Presentation on theme: "Disposal of Clinical Wastes: Tata Memorial Hospital Experience"— Presentation transcript:
1 Disposal of Clinical Wastes: Tata Memorial Hospital Experience Dr Rohini KelkarM.D., D.P.B.Professor & Head, Dept of MicrobiologyTata Memorial Hospital, Mumbai
2 “No one was ever really taught. Each has to teach himself.”Swami VivekanandaThe RealityIgnoranceCommercialization of scienceApathyThe ConcernsOccupationalPublic healthEnvironmental
3 The ScienceThe only documented risk of transmission of infections from waste to healthcare workers is through sharpsThere is however a potential for transmission of several microbial infections due to dumping of untreated wastes by healthcare facilities.Mixing of a small quantity of infectious waste with municipal garbage converts the entire waste to “ infectious”Segregation of wastes at source followed by appropriate treatment is the key to the success of a waste management strategy
11 Safe Disposal of Sharps: Do not recap needles. About Sharps:The only documented transmission of infection from waste to HCWs is through sharp injuries. Thus safe disposal of sharps is the first priority.Sharp injuries:Before or during use (17%)After Use but before disposal (70%)During or after disposal (13%)(Our Experience: Majority of sharp injuries occur due to improper disposal and waste handlers are the victims)5. ENSURE WORKER SAFETY THROUGH EDUCATION, TRAINING AND PROPER PERSONAL PROTECTIVE EQUIPMENTSafe Disposal of Sharps:Do not recap needles.If essential learn the right way to do so.
12 6. PROVIDE SECURE COLLECTION AND TRANSPORTATION Collection network..6. PROVIDE SECURE COLLECTION AND TRANSPORTATION
13 7. DEVELOP PLANS AND POLICIES Waste management Strategy:Reduce Risks and Liabilities: This should be detailed through written policies and continuing training and education of hospital staff.Control Costs: Audit of current practices, search for waste minimization practices is a continuing process.Plan for Future: Look for alternative technologies, co-operative facilities and means of diversification.Commitment towards protecting Human Health and the Environment7. DEVELOP PLANS AND POLICIES
14 Infection Awareness Week 8. INVEST IN TRAININGStreet Play
24 7. Economics Category Rating Weight Score 7.1 Capital Costs 7.2 Annual Costs7.3Life-Cycle CostsGRAND TOTAL SCORE
25 Inauguration of Tata Memorial Hospital waste treatment facility On September 10, 1999, well before the first dead line set by the Ministry of Environment and Forest, 31 December 1999.
26 Selection of Technology and Implementation is not the setting sun Evaluation is a continuous process
27 TMH Waste Audit Nov. 1999 to Dec. 2007 20002001200220032004200520062007Max. medical waste collected in a day341394350362396530429514Average no. of loads required/day54Average medical waste treated in kgs/day217224176241250289253277Average medical waste collected in a month5,4985,6435,2665,9176,2847,2256,3696,959Percentage down time of the system126.96.36.199.88.2101.2Total infectious waste treated – 614 tonnes. 83,511 kg. in Cost of treatment = Rs / kg.
28 TMH Infectious Waste Audit 2008 - 2009 Max. medical waste collected in a day447505Average no. of loads required/day4Average medical waste treated in kgs/day298304Average medical waste collected in a month7,6237,674Percentage down time of the system0.33Total infectious waste treated = 800 tonnes.Cost of treatment = Rs. 14 / kg.
29 TMH Waste ManagementWaste is Sterilized, Dehumidified, Shredded and reduced in terms of Weight and Volume by 75%.It is not recognizable as Medical Waste
31 Environment NewsOn 15 April, 2005, a 51 year-old asbestos laden ship, Kong Fredrick IX was on its way to Alang ship breaking yard, Gujarat for scrapping.The ship's new owners Jupiter Ship Management, a Mumbai based company, had renamed it to 'MV Riky'.Connie Hedegaard, Denmark's environment minister alerted the Indian environment minister saying,"I believe our interests are joint - and I call on you to co-operate in this case by denying the ship to be dismantled in India - and refer the ship to return to Denmark to be stripped of the hazardous waste."Greenpeace March 7th, 2001KODAIKANAL, India -- Greenpeace today accused Anglo-Dutch multinational Unilever, owners of Lipton Tea and Dove soap, of double standards and shameful negligence for allowing its Indian subsidiary, Hindustan Lever, to dump several tonnes of highly toxic mercury waste in the densely populated tourist resort of Kodaikanal and the surrounding protected nature reserve of Pambar Shola, in Tamilnadu, Southern India.
32 India’s significant economic growth and rise in industrialization coupled by lax government enforcement of anti-pollution laws and regulations have had a detrimental effect on India’s natural environment.Hazardous waste from industrial processes, medical waste and India’s thriving scrap recycling businesses pollutes Indian air, soils and waterways.
33 India is a signatory to the three conventions on hazardous chemicals and waste: The Basel Convention on the Control of Trans-boundary Movement of Hazardous Waste and their Disposal,The Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade andThe Stockholm Convention of Persistent Organic Pollutants.
