hazardous medical waste

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medical waste

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SEMINAR ON :

HAZARDOUS WASTE MANAGEMENT AND HANDLING RULES SEMINAR ON

WELCOME :

WELCOME TO HOSPITAL WASTE MANAGEMENT PRESENTED BY Dr. R.B MOHAPATRA 2 Dr.R.B Mohapatra

WHAT IS HOSPITAL WASTE ? :

WHAT IS HOSPITAL WASTE ? Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use. Medical waste : refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals. 3 Dr.R.B Mohapatra

CLASSIFICATION OF HOSPITAL WASTE:

CLASSIFICATION OF HOSPITAL WASTE GENERAL WASTE BIO-DEGRADABLE NON-BIO-DEGRADABLE BIO-MEDICAL WASTE PATHOLOGICAL WASTE INFECTIOUS WASTE SHARPS PHARMACEUTICAL WASTES CHEMICAL WASTES RADIOACTIVE WASTES 4 Dr.R.B Mohapatra

GENERAL WASTES:

GENERAL WASTES The 85% of the waste generated in the hospital belongs to this category. Largely composed of domestic or house hold type waste. It is non-hazardous to human beings. 5 Dr.R.B Mohapatra

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BIO-DEGRADABLE Used cotton, gauge, adhesives, Papers, paper files, folders Paper or cotton bags. Packaging materials. Kitchen wastes. NON-BIODEGRADABLE Plastic containers Caps,lids,tops Plastic utensil like spoon, tray,fork etc. Foil, foil trays etc. 6 Dr.R.B Mohapatra

PATHOLOGICAL WASTE :

PATHOLOGICAL WASTE It consists of tissue, organ, body part, human foetuses, blood and body fluid. Glass slides containing fixed and embedded tissue (human or animal) or Pap smear slides five years or older All materials used in embedding fixed tissue such as foam pads, cassettes and paraffin Containers with fixative for fixing tissue (human or animal) 7 Dr.R.B Mohapatra

INFECTIOUS WASTE :

INFECTIOUS WASTE Infectious waste are all those substances which cannot be resterilized or reused within or brought into patient care or The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases . e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients. 8 Dr.R.B Mohapatra

TYPES OF INFECTIOUS WASTE:

TYPES OF INFECTIOUS WASTE Cultures of microorganisms & biologicals Human blood and blood products Pathological wastes All Sharps (even if not contaminated) Contaminated animal carcasses, body parts, bedding and related wastes Materials (soil, water, or other debris) which result from the cleanup of a spill of any infectious medical waste. Waste contaminated by or mixed with infectious medical waste. 9 Dr.R.B Mohapatra

SHARPS :

SHARPS These are any waste materials which could cause the person handling it, a cut or puncture and have been used in animal/human patient care or treatment. Examples: Needles, syringes, scalpel blades, razors, forceps, broken glass, saws, nail, blades, scalpels. 10 Dr.R.B Mohapatra

PHARMACEUTICAL WASTE :

PHARMACEUTICAL WASTE This includes pharmaceutical products, drugs, and chemicals that have been returned from wards, have been spilled , are outdated, or contaminated. 11 Dr.R.B Mohapatra

CHEMICAL WASTE :

CHEMICAL WASTE This comprises discarded solid, liquid and gaseous chemicals. More than one chemical composition may react with each other to give corrosive actions. cleaning, house keeping, and disinfecting products some expired medicines comes under chemical waste. 12 Dr.R.B Mohapatra

RADIOACTIVE WASTE :

RADIOACTIVE WASTE It includes solid, liquid, and gaseous waste that is contaminated with radionucleides generated from in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization and therapeutic procedures. . 13 Dr.R.B Mohapatra

Evolution of Hospital Waste Globally:

Evolution of Hospital Waste Globally Hospital Waste was brought into focus in 1983. Medical specialists, hospital engineers, administrators from 19 countries participated & concluded that it required a system approach involving: - Awareness, Segregation, Source reduction of radio-active waste. Beach washings in 1998 of the Florida coast, related to syringes, lead to passing of first healthcare legislation- Medical Waste Tracking Act (MWTA) 14 Dr.R.B Mohapatra

Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day:

Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day Hospital waste may: Contain infectious organisms, including drug resistant ones Place cancer causing agents into air or ground water Cause radiation-related illnesses Contribute to global warming harm atmosphere (CFC containing refrigerant gas) Cause injury (sharps, explosion) Cause congenital defects or stillbirth, prematurity, infertility 15 Dr.R.B Mohapatra

WHY HOSPITAL WASTE IS HAZARDOUS?:

WHY HOSPITAL WASTE IS HAZARDOUS? Infectious waste is capable of producing ‘ infectious disease’. Chances of this are higher with in hospitals than outside depending on factors like Dose, Host susceptibility, presence and virulence of a pathogen. 16 Dr.R.B Mohapatra

WHAT CAUSES HOSPITAL WASTE HAZARDOUS:

WHAT CAUSES HOSPITAL WASTE HAZARDOUS Chemical-medications, Solutions, or Bacteria's like TB, Hepatitis B and C, Gases ;- ethylene oxide, formaldehyde, glutaryldehyde, waste anesthetic gases, nitrous oxide, Chemotherapeutic agents, Laser Smoke and Aerosolized medications such as Pentamedine 17 Dr.R.B Mohapatra

HEALTH HAZARDS OF HOSPITAL WASTE :

HEALTH HAZARDS OF HOSPITAL WASTE The hazards are: Fire Breeding of flies and insects Proliferation of rodents Air pollution Water pollution Land pollution Transmission of infections viz hepatitis B, HIV, other microbes Mechanical injury Re-circulation of waste Loss of aesthetics Nuclear waste hazards & carcinogenic effects 18 Dr.R.B Mohapatra

COMMON HAZARDS:

COMMON HAZARDS Anesthetic gases Glutaraldehyde Formaldehyde/formalin Cancer therapeutic agents Ethylene Oxide Radiation Asbestos Blood contaminated sharps Bleach Solvents (xylene, toluene, acetone, ethanol) Pesticides, fungicides Heavy metals (mercury, chronium, cobalt, cadmium, arsenic, lead) Latex Strychnine and cyanide 19 Dr.R.B Mohapatra

ROUTES OF EXPOSURE:

ROUTES OF EXPOSURE Ingestion (Swallowed materials) Inhalation : airborne chemicals and pathogens, Dermal absorption-or through skin openings . Water soluble toxic chemicals can be absorbed throughout the body Drinking and eating in hospital: should be done in well controlled areas 20 Dr.R.B Mohapatra

TRANSMISSION OF INFECTIOUS AGENTS :

TRANSMISSION OF INFECTIOUS AGENTS Individuals are exposed to human sources of microorganisms by three primary routes: Contact transmission Droplet Transmission Airborne Transmission 21 Dr.R.B Mohapatra

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Contact transmission Direct – organism is transferred directly from one person to another, e.g. scabies, Indirect- organism is transferred through contaminated intermediate object or person, e.g. hands or contaminated patient care equipment . 22 Dr.R.B Mohapatra

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Droplet Transmission- relatively large ( >5 microns) droplet heavy with moisture that are propelled relatively short distances from the source (3-6 feet) onto the mucous membranes of the nose, mouth or eyes, of the host and environmental surfaces. Airborne Transmission- droplet nuclei (<5 microns) that remain suspended in the air for long periods, that may be inhaled by the host into the alveoli of lung. 23 Dr.R.B Mohapatra

EFFECTS OF 'IMPROPER HOSPITAL WASTE MANAGEMENT:

EFFECTS OF 'IMPROPER HOSPITAL WASTE MANAGEMENT Hospital infections are a major health problem all over the world Can effect the people working or visiting the hospital The community is invariably effected 24 Dr.R.B Mohapatra

STEPS TO MANAGE WASTES :

