waste management

April 11, 2023 Capital Hospital 1

Capital Hospital Islamabad


Dr. Asif Tauseef Dr. Rizwan Elahi

Chohan

A Freelance Sensitization

Program


Healthcare waste (infectious and toxic

agents)

a grave threat to human health and environment if not disposed off properly

can result in outbreak of deadly diseases like AIDS,

cancer and hepatitis

Food for thought


Ray of hope

Unluckily, proper hospital waste management is almost non- existent in the country. In private sector hospital waste management program: Shalamar Hospital Lahore

United Christian Hospital Lahore An integrated network of 80 healthcare facilities is linked with this system.


Objectives Raising awareness of the participants towards

seriousness and urgency of the issue, Imparting basic knowledge about:

Types & magnitude of hospital waste, Risks associated with hospital waste, Healthcare waste management planning, Waste minimization, recycling and reuse, Handling, storage & transportation of HCW, HWM treatment options and facilities, Application of treatment & disposal of HCW, Linkages & coordination required to sustain a

HWM system,


“Hospital waste management (HWM) means the management of waste produced by hospitals using such techniques that will help to check the spread of diseases through it by disposing off its waste through scientific means.”

Definition


Waste management is a major problem on the globe, Pakistan is also facing this problem. Around 2.5 million tons of medical waste is annually produced from all sorts of health care facilities in the country, having bad effect on the environment by contaminating our land, air and water resources.

Overview


In Pakistan, hospital wastes are simply mixed with the municipal waste in collecting bins at roadsides for their disposal. No systemic measures are taken for the proper management of hospital waste.

Improper disposal of HCW


According to a report, the rate of generation of healthcare waste in Punjab is 1.8 KG/ day/ bed. The province houses 250 hospitals with a total capacity of 41,000 beds.

In Punjab…


Two major categories of healthcare waste:

Non- risk or non- hazardous waste- 85%includes paper and cardboard, packaging, food waste and aerosols, comparable to normal domestic garbage, presents no greater risk,

Risk or hazardous waste- 15%comprises of infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste and radioactive waste,

Types of HCW


This includes:

Cultures from laboratory work, Waste from surgery and autopsies, Waste from infected patients, Waste from infected hemodialysis patients, Infected animals from laboratories, Any material having been in contact with

patients,

Infectious waste


This includes:

Tissues, Organs, Body parts, Fetuses, Blood and body fluids, Lab culture,

Pathological waste


Needles, Syringes, Scalpels, Infusion sets, Saws & knives, Blades, Broken glass, Any other items that could cut or puncture,

Contaminated Sharps


This includes:

Expired or unused pharmaceutical products, Spilled or contaminated pharmaceutical

products, Surplus drugs, vaccines or sera, Discarded items used in the handling of

pharmaceuticals, e.g. bottles, boxes, gloves, masks, tubes or vials,

Pharmaceutical waste


Cytotoxic drugs & outdated material causing mutagenic and teratogenic effects, like Daunomycin, Chlorambucil, Cyclophosphamide etc,

Vomitus, feces or urine from patients treated with cytotoxic drugs.

Contaminated used material from preparation & administration of drugs such as syringes, vials and ampoules etc,

Genotoxic waste


X-ray developing, Chemotherapy, Anaesthesia, Sterilization, Laboratory solvents & Chemicals, Broken mercury containing equipment, Cadmium waste, mainly from discarded

batteries,

Chemical waste


Liquid, solid & gaseous wastes contaminated with radio-nucleotides are generated from:

In vitro analysis of body tissue/ fluids, In vivo body organ imaging and tumor

localization, Investigations/ therapeutic procedures regarding human Body organs and systems,

Radioactive waste


Radio-isotopes decay by emitting radiations

eventually become inert (non-radioactive)

ThusContainers of radioactive wastes are isolated in temporary collection areas with minimum exposure to individuals until the waste has decayed to the point that it can be disposed of in a designated labeled container.

