HANDLING AND DISPOSAL OF HEALTH CARE WASTE

OBJECTIVES At the end of this course, the student should be able to Define medical waste Discuss the various categories of individual at risk of infection due to mishandling of medical waste Outline the stages in the management of medical waste Discuss the importance of colour coding in medical waste management.

WHO estimates that, in 2000, injections with contaminated syringes caused 21 million hepatitis B virus (HBV) infections, two million hepatitis C virus infections and HIV infections worldwide. Many of these infections were avoidable if the syringes had been disposed of safely.

In developing countries, additional hazards occur from scavenging at waste disposal sites and the manual sorting of hazardous waste from health-care establishments. The waste handlers are at immediate risk of needle-stick injuries and exposure to toxic or infectious materials.

Poor management of health care waste poses public health risks; they may be scavenged and reused or children may play with them.

Management of Health Care Waste Poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries and risks polluting the environment. It is essential that all waste materials are segregated at the point of generation, appropriately treated and disposed of safely (WHO, 2013)

Management of Health Care Waste Medical waste is all waste material generated at health care facilities such as hospital, clinics, blood banks, medical research facilities and laboratories. It is any waste generated in the diagnoses, treatment or immunization of human beings or animals, in the testing of biologicals. E.g. blood-soaked bandages culture dishes and other glassware discarded surgical gloves

Management of Health Care Waste discarded surgical instruments discarded needles used to give shots or draw blood (e.g., medical sharps)medical sharps cultures, stocks, swabs used to inoculate cultures removed body organs (e.g., tonsils, appendices, limbs) discarded lancets

Management of Health Care Waste All staff have a responsibility to handle and dispose of waste in a manner that poses minimal hazard to clients, visitors, other health care workers and the community at large. Proper disposal of waste: 1. Minimizes the spread of infections and reduces the risk of accidental injury to s

Management of Health Care Waste 2. Helps provide an aesthetically pleasing atmosphere 3. Reduces odours 4. Attracts fewer insects and animals 5. Reduces the likelihood of contamination of the soil or ground water with chemicals or microorganisms

Management of Health Care Waste Three (3) kinds of waste are generated in the health facilities: 1. General Waste: non-hazardous waste that poses no risk of injury or infection. E.g. paper, boxes, packaging materials, bottles, food related trash etc. 2. Medical Waste: these are materials generated in the diagnosis, treatment or immunization of clients. They include: Blood and blood products as well as other body fluids; materials containing blood or body fluids e.g bandages and surgical sponges

materials containing blood or body fluids e.g bandages and surgical sponges

Management of Health Care Waste Organic waste/pathological waste such as human tissue, body parts, placentas and products of conception. Sharps such as hypodermic suture needles, scalpel blades, blood tubes, glass slide, vials and ampoules.

Management of Health Care Waste 3. Hazardous Waste/Toxic Waste: these are chemical waste that is potentially toxic or poisonous e.g. expired drugs and vaccines, cleaning products, disinfectants, cytotoxic drugs and radioactive compounds.

Components Of Medical Waste Management Health care waste management system comprises of the following components: 1. Collection and segregation 2. Transportation 3. Storage 4. Treatment 5. Final disposal

Components Of Medical Waste Management Collection and Segregation: different types of waste require different methods of disposal; hence it is important that waste is sorted or separate waste into the various categories at the point of generation for effective disposal. For effective sorting of waste in the health facilities, colour coding system is adopted so that each type of waste is placed immediately (or at the point of waste generation) into the appropriate colour-coded container.

colour coding system waste bins: waste is sorted at the point of waste generation into the appropriate colour- coded bin.

Category Container and Colour Code Category General waste Sharps other infectious waste Pharmaceutical and chemical containers Container and Colour Code Black plastic bag and bin Yellow puncture resistant containers Yellow plastic bags and or bins Brown plastic bags and or bin The Approved Colour Codes For Ghana Health Service Medical Waste Management

Management of Health Care Waste Containers for collecting health care waste should : Be non transparent Be impervious Be leak proof Have close fitted lids Have sufficient strength to prevent easy damage during handling or use.

Storage: storage takes place from the time of generation of waste until collection for final disposal. Waste is stored both internally and externally. Internal storage occurs when waste is temporarily placed at the site of generation pending transportation to external storage site. During internal storage: Waste should not be kept for more than 24 hours Waste bins should be emptied when 2/3 full (or daily if not 2/3 full) and bins cleaned and disinfected

Do not put your hands in the waste bins to remove anything from it once waste is dropped into it. NB: every unit/ward should have appropriate and adequate number of waste bins with lids placed at vantage points protected from rain and pests. External storage refers to the site where waste is stored until it is transported for treatment or final disposal. The external storage site should be fenced and locked to protect from humans and animals. The floor should be smooth, impervious and easy to clean.

Transportation: health care waste must be transported directly to disposal or treatment site within the shortest possible time. Vehicles (e.g. wheel barrow) used for transportation should be such that scattering of waste is prevented; they must also be odour and leak proof. Treatment: the recommended treatment options are: Incineration Sterilisation by autoclave or dry heat Chemical disinfection

Final Disposal of Waste Disposal of Solid Waste: the best disposal methods for treated health care waste are controlled disposal at sanitary landfills or burial. Sharps, pharmaceutical as well as pathological waste must be incinerated Disposal of Liquid Waste: guidelines for disposal of liquid waste include the following: Carefully pour liquid waste down a sink dedicated for the purpose, drain, water closet or latrine; otherwise, bury it in a pit along with slid waste.

Rinse the sink, drain or toilet thoroughly with water to remove residual waste, still avoiding splashing Clean these areas with a disinfectant cleaning solution at the end of each day or more frequently if heavily used or soiled Decontaminate the containers that held the liquid waste by filling with or soaking it for 10minutes in 0.5% chlorine solution before washing. Wash your hands after handling liquid waste and decontaminate and wash gloves.

Other wastes  Placenta or body parts should be incinerated or buried in a safe area:  Chemical wastes should be treated as for liquid waste  Genotoxics should be disposed of in consultation with experts.

USE AND DISPOSAL OF SHARPS Sharps include needles, scapels blades, scissors, lancets etc. In health care settings, injuries from these sharps are the nunber-one cause of infections in staff from bloodborne pathogens. All staff who touch sharps are at risk of infection. The following are some of the activities through which injuries from sharps can occur:  During recapping, bending, or breaking of hypodermic needles

When carrying unprotected sharps When sharps are kept at unexpected places e.g. in linen During procedures in they use many sharps, cannot see their hands or when they are working in small confined places When they handle or dispose of waste that contains used sharps When clients move suddenly during injections.

Safe Handling of Sharps To reduce the risk or injuries from sharps (needles, lancet, scapel blades etc.), sharps especially syringes should not be recapped, burnt or cut. Place sharps in the sharps containers (puncture resistant containers) placed at convenient places. The sharps containers should be disposed when ¾ full.

Safety Box for Sharps

ANY QUESTIONS?