Section B Implementing waste management system in a hospital Section B Implementing Waste Management...

Section B

Implementing waste management system in a hospital

Section BImplementing

Waste Management Systemin a Hospital

Section B

Implementing waste management system in a hospital

Project planStage1 – Inputs: Knowledge of the infrastructure of the

hospital/hospital layout Survey of the existing waste

management practices followed in the hospital

Waste survey in the hospital Formation of waste management

committee Setting up of Model Ward Procurement of waste treatment

equipmentB1

Section B

Implementing waste management system in a hospital

Project plan

Stage 2: Training of staff Installation of the waste management

system Regular training and awareness for

the hospital employees Monitoring the system

B2

Section B

Implementing waste management system in a hospital

Flow chart of the work planSurvey:Meeting with the heads of all departments

Forming a waste management committee

Rounds of wards to see the functioning

Creating a model ward

Suggest equipment procurement

Formal training for the nursing staff

Implementing the system throughout theHospital

B3

Section B

Implementing waste management system in a hospital

Waste management committee

Director and Medical Superintendent Infection Control Committee head Representative from Purchase

Department Nursing Supervisor Housekeeping Supervisor Representative from Personnel

Department

B4

Section B

Implementing waste management system in a hospital

Waste management policy

Each hospital should have policy that describes:

Steps taken to comply with the Rules Waste categorisation Staff’s training content and status Policy adopted on segregation, collection,

transport and storage of waste Names and duties of waste management

committee members Immunisation status of staff Format of accident reporting and follow

ups Overall monitoring formats of the system

B5

Section B

Implementing waste management system in a hospital

Occupational safety and health plan: a step towards safety

Requisite training Protective gear-should ensure safety,

should be well fitting and easy to use, to ensure usage

Safe work practices Administrative controls Immunisations Monitoring and evaluation of work

practices

B6

Section B

Implementing waste management system in a hospital

Why do a waste audit?

Helps in classification of waste Avoids and helps rectify over-

classification Highlights area specific

problems/needs Reflects on the level of segregation Possibility of exploring waste

minimisation Scopes of economic gains Helps locate points of

intervention/need based solutions Subsequent evolution of best

practices B7

Section B

Implementing waste management system in a hospital

Setting up a model ward

Choosing a ward Imparting training to all its staff Implementing the system: segregation

of waste, disinfection of infected plastic waste and sharps management

Monitoring and suggesting corrective measures

Implementing the system in the entire hospital

B8

Section B

Implementing waste management system in a hospital

Components of hospital waste management

Training and awareness of hospital staff

Initiating segregation of waste Disinfection and mutilation Secure storage and transportation of waste Sharps and hazardous waste management Final treatment and disposal Monitoring of the system

B9

Section B

Implementing waste management system in a hospital

Segregation

Different types of waste should be collected separately

Should be done at the point of generation

Different colored bins used to make it easy

Segregation ensures occupational & health safety

Segregation also reduces the cost of treatment and disposal

B10

Section B

Implementing waste management system in a hospital

Segregation: make a difference

Tips to ensure good segregation: Optimum number of bins; neither less

nor more All bins equally easy to use in terms

of handling and placement Clean bins Easy operation Different coloured

bins for each category of waste Proper labeling of bins Posters in the work area as a

constant reminder B11

Section B

Implementing waste management system in a hospital

Disinfection and mutilationDecentrally Chemical disinfection: bleach is a

good disinfectant WHO recommended concentration 1%

solution (10gms of bleach in 1 litre water) for 30 minutes

Centrally Alternative technologies, like

autoclave, microwave, hydroclave are preferable

Mutilation Mutilation to avoid illegal reuse

B12

Section B

Implementing waste management system in a hospital

Collection

Some thumb rules for collection: Designate different people for

collection of each type of waste Collection time preferably different Collection bins properly labelled and

different for each category Collection in closed containers Trolleys to be provided for movement Protective gear is a must during

collection

B13

Section B

Implementing waste management system in a hospital

Storage Rules prohibit storage of waste

beyond 48 hrs

Storage site:

Should have proper warning in front Should be accessible by vehicles Should not be accessible to animals or

visitors Should be covered and lockable The surface should be cleanable Should have water and electricity

supply Proper drainage outlet

B14

Section B

Implementing waste management system in a hospital

Transport Avoid patient/crowded areas Avoid using lifts meant for patients

and/or movement of sterile equipment Selection of time important-Select time

of minimum movement (Not while doctors are on rounds; Not during visiting hour)

Preferably use the hospital ramp Ergonomics to be taken into

consideration: avoid lifting, prefer trolleys

Waste bags should be sealed or tied properly

Hazardous and non-hazardous waste should be carried in separate vehicles

B15

Section B

Implementing waste management system in a hospital

Waste movementWARD/

NURSING STATION

INFECTIOUS WASTE

PLASTIC WASTE

GENERAL WASTE

SHARPS

YELLOW BAG

ONE PERSONDESIGNATED

PICKED ONCE

BAGSCOLLECTED IN A TROLLEY

WITH A BIN

INCINERATED

TRANSPARENT BAG

ONE PERSONDESIGNATED

PICKED ONCE

DISINFECTED INWARDS & THE BAGS TAKEN

IN A LARGE BIN

MUTILATEDGIVEN TO A

CONTRACTOR

BLACK BAG

WARD BOY

PICKED TWICE

BAGS TAKENTO A CENTRAL

POINTBY WARD BOYS

MUNICIPALBIN,

PIGGERY

NEEDLEDESTROYER &

BREAD BOX

ONE PERSONDESIGNATED

PICKED ONCE

DISINFECTED IN WARDS, CONTENTS

SIEVED &COLLECTED IN A BUCKET

COLLECTEDIN THE

HOSPITAL

B16

Section B

Implementing waste management system in a hospital

Special cases

Operation theatre Laboratory Emergency Nursing station Kitchen Laundry

B17

Section B

Implementing waste management system in a hospital

Monitoring

Monitoring on a daily basis:

