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HOSPITAL WASTE MANAGEMENT

HOSPITAL

WAST

E

MANAGEM

ENT

by

Dr. INDRAJEET

P.G. STUDENT

DEPARTMENT OF PROSTHODONTICS Dr. RONAK CHOKSI

P.G. STUDENT

DEPARTMENT OF PRODTHODONTICS

K.V.G DENTAL COLLEGE & HOSPITAL

Content

• Introduction • Definition• Areas of waste generation• Classification of BMW • Basic principals of BMW management

• Bio-Medical Waste Management in India• Standard (Universal) Precautions

• Different methods of waste treatment• Personal Protection• Dental wastes and its management• Conclusion• Reference

INTRODUCTION

WHAT BMW MEANS HERE???????

DEFINATLY

NOT

Definition

According to Bio-Medical Waste (Management and Handling) Rules, 1998 of India

"Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals.

• The quantum of waste that is generated in India

• 1-2 kg per bed/day in a hospital and 600g per day/bed in a general practioner’s clinic.

e.g. a 100 bedded hospital will generate 100 – 200 kg of hospital waste/day.

It is estimated that only 5 – 10% of this comprises of hazardous/infectious waste (5–10kgs/day).

Areas of waste generationGovernment hospitals

Private hospitals

Nursing homes

Physician's office/clinics

Dentist's office/clinics

Dispensaries

Primary health centers

Medical research &training establishments

Blood Banks & Collection Centers

Mortuaries

Animal & Slaughter houses

Laboratories & Research organizations

Vaccinating centers

Bio–Technology institutions/Production Units

Classification of bio-medical waste1 • HUMAN ANATOMICAL WASTE

2 • ANIMAL WASTE

3 •MICROBIOLOGICAL & BIOTECHNOLOGICAL WASTES

4 • WASTE SHARPS

5 • DISCARDED MEDICINES & CYTOTOXIC DRUGS

6 • SOLID WASTES WITH BLOOD

7 • SOLID WASTE OTHER THAN WASTE SHARP

8 • LIQUID WASTES

9 •INCINERATION ASH

• CHEMICAL WASTES10

HUMAN ANATOMICAL WASTES

• Human tissues or fluids

e.g. Body parts Blood and other body fluids Fetuses

HUMAN ANATOMICAL WASTE

ANIMAL WASTES

•animal tissues, organs, body parts

•waste generated by veterinary hospitals

•Wastes from laboratory cultures •vaccines

MICROBIOLOGICAL & BIOTECHNLOGICAL WASTE

• wastes from production of biologicals , toxins, dishes and devices used for transfer of cultures

Sharps

• Sharp waste

e.g. Needles Infusion sets Scalpels Knives Blades Broken glass

WASTE SHARPS

Waste comprising of

• outdated, •Contaminated &• discarded medicines

DISCARDED MEDISINES AND CYTOTOXIC DRUGS

Items contaminated with blood, and body fluids: including• cotton• dressings• soiled plaster cast& other material contaminated with blood)

SOLID WASTE CONTAMINATED WITH BLOOD

Solid Waste

Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.

Liquid Waste

Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)

Chemical waste

• Waste containing chemical substances

e.g. Laboratory reagents Film developer Disinfectants that are expired or no

longer needed.

Wastes with high content of heavy metals Batteries, broken thermometers; blood-

pressure gauges.

Pressurized containers Gas cylinders, gas cartridges, aerosol

cans.

Radioactive waste Waste containing radioactive substances

Disposal practices commonly followed• Mainly two types

Wastes sold to contractors, who in turn, sell those that are usable/ worthy for recycling others for proper treatment.

Wastes dumped, along with common urban wastes in corporation dustbins.

Bio-Medical Waste Management in India

Bio-Medical Waste (Management and Handling) Rule 1998, prescribed by the Ministry of

Environment and Forests, Government of India, came into force on 28th July 1998.

These rules applied to those who generate,

collect, receive, store, dispose, treat or handle bio-medical waste in any manner

According to this rule: bio-medical waste should be segregated into

different color coded containers/bags at the point of generation, properly treated and disposed off.

Color coding , Type of container, Method of Disposal

Yellow Type of container • Plastic bag Treatment options• Incineration/deep burial

Note : Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.

