Presentation on theme: "World Health Organization"— Presentation transcript:
1 World Health Organization 11 November, 2018Module 5Health care waste managementWASH FIT
2 Objectives Identify all types of healthcare waste Describe the steps of waste managementDescribe a waste management plan
3 Typical Healthcare Waste Compositions Between 75% and 90% of the waste produced is similar to domestic waste and usually called ‘non- hazardous’ or ‘general health care waste’ 10-25% of health care waste is regarded as ‘hazardous’ and may pose a variety of environmental and health risksSource: Safe management of waste from health-care activities, WHO, 2014
4 Non-hazardous / general waste Waste that does not pose any particular biological, chemical, radioactive or physical hazardCan be disposed of as household waste/garbage through the available landfills/waste disposal sites set by cities / municipalities or waste pits at the facilityExamplesPackaging materials (paper, cartons, sacks…)Plastic bottles and cansFood remainsDry grasses and fallen leavesOutdated equipment/furniture that does not contain hazardous elements (doors, office cabinets, sofa, etc.)
5 Hazardous waste Causes various health and environmental risks Requires special care from the point of generation until final disposalRequires treatment prior to final disposalCategoriesInfectious wasteSharp wastePathological wastePharmaceutical and cytotoxic wasteChemical wasteRadioactive waste
6 Hazardous waste Category Examples Sharps waste Infectious waste Used or unused sharps (i.e. hypodermic, intravenous or other needles; auto-disable syringes; syringes with attached needles; infusion sets; scalpels; pipettes; knives; blades; broken glassInfectious wasteWaste suspected to contain pathogens and pose a risk of disease transmission(i.e. waste contaminated with blood and other body fluids; laboratory cultures and microbiological stocksPathological wasteHuman tissues, organs or fluids; body parts; foetuses; unused blood productsPharmaceutical waste, cytotoxic wastePharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceuticalsCytotoxic waste containing substances with genotoxic properties, e.g. waste containing cytostatic drugs (often used in cancer therapy); genotoxic chemicalsChemical wasteWaste containing chemical substances (i.e. laboratory reagents; film developer; disinfectants that are expired or no longer needed; solvents; waste with high content of heavy metals, e.g. batteries; broken thermometers and blood pressure gauges)Radioactive wasteWaste containing radioactive substances (i.e. unused liquids from radiotherapy or laboratory research; contaminated glassware, packages, or absorbent paper; urine and excreta from patients treated or tested with unsealed radionuclides; sealed sources)
8 Waste minimizationThis is the first and best way to reduce healthcare waste quantities and costsPurchases of material and supplies should be made with waste reduction in mindIssuing of supplies should follow first expire, first out (FEFO) and first in, first out (FIFO) rulesEncouraging the use of tablet medication as an alternative to injection to reduce sharps wasteEncourage recycling and reuse of non-infectious materials (e.g. glass, plastic and cardboard)Example of purchases with waste reductions: quantity of syringe (box size; 1 box of 100 instead of 5 box of 20), most frequently use sizes of PPE items in larger quantity
9 SegregationDifferent types of waste require different handling, treatment and disposalMust start at the sourceAll waste must be segregated into these categories:Basic (all patient care areas) = 3 binsBin for general waste (black bag in a bin)Bin for infectious waste (yellow bag in a labeled pedal bin)Sharp container or needle cutterSpecial areasAnatomical or pathological (operating theatre and labor rooms)Chemical waste e.g. mercury containing waste or x-ray liquidsPharmaceutical waste (pharmacy, wards)Exceptional waste segregationCytotoxic Waste (oncology, pharmacy), Radioactive (oncology – cancer treatment unit)Need to be review…
10 Three-bin System (Basic healthcare waste categories) Black Lined container Yellow Lined Container
11 Handling – basic principles Wear appropriate personal protective equipment (PPE)Handle waste with carePractice hand hygiene before and after handling wasteDo not re-sort wasteNever carry waste bags/containers against bodyAvoid heavy loads (use transport tools)
12 Collection A schedule should be available for reference Waste bags should be collected when 3/4 full or at least dailySharp waste should be collected when the container is 3/4 fullTie bags securelyAfter removing the waste bag, replace with a new one
13 Transport Wear appropriate PPE Transport waste with covered trolley, wheel barrow, wheeled bin, or a cartSeparated transport of hazardous and non-hazardous wasteTransport equipment should be dedicated for waste transportation onlyThe equipment must be cleaned and disinfected at the end of each working dayAdd picture
14 Storage of Infectious and Sharp Waste Inaccessible to unauthorized persons, animals, insects and birdsSign with biohazard symbolFloor and walls are sealed or tiled to allow easy disinfectionKeep well ventilated & protected from rainRestrict access-lock at all timesUse for waste onlyLarge enough to cater for over-flow waste due to collection and treatment breakdowns.