Monitoring of the system by sister in charges and senior hospital personnel

Monitoring sheets to be filled up Take up waste survey before and

after establishing the system

B18

Section B

Implementing waste management system in a hospital

Conduct routine waste assessment

Report findings to department heads Note variations and recommendations

o Staff participation in accurate segregation

o Effectiveness of collection scheduleso Adequacy of containers o Errors in disposal

Offer assistance to rectify problems

B19

Section B

Implementing waste management system in a hospital

Keep score!

Review every bill from waste vendors

Track monthly waste totals comparing to patient census, outpatient and inpatient procedures

B20

Section B

Implementing waste management system in a hospital

Graph it!

Monthly Volumes Biomedical Waste

0

10000

20000

30000

40000

50000

60000

Months

Kg

s o

f w

as

te

kgs

B21

Section B

Implementing waste management system in a hospital

Waste Monitoring SheetWaste Monitoring Sheet – Nursing Superintendent At the Point of Generation WARD/ PLACE DATE: Name of the Doctor / Sister -in-charge: _____________________________ Name of the House Keeper: ______________________________________ Time and Shift : _______________________________________________ S.No

Work Comments

1.

Waste Properly segregated

2.

Disposables mutilated and treated

3.

Needle destroyer working

4.

Chlorine solution replaced for treating mutilated plastic and rubber waste

5.

Bins lined with plastic bags a) infectious waste bin with yellow

bag b) general waste bin with black bag c) plastics bin with translucent

6.

While handling waste, gloves are always worn by the nurses and the house keepers

7.

Needles ,blades, lancets collected in bread box and treated with chlorine solution

8.

Syringe with barrel and plunger separated dipped in bleach solution

9.

Urine ,blood bags, IV sets cut before putting in chlorine soln.

10.

Ampoules in separate carton

B22

Section B

Implementing waste management system in a hospital

Waste Monitoring Sheet Waste Monitoring Sheet - Sanitary Supervisor Name of person : _____________________________________________ Name of the House Keeper: ____________________________________ Date: ______________________________________________________ Area, Time and Shift: _________________________________________ S.No

Work Comments

1.

Separate bins for different waste types

2.

Plastic bags with waste sealed

3.

Is the area around the bins cleaned

4.

Are bins routinely disinfected

5. Waste from bin routinely picked up 6.

Kitchen waste being composed a) Kitchen waste being segregated b) Is the biodegradable waste being

composted c) General waste being thrown in

designated bin d) Is the composting pit smelling e) Slurry of cow dung being added

at regular intervals f) Contents of the pit being mixed g) Is the pit being covered.

Signed (Designation)

B23

Section B

Implementing waste management system in a hospital

Economics of waste management

Treatment technology: Technology option/size of the facility

(central facility economically viable)Equipment: Needle destroyers, scissors and

forceps, bread box, bins Chemical disinfectantProtective clothing: Boots, gloves, face mask, glassesDifferent coloured bags: Size, quantity and quality

B24

Section B

Implementing waste management system in a hospital

Problems faced

Doing the initial trainings at the work place

Changing the attitude of the staff- the initial attitude can be really cold but over the time they appreciate the system

Deciding the equipment for waste management: every place has its own needs and thus procurement can be difficult. Start working on equipment immediately after waste audit and before training

B25

Section B

Implementing waste management system in a hospital

Lessons learnt

Initial training sessions should not be carried out at the work place

Purchasing of equipment takes time- should be decided before starting trainings

While planning the scheme, time should be kept for factors such as purchasing and staff availability

Model Ward should be set up as a pilot system

B26

Section B

Implementing waste management system in a hospital

Reduce, reuse, recycle

Sold for recycling o Glass (I.V. bottles, ampoules, etc.)o Paper and cardboard o Disinfected and mutilated plastics o Discarded linen for paper recyclingo X-ray films o Photographic developer

Kitchen waste sent to piggery Garden waste composted

B27

Section B

Implementing waste management system in a hospital

Waste minimisation

Segregation Source reduction Substitute hazardous

processes/substances Reducing losses by good practices Preferential purchases Resource recovery and recycling Treatment Proper disposal

B28

Section B

Implementing waste management system in a hospital

Monitoring

Section B

Implementing waste management system in a hospital

Secure transportation

Section B

Implementing waste management system in a hospital

Disinfection & Mutilation

Section B

Implementing waste management system in a hospital

Sharps Management

Section B

Implementing waste management system in a hospital

Unclean bins

Section B

Implementing waste management system in a hospital

Uneasy Operation

Section B

Implementing waste management system in a hospital

Different coloured bins

Section B

Implementing waste management system in a hospital

Collection

Section B

Implementing waste management system in a hospital

Non-infectious waste segregation

Section B

Implementing waste management system in a hospital

Recycling of glass & plastics

Section B

Implementing waste management system in a hospital

Recycling of cardboard

Section B

Implementing waste management system in a hospital

Vermi composting of garden waste