STEPS TO MANAGE WASTES Know what hazards you have. Purchase smallest quantity needed. Don’t purchase hazardous materials if safe alternative exists . Limit use and access to trained persons with personal protective gear. Don’t accumulate unneeded products. Don’t let peroxides and oxidizing agents turn into bombs Label with Agent, Concentration and Hazard Warnings. 25 Dr.R.B Mohapatra

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Communicate about Workplace Hazards. Such as :- Job description, Posters on doors Labels on hazards, Give feedback on use of PPE. Separate dustbins for bio-degradable, hazardous, infectious wastes and particularly sharps should be used so that handling will be minimum. 26 Dr.R.B Mohapatra

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Conducting walk around interviews:- Ask about the hazardous substances staff work with, how they dispose of them, what they need to be able to dispose of them properly and what could be recycled or reused anywhere. 27 Dr.R.B Mohapatra

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Dr.R.B Mohapatra 28 . Keep an inventory, perhaps though the purchasing office who can track what comes in. They will need assistance. Don’t purchase hazards when alternatives exist. When a new thermometer is purchased, purchase an alcohol or digital thermometer.

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Slide 29 Dr.R.B Mohapatra

Because no Disposal Method is Easy or Completely Safe…:

Because no Disposal Method is Easy or Completely Safe… Prevention is best! Eliminate purchase by buying safer alternatives Use smallest quantities possible, use with engineering controls and Personal Protective Equipment Segregate hazards into separate waste streams at source and try to Recycle the recyclables. Supervise disposal using best available ecologic option. 30 Dr.R.B Mohapatra

WASTE DISPOSAL OPTIONS :

WASTE DISPOSAL OPTIONS Disinfection – Autoclaving / Microwaving, treatment, shredding Land Disposal Burial Encapsulation Incineration Inertisation Managed Land-fill On-site disposal 31 Dr.R.B Mohapatra

Disposal of Pharmaceutical Waste:

Disposal of Pharmaceutical Waste Small amounts: Disperse in landfill sites, encapsulate or bury on site Discharge to sewer Incinerate Large amounts Incinerate at high temperatures or encapsulate LANDFILL IS NOT RECOMMENDED 32 Dr.R.B Mohapatra

Sterilization Of Infectious Waste:

Sterilization Of Infectious Waste All infectious waste must be autoclaved for 90 minutes Bags must then transferred to black plastic bags in a separate location. Disposable waste must be taken to the dumpster in regular intervals. 33 Dr.R.B Mohapatra

SAFE DISPOSAL OF INFECTIOUS SHARPS:

SAFE DISPOSAL OF INFECTIOUS SHARPS Do not recap sharps before disposal Dispose of sharps at the point of use in a leak proof puncture proof container Avoid handling, emptying or transferring used sharps between containers Autoclave highly infectious waste before disposal Control public access to syringes and medical equipment Shred, encapsulate and bury according to national legislation 34 Dr.R.B Mohapatra

SAFETY FROM BLOOD AND BLOOD BORNE PATHOGEN:

SAFETY FROM BLOOD AND BLOOD BORNE PATHOGEN No eating, drinking, smoking, applying cosmetics or contact lenses in the labs. No mouth pipetting; use pipetting device Protective clothing appropriate to the level of risk and use of barriers to exposure Universal Precautions: Bloodborne pathogens are organisms carried in human blood that cause disease, includes bacteria and viruses like HBV and HIV Treat all human blood and byproducts as if it is contaminated 35 Dr.R.B Mohapatra

DISPOSAL OF CHEMICAL WASTE :

DISPOSAL OF CHEMICAL WASTE Keep different hazardous chemicals separate Do not dispose into the sewers or street Do not encapsulate large amounts of disinfectants as they are corrosive and flammable Do not bury large amounts of chemicals 36 Dr.R.B Mohapatra

Disposal of Wastes with Heavy Metals :

Disposal of Wastes with Heavy Metals Wastes with mercury, cadmium, lead, arsenic, strychnine, are poisonous (e.g., thermometers, batteries, lead paints, dyes) Never incinerate or burn Never dispose of in municipal landfills Best solution: Avoid purchase OR Recycle in specialized cottage industry or export to countries with specialized facilities Encapsulation mercury-free thermometers could be used 37 Dr.R.B Mohapatra

