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Managing Medical Waste

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Presentation on theme: "Managing Medical Waste"— Presentation transcript:

1 Managing Medical Waste
1 Managing Medical Waste Session 5: Infection Control Basics

2 Learning Objectives 2 Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority Learn ways to minimise waste Know the criteria for safe management of sharps 5: Managing Medical Waste

3 Part I: Health Care Waste Overview
3 Part I: Health Care Waste Overview

4 Definitions of Waste Health care waste
4 Health care waste All types of waste from all health care activities Hazardous health care waste Waste that presents a health hazard of some kind Note: Most health care waste is no more hazardous than household waste 5: Managing Medical Waste

5 Types of Hazards to Consider
5 Flammable Toxic - mutagenic, cytotoxic, teratogenic, etc Reactive Allergen, contact sensitiser Explosive Infectious Radioactive Corrosive Caustic Alcohol Cancer chemotherapy, tar-based products Sulphuric acid, chlorine powder Glutaraldehyde Picric acid, fertiliser, ammonia TB cultures Barium enema, X-rays Bleach Lye 5: Managing Medical Waste

6 Hazardous Health Care Waste
6 Infectious hazard: Anatomic waste Laboratory cultures Sharps Live viruses Corrosive, teratogenic, reproductive hazard: Heavy metals Pesticides Cleaning products Pressurised containers Mercury Cancer therapy Can you give additional examples? Are there other types of hazards? 5: Managing Medical Waste

7 Is Health Care Waste an Important Source of Infectious Disease?
7 Yes! IF needles and syringes are scavenged and re-used, then many diseases can be spread Keep used sharps and syringes out of public access No! Most medical waste does not have more germs than household waste It causes visual pollution, generates fear, but unless re-use of sharps occurs, medical waste causes little disease 5: Managing Medical Waste

8 Then Why does this Waste Matter?
8 Sharps injuries may harm workers and communities Medical waste potentially impacts patients, workers, community, and economy because of the volume and permanence of waste 5: Managing Medical Waste

9 Health Care Institutions Generate about 3
Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day 9 Health care 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 Waste generated per day ranges from 0.2 kg to 10 kg 5: Managing Medical Waste

10 Which Waste to Address First?
10 IC Committees should START with infectious waste, especially used sharps and microbiological culture waste 5: Managing Medical Waste

11 How to Safely Dispose of Infectious Sharps
11 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 Note to facilitators: Refer participants to Handout 5.1 How to Dispose of Infectious Sharps in the Participant’s Manual Minimise unnecessary injections to reduce the number of sharps. Most injections are unnecessary! Do not recap sharps before disposal. Dispose of sharps at the point of use in a leak proof puncture proof container for sharps only. Avoid handling, emptying or transferring used sharps between containers since needlestick occur then. Autoclave highly infectious waste such as lab cultures from laboratories before disposal. Control public access to syringes and medical equipment to prevent re-use. Shred, encapsulate and bury according to national legislation. 5: Managing Medical Waste

12 For Non-Infectious Hazardous Waste, the Risks Depend on:
12 Severity of acute or chronic exposure Duration of exposure Frequency of exposure Concentration agent (1% versus 50%) Individual vulnerability including pregnancy, weight Route of exposure (skin, respiratory, oral, etc.) Steps taken to protect (PPE, relieved from immediate contact etc.) 5: Managing Medical Waste

13 Who is at Risk? Doctors - anesthesiologists, pathologists
13 Doctors - anesthesiologists, pathologists Nurses - oncology nurses, OT, ER Hospital support staff - X-ray assistants, pharmacy, morgue, and lab staff Cleaning staff - those cleaning sewage lines General public - those using sharps found in the waste 5: Managing Medical Waste

14 Common Hazards Anesthetic gases Glutaraldehyde Formaldehyde/formalin
14 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 5: Managing Medical Waste

15 12 Steps to Manage Hazardous Wastes before Disposal
15 1. Know what hazards you have 2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists 1. The first step is to know what hazards you have. Keep an inventory, perhaps though the purchasing office who can track what comes in. They will need assistance. 2. Don’t purchase hazards when alternatives exist. When a new thermometer is purchased, purchase an alcohol or digital thermometer. **Use mercury-free thermometers 5: Managing Medical Waste

