categorizing anddisposing healthcare wastes

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CATEGORIZING BIOMEDICAL AND HEALTHCARE WASTES Dr. Prashant Mehta Assistant Professor, National Law University, Jodhpur Email: [email protected]

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Gives basic idea about hospital and biomedical waste

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  • 1.CATEGORIZINGBIOMEDICAL ANDHEALTHCARE WASTESDr. Prashant MehtaAssistant Professor,National Law University, JodhpurEmail: [email protected]

2. INTRODUCTIONDEFINITION Healthcare waste includes all the waste generated by healthcare establishments (hospitals and Dispensaries), Research facilities, and diagnostic laboratories besides healthcare activities like immunizations, diagnostic tests, medical treatments procedures, and laboratory examinations. In addition, it includes the waste originating from "minor" or "scattered" sources such as that produced in the course of healthcare undertaken in the home (dialysis, insulin injections, etc.). Between 75% - 80% of the waste produced byhealthcare providers is non-risk or "general" healthcarewaste which is comparable to domestic waste. Theremaining 20% of wastes are considered hazardousdisposed of materials that may be of infectious naturelike organs, toxic materials, or radioactive wastes. Thewastes and by products and are produced cover adiverse range of materials. 3. Categories of Healthcare Wastes 4. Infectious WastesInfectious waste is suspected to contain pathogens (bacteria,viruses, parasites, or fungi) in sufficient concentration or quantity tocause disease in susceptible hosts. This category includes: Waste suspected to contain pathogens e.g. laboratory cultures; waste from isolation wards; tissues (swabs), materials, or equipment that have been in contact with infected patients; excreta. Waste from surgery and autopsies on patients with infectious diseases (e.g. tissues, and materials or equipment that have been in contact with blood or other body fluids). Waste from infected patients in isolation wards (e.g. excreta, dressings from infected or surgical wounds, clothes heavily soiled with human blood or other body fluids). Waste that has been in contact with infected patients undergoing haemodialysis (e.g. dialysis equipment such as tubing and filters, disposable towels, gowns, aprons, gloves, and laboratory coats). Any other instruments or materials that have been in contact with infected persons or animals. Discarded diagnostic samples etc. 5. Pathological Wastes Pathological waste consists of human tissues, organs, body parts, human fetuses,body fluids. Within this category, recognizable human or animal body parts arealso called anatomical waste. This category should be considered as a subcategoryof infectious waste, even though it may also include healthy body parts. Anatomic - recognizable body parts and animal carcasses. Infectious and anatomicwastes together represent the nearly 15% of the hazardous waste of the totalwaste generated from healthcare activities. 6. 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, and nails. Whether or notthey are infected, such items are usually considered as highlyhazardous healthcare waste. Sharps represent about 1% of the total waste from healthcareactivities. Throughout the world every year an estimated 2,500 millioninjections are administered and all needles and syringes are notproperly disposed of giving an opportunities for reuse, thus it resultsin risk for injury and infection like hepatitis B, hepatitis C and HIVinfections. Many of these infections could be avoided if syringeswere disposed of safely. In developing countries, additional hazards occur from scavengingon waste disposal sites and manual sorting of the wasterecuperated at the back doors of healthcare establishments. Thesepractices are common in many regions of the world. The wastehandlers are at immediate risk of needle-stick injuries and otherexposures to toxic or infectious materials. 7. Geno-Toxic Wastes Geno-toxic waste is highly hazardous and may have mutagenic, terato-genic, or carcinogenicproperties. It raises serious safety problems, both inside hospitals and after disposal.Genotoxic waste may include certain cytostatic drugs used in cancer treatment , vomitus,urine, or faeces from patients treated with cytostatic drugs, chemicals, and radioactivematerial. Cyto-toxic (or antineoplastic) drugs are most often used in specialized departments such asoncology and radiotherapy units to treat cancers. The principal substances in this category,have the ability to kill or stop the growth of certain living cells and are used in chemotherapyof cancer. They play an important role in the therapy of various neoplastic conditions but arealso finding wider application as immunosuppressive agents in organ transplantation and intreating various diseases with an immunological basis. 8. Pharmaceutical Wastes Pharmaceuticals Expired or no longer needed, unused, and contaminated drugs.The drugs themselves (sometimes toxic and powerful chemicals) or theirmetabolites, vaccines and sera. Chemicals and pharmaceuticals amount to aboutnearly 03% of waste from healthcare activities. 9. Chemical Wastes Chemical waste consists of discarded solid, liquid, and gaseous chemicals, for example fromdiagnostic and experimental work and from cleaning, housekeeping, and disinfectingprocedures. Chemical waste from health care may be hazardous or non-hazardous consists ofchemicals with none of the above properties, such as sugars, amino acids, and certain organicand inorganic salts); in the context of protecting health, it is considered to be hazardous if it hasat least one of the following properties: toxic; corrosive (e.g. acids of pH < 2 and bases of pH >12); inflammable; reactive (explosive, water- reactive, shock- sensitive); genotoxic (e.g.cytostatic drugs) used most commonly in maintenance of healthcare centres and hospitals. 