15 StorageStorage times for infectious waste (e.g. the time gap between generation and treatment) should not exceed the following periods:Temperate climate:72 hours in winter48 hours in summerWarm climate:48 hours during the cool season24 hours during the hot seasonSource: Safe management of waste from health-care activities, WHO, 2014
16 General waste storage areas Sized according to the quantities of waste generated and the frequency of collectionFenced and pavedEasy access for municipal waste collection trucksIn case of recycling activities separate areas for recyclables should be available
17 Treatment - Incineration An incinerator is the ideal method for burning infectious and sharp wasteThe incinerator should have two burning chambersThe location of the incinerator should be away from the medical wards and public housingWear heat-resistant gloves when handling flammable materialIt is essential to make sure that total incineration has taken placeBasic waste treatment technology. WASH 28
18 Alternative treatment technologies Autoclaves (steam treatment technology)Gravity displacement autoclaves (with and without integrated shredder systemsPre-vacuum or high vacuum autoclavesPressure pulse autoclavesMicrowave treatment technologiesFrictionated heat treatment technologies
19 Final disposal methods Ash pit: Disposal of incineration ashLandfill or waste burying pit: Disposal of general waste including the autoclaved wasteBurning pit: Disposal of waste only during emergency in the absence of incinerators/autoclaves. It causes higher smoke pollution and other health risksEncapsulation: Disposal of expired vaccines, medications by adding immobilizing materials i.e. cement and seal the containerPlacenta pit: Disposal of placenta and body parts
20 Example drawings: Pits Source: Technical Specifications, Healthcare Without Harm / MSF
21 Final disposal methods - Landfill Lined to prevent leachate from contaminating the environmentFor liquid waste where do we dispose??Cross-section of an active Landfill
22 What is wrong in this picture? Waste is:Not segregatedExposedNot treatedNot properlydisposed
23 Risk assessmentThink about your workplace, what can harm you, patients and their families?Which part of your body can be exposed to the harm?Which PPE items can protect you?Change questions
24 Healthcare Waste Officer A responsible person for the management of healthcare waste should be appointed (Healthcare Waste Officer – HWO)Roles and duties:Introduction of supervisionof safe handling methodsData recordingRegular training ofmedical and logistic staffDevelopment and revisionof a waste management planObserving thelegal regulationsSupervision of safe waste treatment and disposal
25 Content of a Waste Management Plan Aims and ObjectivesLegal background and ResponsibilitiesGenerated waste and waste amountsWaste handling proceduresSegregation, Collection, Transport, Storage, Treatment, DisposalOccupational SafetyEducation and AwarenessDocumentation and RecordingAction Plan and budget
26 WASH FIT Indicators (1)ESSENTIAL 2.11 A trained person is responsible for the management of health care waste in the health care facility. 2.12* Functional waste collection containers for 1) non-infectious (general) waste, 2) infectious waste and 3) sharps waste in close proximity to all waste generation points Waste correctly segregated at all waste generation points Functional burial pit/fenced waste dump or municipal pick-up available for disposal of non-infectious (non-hazardous/general waste).
27 WASH FIT Indicators (2)ESSENTIAL 2.15* Incinerator or alternative treatment technology for the treatment of infectious and sharp waste is functional and of a sufficient capacity Sufficient energy available for incineration or alternative treatment technologies (mark if not applicable) ADVANCED 2.17 Hazardous and non-hazardous waste are stored separately before being treated/disposed of or moved off site. 2.18* All infectious waste is stored in a protected area before treatment, for no longer than the default and safe time.
28 WASH FIT Indicators (3)ADVANCED 2.19* Anatomical-pathological waste is put in a dedicated pathological waste/placenta pit, burnt in a crematory or buried in a cemetery (if applicable). 2.20* Dedicated ash pits available for disposal of incineration ash (if applicable) Protocol or SOP (Standard Operating Procedure) for safe management of health care waste clearly visible and legible. 2.22* Appropriate protective equipment for all staff in charge of waste treatment and disposal.
29 WASH FIT Indicators3.10 Dedicated ash pits available for disposal of incineration ash (mark if not applicable) 3.11 Protocol or SOP (Standard Operating Procedure) for safe management of health care waste clearly visible and legible Appropriate protective equipment for all staff in charge of waste treatment and disposal.