What happens…


Hospital waste stream


These may be through:

A puncture, abrasion or cut in the skin, The mucus membranes, Direct inhalation, Oral ingestion,

Health impacts of HCW


Reuse of disposable syringes is a common practice in Pakistan. People pick up used syringes from the hospital waste and sell them, leading to spread of diseases,

The hospital staff should dispose the syringes off properly by cutting the needles of the syringes with the cutter to prevent their reuse,

A common practice


Doctors & nurses, Patients, Hospital support staff, Waste collection and

disposal staff, General public,

Who is at risk?


Breeding flies from rotting garbage, Mosquitoes, Dogs, cats and rats mostly living in or

around the refuse,

Who transmits disease


Potential health effects of hazardous waste are: Hepatitis B & C, AIDS, Gastro- enteric infections, Respiratory infections, Blood stream infections, Skin infections, Radioactive effects, Intoxication,

Public Health risks of HCW


Serious concern about infection with HIV & hep. B and C in sanitary workers

strong evidence of transmission, while dealing healthcare risk waste,

The virus is transmitted through reuse of contaminated syringes,

Shared use of disposable syringes by drug addicts,

HCW & communicable diseases


Appropriate measures should be taken for proper segregation, collection and disposal of healthcare waste through:

Suitable training, Clear standards, Tough enforcement,

What is the solution?


Waste Management Plan


Non- risk waste: 85%Dumped in suitable black container or a container lined with black plastic bag, and marked “NON- RISK WASTE.”

Risk waste: 15%

Dumped in suitable yellow container or a container lined with yellow plastic bag, and marked “DANGER! RISK WASTE.”

Identification


Waste Management includes:

Waste minimization and re-use, Waste segregation, Waste collection, Waste transportation, Waste storage, Waste disposal,

Waste Management


Waste minimization includes any source reduction or recycling activity by the waste generator to reduce: the quantity, orthe toxicity of the hazardous waste, thus minimizing present & future threats to human health and its environment.

Waste minimization


Risk waste should be separated from non- risk waste at source, i.e. ward bedside, operating theatre, laboratory etc, All disposable supplies like syringes, needles, drips and infusion bags should be cut or broken, rendering them non-reusable at source, Sharps including the cut or broken syringes and needles should be placed in high density plastic containers resistant to penetration or leakage,

Waste segregation


All sanitary staff and sweepers should, when handling waste, wear face masks, aprons, boots and heavy duty gloves,

Waste should be collected at least daily, but more often if necessary,

All bags must be appropriately labeled,

All the removed bags are immediately replaced with the new ones of the same type,

Waste collection


Infectious waste must be contained in double disposable plastic bags that are impervious to moisture. The bags must be strong enough to prevent ripping, tearing or bursting during normal use and handling. All disposal bags must be yellow and conspicuously labeled "Infectious Waste" or "Biohazard" with the international symbol.

Waste marking


Sealed plastic bags should be carefully loaded by hand onto the trolley,

Yellow bagged risk waste and black bagged non- risk waste should be collected on separate trolleys painted in their corresponding colors,

The collected waste should not be left even temporarily anywhere other than at the designated central storage facility,

The transportation of waste is properly documented,

Waste transportation


A central storage facility for risk waste: Be located within the hospital

premises close to the incinerator, Be large enough to contain all the risk

waste produced by the hospital, No material other than yellow bagged

waste should be stored there. No waste should be stored at the

central storage facility for more than 24 hours,

Waste storage


Various garbage treatment techniques available are:

Steam autoclaving, Chemical treatment, Microwave radiation, Infrared radiation/ Gamma

radiation, Incinerators, Deep burial or Landfill,

HCW treatment techniques


It is a most widely used technique and is most efficient alternative medical waste treatment technology. This jointly operates with a shredder and a compactor to reduce waste volume. The effects of heat from saturated steam and increased pressure decontaminate medical waste by inactivating and destroying microorganisms.

Steam autoclaving


An anti- microbial chemical such as sodium hypochlorite, chlorine dioxide or peracetic acid decontaminates the medical waste at ambient temperature.

Chemical treatment


Micro waving is an expensive system. Medical waste enters this system by batch or continuous mode where it is wetted with steam or water followed by irradiation to decontaminating temperatures.

Microwave radiation


Pathological waste, i.e. body parts, organs, fetuses, research animals etc. should be disposed off either by crematoria (burning of the body), or deep burial.