Waste category

Cat. 1 :Human Anatomical Waste, Cat. 2:Animal Waste Cat. 3:Microbiology and Biotechnology Cat. 6:Solid waste

Type of container • Disinfected container/plastic bag Treatment options• Autoclaving /Microwaving/Chemical Treatment

Note: Red bag is never incinerated. This is because it contains lead which

is heavy metal and cause emission problems.

RED

Cat 6: Solid waste contaminated with blood Cat 7: Solid waste other than waste sharps

Cat3: Microbiology and Biotechnology

Waste category

Blue/white translucentType of container • Plastic bag/puncture proof container

Treatment options • Autoclaving/Microwaving/Chemical Treatment and Destruction/Shredding

Cat 4:Waste sharps Cat 7: Solid waste

Waste category

Chemical treatment using at least 1 % hypo chloride solution or any other equipment chemical reagent. It must be ensured that chemical treatment ensures disinfection.

Mutilation / shredding must be such so as to prevent unauthorized reuse.

Black

Type of container • Plastic bag

Treatment options • Disposal in secured land fill

• Discarded medicines and Cytotoxic drugs.

• Wastes comprising of outdated, contaminated and discarded medicines.

• Also Black bag is Internationally used for Non infectious municipal Solid waste management.

Standard (Universal) Precautions

• In 1996, CDC developed a new system of standard precautions synthesizing the features of universal precautions and body substance isolation.

• Standard precautions are used in the care of all

patients and apply to blood, all body fluids, secretions and excretions except sweat, regardless of whether they contain visible blood.

Standard precautions include:

• Hand washing�• Barrier protection�• Safe handling of sharp items�• Safe handling of specimen (blood, etc.)�• Safe handling of spillage of blood/body fluids�• Use of disposable/sterile items�

Basic Principals of Bio-medical Waste Management

• Waste Minimization • Waste treatment on-site • Waste transportation • Waste treatment off-site • Final Disposal

Cradle to Grave Aspect• Segregation (Separation)• Identification• Collection• Storage• Transport• Measurement• Treatment• Disposal• Training, Health and safety records of the

workers

• Poor segregation is noted as a primary cause for increased risk of bio-medical waste management

NUCLEAR WASTE

Different methods of waste treatmentIncinerators• Comes from a Greek word ..Meaning “BURN

TO ASHES”• No universal incinerator exists• It must be specifically selected, designed , and

built to meet the needs of the individual Hospital

• Design depends upon type of waste , calorific value ,quantities and volume of waste

Important things to Know…• The incinerator must reach temperatures

above 300°C.• As per Biomedical rules, for incinerators the

combustion efficiency must be at least 99% with zero emission standards.

• There will be no chemical pretreatment before incineration.

• Chlorinated plastics shall not be incinerated.

Waste types not to be incinerated are : (a) Pressurized gas containers(b) large amount of reactive chemical wastes(c) Silver salts and photographic or radiographic

wastes(d) Halogenated plastics such as PVC(e) Waste with high mercury or cadmium content,

such as broken thermometers, used batteries, and lead-lined wooden panels

(f) Sealed ampules or ampules containing heavy metals

Formaldehyde

GlutaraldehydeChlorine dioxide

Sodium hypochlorite

Chemical disinfection• Chemicals are added to waste to kill or

inactivate the pathogens it contains. This treatment usually results in disinfection rather than sterilization.

• Chemical disinfection is most suitable for treating liquid waste such as blood, urine, stools or hospital sewage.

• However, solid wastes including microbiological cultures, sharps etc. may also be disinfected chemically with certain limitations.

Recommended concentration/dilution of Chemical disinfectants

DISINFECTANT( A contact period 0f 30 minutes is required for effective disinfection )

CONTAMINATED CONDITION

GROSSLY CONTAMINATED

CONDITION

Sodium hypochlorite 5% available chlorine as liquid bleach

20 ml / L 200 ml /L

Tincture of Iodine/Povidone Iodine 2.5 % 2.5 %

Ethyl Alcohol 70 % 70 %

Isopropyl Alcohol 70 % 70 %

Gluteraldehyde 2 % 2.5 % 2.5 %

Formaldehyde 40 % 5 % 10 %

Savlon 5 % 10 %

Dettol 4.8 % v/v 4 % 10 %

Cresol 2.5 % 5 %

Advantages : • Highly efficient disinfection under good

operating conditions.• Some chemical disinfectants are relatively

inexpensive.