16 12 Steps to Manage Hazardous Wastes (cont’d)
16 3. Limit use and access to trained persons with personal protective gear 5: Managing Medical Waste

17 4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards
17 5: Managing Medical Waste

18 5. Get Rid of Unnecessary Stuff
18 Don’t accumulate unneeded products Don’t let peroxides and oxidising agents turn into bombs Photo of bomb robot called into hospital to dispose of picric acid. 5: Managing Medical Waste

19 6. Label with Agent, Concentration and Hazard Warnings
19 Examples of hazard labels: 5: Managing Medical Waste

20 7. Communicate about Workplace Hazards
20 Job description Posters on doors Labels on hazards Give feedback on use of PPE and disposal in evaluation Role model safe use and disposal Contact point who is responsible Who is responsible at your work place regarding hazards? Has this role been assigned? 5: Managing Medical Waste

21 8. Recycle Products When Possible
21 Examples of labels for plastic: Type 1 and 2 are commonly recycleable. Other symbols: nickel cadmium batteries, paper, food and organic waste for gardening, CFC labels for refrigerant gas. Type 1 - PETE Polyethylene Terephthalate (PET) Soda & water containers, some waterproof packaging. Type 2 - HDPE High-Density Polyethylene Some syringes, Milk, detergent & oil bottles. Toys and plastic bags. Type 3 - V Vinyl/Polyvinyl Chloride (PVC) Some syringes. food wrap, vegetable oil bottles, blister packages. Type 4 - LDPE Low-Density Polyethylene Many plastic bags. Shrink wrap, garment bags. Type 5 - PP Polypropylene Refrigerated containers, some bags, most bottle tops, some carpets, some food wrap. Type 6 - PS Polystyrene Throwaway utensils, meat packing, protective packing. Type 7 - OTHER Usually layered or mixed plastic. No recycling potential - must be landfilled. 5: Managing Medical Waste

22 5: Managing Medical Waste

23 Group Discussion: Recycling
23 Why should recycling be promoted? Which products can be safely and cost effectively recycled in your facility? Refer to Facilitator’s guide 5: Managing Medical Waste

24 9. Segregate Hazards at the Source
24 Separate sharps and infectious waste where they are used This prevents injuries that can occur when people sort the trash after it is disposed Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members Once the waste Is separated (i.e. sharps), staff should not go through the waste by hand to remove things. Staff should not combine sacks of waste that have been separated. 5: Managing Medical Waste

25 10. Have Written Policies on Waste Disposal
25 Sharps and infectious waste Chemotherapy (cancer) Heavy metals (batteries) Chemicals Post brief, colorful instructions on walls to remind workers 5: Managing Medical Waste

26 11. Minimise the Handling of Wastes
26 Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly 5: Managing Medical Waste

27 12. Conduct Walk-Around Interviews
27 Ask about the hazardous substances staff work with, how they dispose of them, and what they need to be able to dispose of them properly Have a no-blame philosophy that strives to solve problems, NOT to assign blame 5: Managing Medical Waste

28 Part II: Waste Management Methods
28 Part II: Waste Management Methods This section includes a brief overview of possible waste management methods for those those redesigning a medical waste system.

29 Options for Specific Types of Waste
29 Pharmaceutical Cytotoxic Other chemical wastes Heavy metals Pressurised containers Radiation Infectious 5: Managing Medical Waste

30 Pharmaceutical Waste Small amounts:
30 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 5: Managing Medical Waste

31 Cytotoxic Waste NEVER LANDFILL or DISPOSE TO SEWER Disposal Options:
31 NEVER LANDFILL or DISPOSE TO SEWER Disposal Options: Return to supplier Incinerate at high temperature Chemical degradation 5: Managing Medical Waste

32 Chemical Waste - Further Recommendations
32 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 5: Managing Medical Waste

33 Wastes with Heavy Metals
33 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 specialised cottage industry or export to countries with specialised facilities Encapsulation 5: Managing Medical Waste

