniques Awareness & education Proforma References

Definition of biomedical waste::

Definition of biomedical waste: Biomedical waste means any waste which is generated during the diagnosis, treatment or immunization of human being or animals or in research activities pertaining there to or in production of biologicals.

Aims of biomedical waste management::

Aims of biomedical waste management: To prevent transmission of diseases To prevent injuries To prevent general exposure to harmful effect of biomedical waste.

CLASSIFICATION OF HEALTH CARE WASTE::

CLASSIFICATION OF HEALTH CARE WASTE: Hazardous waste (10-25%) Non-hazardous waste (75-90%) Infectious (15-18%) Other hazardous (5-7%) Sharps Non sharps Plastic disposables Liquid waste Radioactive waste Chemical waste Cytotoxic waste Pressurised containers Municipal dump

Proportion of different waste in hospital waste:

Proportion of different waste in hospital waste 80% 15% 1 % 3% 1%

Sources of biomedical waste::

Sources of biomedical waste: Govt. hospitals Private hospitals Nursing homes Physicians/Dentist clinic Dispensaries PHC Medical research &training establishment Mortuaries Blood banks, collection centers , laborites Animal houses, slaughter houses.

Health hazard from infectious waste &sharp::

Health hazard from infectious waste &sharp: Infectious diseases Hazard from chemical & pharmaceutical waste Hazards from cytotoxic / genotoxic drugs Hazards from Radioactive waste

Person at risk:

Person at risk Medical doctors, nurses, compounders, dressers, OT asst., ward boy, sweepers Patients Visitors Workers in support services Rag pickers

Routes of transmission :

Routes of transmission Inhalation Ingestion Contamination of wounds Absorption from coetaneous & mucous membrane

Legislation: Biomedical waste regulation 1998:

Legislation: Biomedical waste regulation 1998 Classified in 10 categories. Color coding & types of container for different categories & their corresponding treatment &disposal option with standards Generation of hospital waste in India: Total waste generation – 330,000 tones/yr 1-3kg/bed/day.

Table: Categories of biomedical waste and methods of disposal:

Table: Categories of biomedical waste and methods of disposal Category Waste type Treatment and disposal Cat 1 Cat 2 Cat 3 Cat 4 Cat 5 Human waste (tissues , organs body parts) Animal waste Microbiology and biotechnology waste Sharps Discarded medicines and cytotoxic drugs Incineration /deep burial Incineration /deep burial Autoclave / microwave/ incineration Disinfection (chemical treatment autoclave/microwave mutilation /shredding ) Incineration/destruction and drug disposal in secured landfills

Table: contd..:

Table: contd.. Category Waste type Treatment and disposal Cat 6 Cat 7 Cat 8 Cat 9 Cat 10 Contaminated solid waste Solid waste Liquid waste Incineration ash Chemical waste Incineration / autoclaving microwaving Disinfection by chemical technology autoclaving / microwaving and mutilation / shredding Disinfection by chemical treatment and discharge into drains Disposal in municipal land fills Chemical treatment and discharge into drains for liquids and secured landfills for solids.

Flow process hospital waste management:

Flow process hospital waste management ORIGINATION INTERIM STORAGE COLLECTION TRANS-PORTATION FINAL DISPOSAL

Characteristics of good waste disposal system.:

Characteristics of good waste disposal system. Good appearance Safety Pest control Odor control Public health safety

Waste collection and segregation:

Waste collection and segregation Waste should be collected and segregated at the site of generation itself Segregation of waste denotes, separation of waste into various specified categories as per its nature For this purpose use of specifically colored waste containers and plastic bags is mandatory

Color coding and types of containers for disposal of biomedical waste :

Color coding and types of containers for disposal of biomedical waste Colour coding Type of container Waste category Treatment option Yellow Red Blue/ white black Plastic bag Disinfected container/plastic bag Plastic bag/ puncture proof container Plastic bag Cat 1,2,3,6 , Cat 3,6,7 , Cat 4,7, Cat 5,9,10 Incineration/ deep burial Autoclaving /microwaving/chemical treatment Autoclaving /microwaving/chemical treatment and destruction / shredding Disposal in secured landfill