34 The Hazardous Substances Management Division (HSM) of the Ministry of Environment and Forests (MoEF) has the responsibility for promoting safe management and use of hazardous substances, including hazardous waste.The HSM has established three sets of rules:The Hazardous Wastes (Management and Handling) Rules (1989, amended in 2003),The Bio-medial Wastes (Management and Handling) Rules (1998/2000), andThe Batteries (Management and Handling) Rules (2001).
35 The HSM relies primarily on the The Central Pollution Control Board (CPCB),The State Pollution Control Boards (SPCBs) or State Pollution Control Committees (SPCCs), andThe environmental departments in India’s 25 statesto implement, monitor and prosecute.
36 Approximately 5 million tonnes of hazardous waste is produced annually in India. According to a 2003 report, Indian industries in the following five states had generated over 80% of the country’s hazardous waste:Andhra Pradesh,Gujarat,Karnataka,Maharashtra andTamil Nadu.
37 European Commission focus on waste management LandfillCompostingIncinerationRecyclingTransportationAirEmission of CH4, CO2; odoursEmission of SO2, NOx, HCl, HF, NMVOC, CO, CO2 N2O, dioxins, dibenzofurans, heavy metals(Zn, Pb, Cu, As)Emissions of dustEmissions of dust NOx, SO2, release of hazardous substances from accidental spillsWaterLeaching of salts, heavy metals, biodegradable and persistent organics to groundwaterDeposition of hazardous substances on surface waterWaste water dischargesRisk of surface water and groundwater contamination from accidental spillsSoilAccumulation of hazardous substances in soilLandfilling of slags, fly ash and scrapLandfilling of final residuesRisk of soil contamination from accidental spillsPitfalls of the currently available technologies for managing wastes
38 European Commission focus on waste management LandfillCompostingIncinerationRecyclingTransportationLandscapeSoil occupancy; restriction on other land usesVisual intrusion; restriction on other land usesVisual intrusionTrafficEcosystemsContamination and accumulation of toxic substances in the food chainRisk of contamination from accidental spillsUrban areasExposure to hazardous substancesNoiseRisk of exposure to hazardous substances from accidental spills; trafficPitfalls of the currently available technologies for managing wastes
39 E-waste How green is your Apple E-waste How green is your Apple? Aug 25th 2006 From The Economist print edition
40 God proposes, man disposes Waste and tasteDec 11th From Economist.comThe rubbish tip as cultural artefactFRESH Kills landfill in New York, until recently the biggest rubbish tip on earth, was said to be one of the very few man- made objects visible from space, along with the Great Wall of China.
41 LIST OF WASTE SUBSTANCES WITH CONCENTRATION LIMITS Class A Concentration limit: 50 mg/kg A1 Antimony and antimony compounds A2 Arsenic and arsenic compounds A3 beryllium and cadmium compounds A4 Cadmium and beryllium compounds A5 Chromium (VI) compounds A6 Mercury and mercury compounds A7 Selenium and selenium compounds A8 Tellurium and tellurium compounds A9 Thallium and thallium compounds A10 Inorganic cyanide compounds (cyanides) A11 Metal carbonyls A12 Napthalene A13 Anthracene A14 Phenanthrene A15 Chrysene, benzo(a) anthracene, fluoranthene, benzo(a) pyrene, benzo(K)fluoranthene, indeno(1, 2, 3-ed) pyrene and benzo(ghi)perylene A16 Halogenated fused aromatic rings, e.g. polychlorobiphenyls plus derivatives A17 Halogenated aromatic compounds A18 Benzene A19 Dieldrin, aldrin, and endrin A20 Organotin compoundsMinistry of Environment & Forests:Hazardous Wastes (Management and Handling) Amendment Rules, 2002
42 LIST OF WASTE SUBSTANCES WITH CONCENTRATION LIMITS Class BConcentration limit: 5,000 mg/kg B1 Chromium (III) compounds B2 Cobalt compounds B3 Copper compounds B4 Lead and lead compounds B5 Molybdenum compounds B6 Nickel compounds B7 Tin compounds B8 Vanadium compounds B9 Tungsten compounds B10 Silver compounds B11 Organic halogen compounds B12 Organic phosphorus compounds B13 Organic peroxides B14 Organic nitro-and nitroso-compounds B15 Organic azo-and azo-oxy compounds B16 Nitriles B17 Amines B18 (Iso-and thio-) cyanates B19 Phenol and phenolic compounds B20 Merceptans B21 Asbestos B22 Drilling, cutting, grinding and rolling oil or emulsions thereof B23 Halogen-silanes B24 Hydrazine(s) B25 Fluorine B26 Chlorine B27 Bromine B28 White phosphorus B29 Ferro-silicon and alloys B30 Manganese-silicon B31 Halogen-containing substances which produce acidic vapours on contact with damp air or water, e.g. silicon tetrachloride, aluminum chloride, titanium tetrachlorideMinistry of Environment & Forests:Hazardous Wastes (Management and Handling) Amendment Rules, 2002