Disadvantages : • Requires highly qualified technicians for

operation of the process.• Uses hazardous substances that require

comprehensive safety measures.• Inadequate for pharmaceutical, chemical and

some types of infectious waste.

THERMAL TREATMENT

1. WET THERMAL TREATMENT

2. DRY THERMAL TREATMENT

WET THERMAL TREATMENT• Wet thermal treatment or steam disinfection is

based on exposure of shredded infectious waste to high temperature, high pressure steam, and is similar to the autoclave sterilization process.

• The process is inappropriate for the treatment of anatomical waste and animal carcasses, and will not efficiently treat chemical and pharmaceutical waste.

HYDROCLAVE

- This is a steam sterilization technology in which the steam is used as an indirect heating source thus allowing total dehydration of waste material.- The holding time for waste is 15 minutes at 132°C or 30 minutes at 121°C.

- The organic components of the waste are hydrolyzed and the waste matter is reduced by weight and volume.

Advantages: • Environmentally sound.• Relatively low investment and operating costs.

Disadvantages: • Shredders are subject to frequent breakdowns

and poor functioning. • Operation requires qualified technicians.• Inadequate for anatomical, pharmaceutical,

chemical waste and waste that is not readily steam-permeable.

Dry thermal treatmentSCREW-FEED TECHNOLOGY: • Screw-feed technology is the basis of a non-

burn, dry thermal disinfection process in which waste is shredded and heated in a rotating device.

• Waste is reduced by 80 per cent in volume and by 20-30 per cent in weight. This process is suitable for treating infectious waste and sharps, but it should not be used to process pathological, cytotoxic or radioactive waste.

Microwave irradiation• Most microorganisms are destroyed by the

microwave of a frequency of about 2450 MHz and a wave length of 12.24 cm.

• The water contained within the waste is rapidly heated by the microwaves and the infected components are destroyed by heat conduction. -The heat produced at 95 - 100°C for a holding period of 25 minutes

• The efficiency of the microwave disinfection should be checked out through bacteriological and virological tests.

Advantages: • Good disinfection efficiency under appropriate

operating conditions.• Drastic reduction in waste volume.• Environmentally sound.

Disadvantages: • Relatively high investment and operating costs.• Potential operation and maintenance

problems.

Land disposalMUNICIPAL DISPOSAL SITES: If a municipality or any authority genuinely

lacks the means to treat waste disposal, the use of a land fill has to be regarded acceptable disposal route.

There are two types of• Open dumps • Sanitary landfills

Sanitary landfills are designed to have at least advantages over open dumps :

• Geological isolation of from the environment.• Appropriate engineering preparation before

the site is ready to accept waste.• Staff present on control operations. • Organized deposit and daily coverage of waste.

Inertization• The process of “Inertization” involves mixing

waste with cement and other substances before disposal, in order to minimize the risk of toxic substances contained in the wastes migrating into the surface water or ground water.

• A typical proportion of the mixture is: 65 % pharmaceutical waste 15 % cement 15 % lime 5 % water

• A homogeneous mass is formed and cubes or pellets are produced on site and then transported to suitable storage sites.

Advantages: Relatively inexpensive.

Disadvantages: Not applicable to infectious waste.

Safe burying

Advantages: • Low costs.• Relatively safe if access to site is restricted and

where natural infiltration is limited.

Disadvantages: • Safe only if access to site is limited and certain

precautions are taken.

Personal protectionGeneral

• Hand washing facility : Soap and water should be available at all times.

• Drinking water: Safe drinking water must be available for waste handlers working near boilers to prevent dehydration.

• Immunization : Tetanus, Hepatitis B. • Maintenance of health records.

• Personal protective clothing (PPC) and personal protective equipment (PPE) must be available to the staff and its usage ensured

Personal protective clothing (PPC)1.Gloves a. Disposable vinyl gloves in all patient care areas b. Latex surgical gloves for operative procedures c. Heavy duty thick rubber gloves for waste

handlers.

2.Masks: Simple, reusable plastic masks to protect health care workers from splashes.

3.Aprons : Full sleeved, knee length cotton aprons must be worn at all times.

Personal Protective Equipment• Footwear: Gumboots for waste handlers, The

trousers must remain outside the gum boots.

• Eye shield.

• Apron : A reusable heavy duty, autoclavable rubber apron may be worn where heavy contamination/excessive splashing is expected, e.g. in labour room, operation theatre etc.