Pathological waste disposal


Incineration of solid medical waste can significantly reduce the quantity of waste that must be disposed in landfills, It should only be used when the incinerator units are in good working condition, are retrofitted with pollution control devices, and are properly operated and maintained. When waste containing plastic is burnt, Dioxin is produced which can cause cancer, birth defects, hearing deficits, and behavioral alterations in infants.

Incineration


General Features:

It should be housed in a building to protect it from rain,

Has two chambers, i.e. primary (800C) & secondary (1200C for 2 seconds),

Average stack height is 40 feet, or 10 feet higher than the nearest building,

Should be specifically designed to destroy all types of medical waste,

Incinerator


A modal incinerator

A complete system often includes a waste heat boiler for energy recovery, followed by an air pollution control system to remove acid gas.


Landfills should be located at sites with minimal risk of pollution of ground water and rivers, Access to the site should be restricted to authorized personnel only, Risk waste should be buried in a separate area of landfill under a layer of earth, The landfill should be regularly monitored for groundwater contamination and air pollution,

Landfills


Yellow-bagged waste should be inactivated or rendered safe before final disposal. Finally it should be disposed off by burning in an incinerator or by burial in a landfill,

All risk-waste delivered to an incinerator should be burned within 24 hours,

Ash/ residue from incinerator should be sent to designated landfill site,

Radioactive waste should either be buried in a landfill or incinerated after proper decay,

Sharps should be disposed off by encapsulation or any other method of disposal,

Waste disposal


Prevent or minimize, Re-use or recycle, Incinerate with heat recovery, Use alternative to incineration, Landfill the residues,

Waste hierarchy


Infectious waste is to be disposed of in four ways:

Incineration in a controlled-air, multi- chambered incinerator that provides complete combustion, Burial in a Class I or Class II disposal site as regulated by the state, Discharge to a sewage system if the waste is liquid or semi-liquid, and Sterilization in a steam sterilizer.

Disposal plan


Disposal of liquid medical waste like blood and body fluids, ground pathological tissues, dialysate, and some laboratory fluids in sewer systems should only be followed when the sewage is treated at a treatment facility to render the waste non-infectious. Contaminated sharps are landfilled or incinerated. These sharps are not compacted prior to landfilling as the waste often contains residual fluids. Landfilling is used for the final disposal of many types of solid medical waste, including treated glassware, containerized sharps, boxed animal carcasses, packaged blood-soaked materials, incinerator ash, and treated, boxed cultures and stocks.

Remember…


“Every hospital shall stand responsible for the proper management of the waste generated by it till its final disposal in accordance with the

provisions of the Healthcare Waste Management Guidelines.”

Responsibility of waste management


Keeping your Hospital

&

isin our own hands


Wash hands and other body parts thoroughly with soap & water which have been contaminated with blood or other body fluids,

Cover all open wounds & lesions on hands and arms with a waterproof dressing,

Wear mask while handling a patient for your own safety,

Wear good quality, durable gloves, and dispose them off after use,

Preventing risks…

Contd.


If gloves are not disposable, they should be properly sterilized before reuse,

Heavy duty gloves should be used when working with sharps to avoid accidental injuries,

Disposable syringes should be used for injections and drawing samples of blood,

Proper disposal of he syringes should be carried out,

Needle should neither be recapped nor removed from the syringe,

Preventing risks…


Our hospital incinerator facility

Unit was installed in early eighties,

Effectively meeting hospital’s healthcare waste disposal needs to a larger extent.


Hospital incinerator

Made in Hungary


Incinerator kiln


Garbage at random


Waste collection in hospital


Birds hovering on waste bin


Our future at stake

Deadly Waste Bins


Oh God, protect us from deadly diseases


Good waste management in hospital depends on:

A dedicated waste management team, Good administration, Careful planning, Sound organization, Underpinning legislation, Adequate financing, Full participation by trained staff,

Healthcare waste management


Create an awareness among healthcare providers regarding hazards of hospital waste,

Constitute a team for HCW management,

Ensure appropriate handling, collection and disposal of waste, both non- risk & risk,

Monitor periodically,

Doctor’s responsibilities


Save Environment!