43 LIST OF WASTE SUBSTANCES WITH CONCENTRATION LIMITS Class CConcentration limit: 20,000 mg/kgC1 Ammonia and ammonium compounds C2 Inorganic peroxides C3 Barium compounds, except barium sulphate C4 Fluorine compounds C5 Phosphorus compounds, except the phosphates of aluminum, calcium and iron C6 Bromates, (hypo)bromites C7 Chlorates, (hypo)chlorites C8 Aromatic compounds C9 Organic silicon compounds C10 Organic sulphur compounds C11 Iodates C12 Nitrates, nitrites C13 Sulphides C14 Zinc compounds C15 Salts of per-acids C16 Acid halides, acid amides C17 Acid anhydridesMinistry of Environment & Forests:Hazardous Wastes (Management and Handling) Amendment Rules, 2002
44 LIST OF WASTE SUBSTANCES WITH CONCENTRATION LIMITS Ministry of Environment & Forests:Hazardous Wastes (Management and Handling) Amendment Rules, 2002Class DConcentration limit: 50,000 mg/kg D1 Sulphur D2 Inorganic acids D3 Metal bisulphates D4 Oxides and hydroxides except those of: hydrogen, carbon, silicon, iron, aluminum, titanium, manganese, magnesium, calcium D5 Aliphatic and napthenic hydrocarbons D6 Organic oxygen compounds D7 Organic nitrogen compounds D8 Nitrides D9 Hydrides
45 LIST OF WASTE SUBSTANCES WITH CONCENTRATION LIMITS Ministry of Environment & Forests:Hazardous Wastes (Management and Handling) Amendment Rules, 2002Class ERegardless of concentration limitE.1 Highly flammable substances E.2 Substances which generate dangerous quantities of highly flammbale gases on contact with water or damp air.
46 LIST OF PROCESSES GENERATING HAZARDOUS WASTES Ministry of Environment & ForestsHazardous Wastes (Management and Handling) Amendment Rules, 20031Petrochemical processes and pyrolytic operations2Drilling operation for oil and gas production3Cleaning, emptying and maintenance of petroleum oil storage tanks including ships4Petroleum refining/re-refining of used oil/recycling of waste oil5Industrial operations using mineral/synthetic oil as lubricant in hydraulic systems or other applications6Secondary production and/or use of zinc7Primary production of zinc/lead/copper and other non-ferrous metals except aluminium8Secondary production of copper9Secondary production of lead10Production and/or use of cadmium and arsenic and their compounds11Production of primary and secondary aluminium
47 LIST OF PROCESSES GENERATING HAZARDOUS WASTES Ministry of Environment & ForestsHazardous Wastes (Management and Handling) Amendment Rules, 200312Metal surface treatment, such as etching, staining, polishing, galvanising, cleaning, degreasing, plating, etc.13Production of iron and steel including other ferrous alloys (electric furnaces; steel rolling and finishing mills; Coke oven and by product plant)14Hardening of steel15Production of asbestos or asbestos-containing materials16Production of caustic soda and chlorine17Production of acids18Production of nitrogenous and complex fertilizers19Production of phenol20Production and/or industrial use of solvents21Production and/or industrial use of paints, pigments, lacquers, varnishes, plastics and inks22Production of plastic raw materials
48 LIST OF PROCESSES GENERATING HAZARDOUS WASTES Ministry of Environment & ForestsHazardous Wastes (Management and Handling) Amendment Rules, 200323Production and/or industrial use of glues, cements, adhesive and resins24Production of canvas and textiles25Industrial production and formulation of wood preservatives26Production or industrial use of synthetic dyes, dye-intermediates and pigments27Production or industrial use of materials made with organo-silicone compounds28Production/formulation of drugs/ pharmaceuticals29Production, use and formulation of pesticides including stock-piles30Leather tanneries31Electronic Industry32Pulp & Paper Industry33Disposal of barrels / containers used for handling of hazardous wastes / chemicals34Purification processes for air and water35Purification process for organic compounds/solvents36Waste treatment processes, e.g. incineration, distillation, separation and concentration techniques
49 REPORT ON CLINICAL WASTE AUDIT 2005 Infectious waste treated from Jan-Dec 200586,704 KilogramsAverage waste treated per month7,225 KilogramsWeight of sharps treated in 20052,917 KilogramsAverage weight of sharps treated per month243 KilogramsBlood & blood products300 litersLiquid Wastes:Total effluent per month164 lakh litresLaundry effluent per month3 lakh litresX’ray developer per month140 litresHazardous liquids consumed in labs per month588 litresHazardous chemicals as solids weight per month260 gramsDilution factor of hazardous liquids 27,333.
52 In Conclusion: Key Issues Awareness and educationReporting systems & documentationSegregation of identified clinical infectious wastes at sourceTimely treatment by non-polluting technologies on-site or off-siteWaste auditWaste monitoring systemsElevation of safety standards by all healthcare facilitiesAll HCWs must have “hygiene in their genes”.
53 “ Men occasionally stumble over the truth but most of them pick themselves up and hurry off as if nothing has happened.”- Sir Winston Churchill.