Dental wastes and its management• Amalgam wastes

contact and non-contact scrap amalgam from capsule mixing, chair-side traps & vacuum pump filters, amalgam sludge from separators

• Elemental mercury • Unused x-ray developer • Lead foil from x-ray film • Worn out lead aprons ,Lead lined boxes • Cleaning and disinfecting solutions

Amalgam waste management• Amalgam waste is separated to prevent

polluting our environment. It is placed along the vacuum suction line to prevent amalgam from entering the drain lines which ultimate goes out to our environment.

• Do not dispose amalgam capsules in the garbage, the red biomedical bag or through incineration.

• The capsules are hazardous waste and must be properly recycled or disposed through a hazardous waste hauler.

What should we do in the case of a mercury spill?

• Put on disposable nitrile gloves and clean it up immediately.

(Note : Do not use latex gloves as mercury can penetrate latex).

• Clean up all visible elemental mercury using a mercury spill kit.

• Never suck up spilled mercury with a vacuum cleaner.

X-ray wastes• Used fixer from X-ray processing is defined as a

dangerous waste because it contains high concentrations of silver – 3,000 to 8,000 parts per million (anything over 5 ppm is dangerous waste).

• UNUSED developer contains hydroquinone which is a toxic substance, so unused developer cannot go down the drain.

• Because hydroquinone is used up in the developing process, USED developer is non-hazardous and is safe to be disposed to SEWER.

• Used x-ray film contains silver. If the silver concentration is high enough, the used film would be a dangerous waste.

• Although most film does not contain enough silver to make it a dangerous waste, the best management practice is to collect it for silver recycling.

• Lead is a dangerous waste and should not be put in the garbage or in with red bag biomedical waste or sharps.

• Collect lead foil from x-ray packets for recycling.

• When lead aprons are no longer usable, they must be disposed of as dangerous waste due to their lead content.

Effective Waste Management

Waste Avoidance

Waste Reduction

Waste Re-Use/Recycling/Reclamation

Waste Treatment

Waste disposal

CONCLUSION

Let the wastes of “ the sick ”

not contaminate the lives of

“ the healthy ”

Reference

• Park’s text book of preventive and social medicine, K. Park, 14th edition.

• Short text book of medical microbiology, Satish Gupte, 6th edition.

• http//www.Hospital Bio-Waste Management.com.

• http//www.Indian Society of Hospital Waste Management.com.

• All the activities, administrative and

operational, involved in handling, treatment, conditioning, storage and disposal of waste (Including transportation) comes under waste management.

• This includes hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories and blood banks.

Waste is considered Infectious• Contaminated by an organism that is

pathogenic to healthy humans.

• The organism is not routinely available in the environment.

• The organism is in significant quantity and virulence to transmit disease.

Classification of waste Kitchen wasteWaste generated from office etc

Non infecti

ous

Waste generated from office which is capable of causing infection

Infectious

80

Option Waste Category Treatment & DisposalCategory No. 1 Human Anatomical Waste

(human tissues, organs, body parts)

incineration @/deep burial*

Category No. 2 Animal Waste(animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses)

In

Category No. 3 Microbiology & Biotechnology Waste(Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures)

local autoclaving/micro-waving/incineration@

Category No. 4 Waste Sharps(needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps)

disinfection (chemical treatment @@@/auto claving/microwaving and mutilation/shredding##

Category No. 5 Discarded Medicines and Cytotoxic drugs(Waste comprising of outdated, contaminated and discarded medicines)

incineration@/destruction and drugs disposal in secured landfills

Schedule-ICATEGORIES OF BIO-MEDICAL WASTE

81

Category No. 6 Soiled Waste(items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood)

incineration@autoclaving/microwaving

Category No. 7 Solid Waste(Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.)

disinfection by chemical treatment@@ autoclaving/microwaving and mutilation/shredding##

Category No. 8 Liquid Waste(Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)

disinfection by chemical treatment@@ and discharge into drains

Category No. 9 Incineration AshAsh from incineration of any bio-medical waste)

disposal in municipal landfill

Category No. 10 Chemical Waste(Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in disinfection, as insectricides, etc.)

chemical treatment@@ and discharge into drains for liquids and secured landfill for solids

Schedule-ICATEGORIES OF BIO-MEDICAL WASTE (continue)