DISPOSAL OF GAS CONTAINERS:

DISPOSAL OF GAS CONTAINERS NEVER INCINERATE Return undamaged gas cylinders and cartridges to the manufacturer for reuse Damaged containers: empty completely and crush, landfill 38 Dr.R.B Mohapatra

DISPOSAL OF RADIOACTIVE WASTE:

DISPOSAL OF RADIOACTIVE WASTE Use requires a national strategy including: Appropriate legislation. A competent regulatory organization. Trained radiation protection officer to monitor exposures. Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme. 39 Dr.R.B Mohapatra

Burying Inside Hospital Premises :

Burying Inside Hospital Premises Apply the following rules: Access to the site restricted and controlled If waste is retained on site, ensure rapid burial to isolate from animal or human contact Only hazardous HC Waste to be buried Each deposit covered with soil Site lined with low permeable material-concrete Groundwater pollution must be avoided Not recommended for untreated hazardous waste 40 Dr.R.B Mohapatra

Incineration:

Incineration Combustible waste turned to ash at temps >800 C Reduces volume and weight Residues are transferred to final disposal site Treatment efficiency depends on incineration temperature and type of incinerator Not all wastes can be incinerated Costs vary greatly according to type of incinerator Produces combustion gases 41 Dr.R.B Mohapatra

Do not Incinerate:

Do not Incinerate Do not incinerate the following: Plastics especially halogenated plastics (e.g. PVC) Pressurized gas containers Large amounts of reactive chemical waste Radioactive waste Silver salts or radiographic waste Mercury or cadmium Ampoules of heavy metals 42 Dr.R.B Mohapatra

Land-fill in Municipal Landfills:

Land-fill in Municipal Landfills If hazardous health-care waste cannot be treated or disposed elsewhere: A site for hazardous Waste should be designated Access to this place should be limited. to avoid human or animal contact the waste should rapidly be buried. More suitable treatment methods should be investigated. 43 Dr.R.B Mohapatra

PERSONAL PROTECTIVE EQUIPMENT:

PERSONAL PROTECTIVE EQUIPMENT When selecting PPE consider The highest level hazard present, The source of the hazard, And the potential for simultaneous exposures . 44 Dr.R.B Mohapatra

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Face protection Goggles or safety glasses with side shields Clothing Lab coats, scrub suits, gowns (long pants only, no open toed shoes) Clothing should be replaced immediately when contaminated 45 Dr.R.B Mohapatra

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Gloves Verify that gloves are compatible with your specific application, process and materials before using Gloves should be replaced immediately if torn Gloves should not be worn outside the lab area Always wear heat resistant gloves and keep your face away from the door when loading and unloading the autoclave. 46 Dr.R.B Mohapatra

RECOMMENDATIONS :

RECOMMENDATIONS To reduce the burden of disease, healthcare waste needs sound management, including alternatives to incineration. Management of Healthcare waste requires 'increased attention’ and Diligence. Incinerators provide an interim solution for developing countries where options of waste disposal such as Autoclaving, shredder, microwave or newer technologies like plasma incinerators are limited. Whatever the technology used, best practice must be promoted to ensure optimal operation of the system. 47 Dr.R.B Mohapatra

BEST PRACTICES :

BEST PRACTICES Construction following detailed dimensional Plans to avoid flaws that can lead to incomplete destruction of waste, higher emissions and premature failure of incinerators. Follow proper operational procedures: utilize appropriate start up and cool down procedures. Periodic maintenance to replace or repair faulty components, regular inspection, maintaining spare parts inventory, record keeping etc. 48 Dr.R.B Mohapatra

BEST PRACTICES :

BEST PRACTICES Training and Management: Regular training and upgrading skills. Making available an Operating and Maintenance manual and maintenance program for incorporation of certification and inspection programmes for operation and an excellent management oversight are an essential components. 49 Dr.R.B Mohapatra

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THANK YOU 50 Dr.R.B Mohapatra