34 Pressurised Gas Containers
34 NEVER INCINERATE Return undamaged gas cylinders and cartridges to the manufacturer for reuse Damaged containers: empty completely and crush, landfill 5: Managing Medical Waste

35 Radioactive Waste Use requires a national strategy including:
35 Use requires a national strategy including: Appropriate legislation A competent regulatory organisation Trained radiation protection officer to monitor exposures Return to the manufacturer Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme 5: Managing Medical Waste

36 Simple Chemical Disinfection
36 Requires shredding of waste May introduce strong chemicals into the environment (chorine bleach turns into dioxin when burned) Efficiency varies Only the surface is disinfected Does not disinfect human tissue Special disposal required to avoid pollution 5: Managing Medical Waste

37 Waste Disposal Options Include
37 Disinfection – Autoclaving/ Microwaving, treatment, shredding Land Disposal Burial Encapsulation Incineration Inertisation Managed Land-fill On-site disposal 5: Managing Medical Waste

38 Infectious Waste: Autoclaving
Pressure and temperature Holding time Sterility indicators Type of waste Followed by shredding / burial / recycled 5: Managing Medical Waste

39 Commercial Disinfection Systems
39 Shred waste, treat chemically, encapsulate Possible advantages: Encapsulated residue can be placed in landfill Environmentally friendly Easy to operate Possible disadvantages: Requires specialised operators May be expensive 5: Managing Medical Waste

40 Burying Inside Hospital Premises
40 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 Management controls on what is dumped Each deposit covered with soil Site lined with low permeable material-concrete Groundwater pollution must be avoided Not recommended for untreated hazardous waste 5: Managing Medical Waste

41 Disposal to Land by Encapsulation
41 Fill metal or plastic containers to 3/4, add: plastic foam bituminous sand cement mortar clay material When dry, label and seal containers and landfill May be used for sharps, chemicals, drugs etc. 5: Managing Medical Waste

42 Incineration Combustible waste turned to ash at temps >800 C
42 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 Questions for discussion: What are alternatives to incineration for disposal of infectious waste? Are any of these solutions economically viable? If not, what recommendations would you have? 5: Managing Medical Waste

43 Do not Incinerate Do not incinerate the following:
43 Do not incinerate the following: Plastics especially halogenated plastics (e.g. PVC) Pressurised gas containers Large amounts of reactive chemical waste Radioactive waste Silver salts or radiographic waste Mercury or cadmium Ampoules of heavy metals 5: Managing Medical Waste

44 Advantages of Incineration of HC Waste:
44 Good disinfection efficiency Drastic reduction of weight and volume Good for chemical + pharmaceutical waste 5: Managing Medical Waste

45 Disadvantages of Incineration of HC Waste:
45 Doesn’t destroy chemical waste at lower temperature for rotary kiln Toxic air emissions if no control devices in place Maintaining temperature levels (and efficiency) in field incinerators is difficult, need to balance loads with non-hazardous materials High costs for high temperature incineration 5: Managing Medical Waste

46 Land-fill in Municipal Landfills
46 If hazardous health-care waste cannot be treated or disposed elsewhere: Designate a site for hazardous HC Waste Limit access to this place Bury the waste rapidly to avoid human or animal contact Investigate more suitable treatment methods 5: Managing Medical Waste

47 Because no Disposal Method is Easy or Completely Safe…
47 Prevention is best! Eliminate purchase by buying safer alternatives Recycle Use smallest quantities possible, use with engineering controls and Personal Protective Equipment Segregate hazards into separate waste streams at source Supervise disposal using best available ecologic option 5: Managing Medical Waste

48 For More Information: 48 Safe Management of wastes from health-care activities. Edited by A Prüss, E Giroult, P Rushbrook. Geneva World Health Organisation p. Available online. Includes a teachers guide A website managed by the working group on waste 5: Managing Medical Waste

49 More Free References 49 Health Care Waste Management at a Glance “First, do no harm.” WHO/V&B/02.26 Available at Contains information about the disposal options for sharps 5: Managing Medical Waste

50 Thank You!

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