Label for biomedical waste and containers/ bags:

Label for biomedical waste and containers/ bags Cytotoxic substance Bio hazard symbol c

Transportation and storage:

Transportation and storage Site generation central final Of waste storage disposal area site

Disposal technique:

Disposal technique Disposal of biomedical waste is in two steps Pre treatment Final disposal

Pre treatment:

Pre treatment Chemical disinfection : it is required for plastic rubber and metallic items must be chemical disinfected before they send to final disposal 1 % hypochlorite solution is used Auto clave: It is insulated pressure chamber in which saturated steam is used to elevate the temp. types: 1. gravity type 2. vacuum type temp used 275 F (135 C ), 60-75 psi cycle time 1hr

Microwave irradiation: :

Microwave irradiation: Bio medical waste first shrdded(in unit it self)and then humedified and irradiated Municipal waste system Shredder: for plastic material cut the plastic waste into small pieces into 1 cm size chips

Final disposal Incinerator:

Final disposal Incinerator Double-chamber pyrolytic incinerators specially designed to burn infectious health-care waste Single-chamber furnaces with static grate, used only if pyrolytic incinerators are not affordable Rotary kilns operating at high temperature, capable of causing decomposition of genotoxic substances and heat-resistant chemicals.

Land fill:

Land fill Open dumping : not recommended Sanitary land fill disposal: disposing of certain types of healthcare waste (infectious waste and small quantities of pharmaceutical waste) in sanitary landfill is acceptable.

Alternative techniques:

Alternative techniques Plasma arc technology Operates on principles of an electrical arc struck between two electrodes. There is no burning and no formation of ash.

Electro thermal deactivation technology:

Electro thermal deactivation technology Uses radio active frequency wave for treatment of regulated waste Advantage over microwave is that radio active frequency have a longer wave length having deeper penetration

Awareness and education:

Awareness and education Objectives: To create awareness about health hazards of indiscriminate disposal of waste To highlight issue of handling, segregating, transporting, disinfecting, labeling and storage and disposal of waste

Formulation and development of educational material:

Formulation and development of educational material Teaching and training aids: Print material Audio visual aids Methodology Group discussion Lecturers Modular training Field visits

Conclusion:

Conclusion Prevent and minimize waste production Reuse or recycle the waste to the extent possible. Treat waste by safe and environmentally sound methods. Dispose off the final residue by land fill in confined and carefully designed sites.

Monitoring proforma for hospital waste management:

Monitoring proforma for hospital waste management Name and address of the hospital Name and tel. No. of medical superintendent Whether hospital is having a HWM committee Whether authorization for biomedical waste management has been taken from competent authority

PowerPoint Presentation:

5. What steps are being taken to prevent recycling 6. What are modes of disposal available in the hospital 7. Whether the hospital was inspected by CPCB / state PCB 8. Frequency of inspection by medical superintendent

PowerPoint Presentation:

9. a) total quantity of waste generated last month b) quantity per bed per day c) quantity (in kg/l) of various types of hospital waste 10. Whether segregation done as per BMW rules 11. Use of protection devices by waste handlers

PowerPoint Presentation:

12. No of accidents during waste handling 13. Availability of waste handling materials a) uniform/ protective gears b) Bins / bags c) carts / trolleys 14. Whether financial assistance / loan received from any agency like WHO/NACO

References:

References K.Park , Hospital Waste Management, Text Book of Preventive and Social Medicine, Banarsidas Bhanot, India, 19 th edi,2007 p-644-650 Seymourus. Block,Infectious Waste Efficient Management, Book of Disinfection, Sterilization and Preservation Lippincott Williams and Wilkins Philadelphia, 5 th edi 2001,p-1139-1147 Madhuri sharma, Hospital waste management and its monitoring Jaypee brothres, India,1 st edi 2002. B.M.Sakarkar, Disposal of Hospital waste-Principle of hospital administration and plan, Jaypee bros, India 1 st edi.2003, p-274-280 Environmental engineering and management program, Asian institute of Technology, Thailand, Health care waste Management in south Asia, available from: http://www.facuilty.ait.ac/visu

Thank You:

Thank You