10. Chemical Waste Formaldehyde - Formaldehyde is a significant source of chemical waste in hospitals. It is usedto clean and disinfect equipment (e.g. haemodialysis or surgical equipment), preservespecimens, disinfect liquid infectious waste, used in pathology, autopsy, dialysis, embalming,and nursing units. Photographic Chemicals - Photographic fixing and developing solutions are used in X-raydepartments. The fixer usually contains 5-10% hydroquinone, 1-5% potassium hydroxide, andless than 1% silver. The developer contains approximately 45% glutaraldehyde. Acetic acid isused in both stop baths and fixer solutions. Solvents - Wastes containing solvents are generated in various departments of a hospital,including pathology and histology laboratories and engineering departments. Solvents used inhospitals include halogenated compounds, such as methylene chloride, chloroform,trichloroethylene, and refrigerants, and non-halogenated compounds such as xylene,methanol, acetone, isopropanol, toluene, ethyl acetate, and acetonitrile. Organic Chemicals Waste generated in HealthCare Facilities Include: disinfecting, cleaningsolutions such as phenol-based chemicals used for scrubbing floors, perchlorethylene used inworkshops and laundries; oils such as vacuum-pump oils, used engine oil from vehicles(particularly if there is a vehicle service station on the hospital premises); insecticides,rodenticides. Inorganic Chemicals - Waste inorganic chemicals consist mainly of acids and alkalis (e.g.sulfuric, hydrochloric, nitric, and chromic acids, sodium hydroxide and ammonia solutions).They also include oxidants, such as potassium permanganate (KMnO4 ) and potassiumdichromate (K 2Cr2O7), and reducing agents, such as sodium bisulfite (NaHSO3) and sodiumsulfite (Na2SO3). 11. Heavy Metal Waste Wastes with a high heavy-metal content represent a subcategory ofhazardous chemical waste, and are usually highly toxic. Mercury wastes are typically generated by spillage from broken clinicalequipment but their volume is decreasing with the substitution ofsolid-state electronic sensing instruments (thermometers, blood-pressure gauges, etc.). Residues from dentistry have a high mercurycontent. Cadmium waste comes mainly from discarded batteries. Lead Waste comes from certain "reinforced wood panels are stillused in radiation proofing of X-ray and diagnostic departments. Arsenic Waste - A number of drugs contain arsenic, but these aretreated here as pharmaceutical waste. Healthcare waste is a reservoir of potentially harmful micro-organismswhich can infect hospital patients, healthcare workers and the generalpublic. Wastes and by-products can also cause injuries, for exampleradiation burns or sharps-inflicted injuries; poisoning and pollution,whether through the release of pharmaceutical products, in particular,antibiotics and cytotoxic drugs, through the waste water or by toxicelements or compounds such as mercury or dioxins. 12. Pressurized Containers Many types of gas are used in health care, and are often stored inpressurized cylinders, cartridges, and aerosol cans. Whether inert orpotentially harmful, gases in pressurized containers should always behandled with care; containers may explode if incinerated or accidentallypunctured. The main types of gases used in hospitals are: Anaesthetic gases: nitrous oxide, volatile halogenated hydrocarbons (suchas halothane, isoflurane, and enflurane), which have largely replaced etherand chloroform. These are used in hospital operating theatres, duringchildbirth in maternity hospitals, in ambulances, in general hospital wardsduring painful procedures, in dentistry, for sedation, etc. Ethylene oxide - Applications - for sterilization of surgical equipment andmedical devices, in central supply areas, and, at times, in operating rooms. Oxygen - Stored in bulk tank or cylinders, in gaseous or liquid form, orsupplied by central piping. Application - inhalation supply for patients. Compressed air - Applications - in laboratory work, inhalation therapyequipment, maintenance equipment, and environmental control systems. 13. Radioactive Wastes The use of radiation sources in medical and other applications is widespread throughout theworld. Occasionally, the public is exposed to radioactive waste, usually originating fromradiotherapy treatments, that has not been properly disposed of. With new methods oftreatment the threat to such wastes will grow exponentially 14. Immunisation is vital to prevent disease and save lives. However, large scale vaccinationprograms can create enormous amounts of waste. Often, waste is open burned or donorsbuild cheap small scale incinerators which are used to burn syringes from the vaccinationprogram and other medical waste after the vaccination program is over, perpetuating theproblem of dioxin pollution. In June 2000, six children were diagnosed with a mild form ofsmallpox (vaccinia virus) after having played with glass ampoules containing expired smallpoxvaccine at a garbage dump in Vladivostok (Russia). Although the infections were not life-threatening, the vaccine ampoules should have been treated before being discarded. 15. Components of Bio-Medical Wastes Human Anatomical Waste (tissues, organs, body parts etc.) Animal Waste(as above,generated duringresearch/experimentation, from veterinary hospitals etc.) Microbiology and biotechnology waste, such as, laboratorycultures, micro-organisms, human and animal cell cultures, toxinsetc. Waste sharps, such as, hypodermic needles, syringes, scalpels,broken glass etc. Discarded medicines and cyto-toxic drugs Soiled waste, such as dressing, bandages, plaster casts, materialcontaminated with blood etc. Solid waste (disposable items like tubes, catheters etc. excludingsharps) Liquid waste generated from any of the infected areas Incineration Ash Chemical Waste 16. Environmental Concerns Spread of infection and disease throughvectors (fly, mosquito, insects etc.) whichaffect the in-house as well as surroundingpopulation. Spread of infection through contact / injuryamong medical/non-medical personnel andsweepers / rag pickers, especially from thesharps (needles, blades etc). Spread of infection through unauthorisedrecycling of disposable items such ashypodermic needles, tubes, blades, bottles etc. Reaction due to use of discarded medicines. Toxic emissions from defective / inefficientincinerators. Indiscriminate disposal of incineratorash / residues.