Managing Medical Waste Session 5: Infection Control Basics

Managing Medical Waste

Session 5: Infection Control Basics

5: Managing Medical Waste Slide 2

Learning Objectives

Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority

Learn ways to minimise waste

Know the criteria for safe management of sharps

Part I: Health Care Waste Overview


Definitions of Waste

Health care waste

All types of waste from all health care activities

Hazardous health care waste

Waste that presents a health hazard of some kind

Note: Most health care waste is no more hazardous than household waste


Types of Hazards to Consider

Flammable

Toxic - mutagenic, cytotoxic, teratogenic, etc

Reactive

Allergen, contact sensitiser

Explosive

Infectious

Radioactive

Corrosive

Caustic

Alcohol

Cancer chemotherapy, tar-based products

Sulphuric acid, chlorine powder

Glutaraldehyde

Picric acid, fertiliser, ammonia

TB cultures

Barium enema, X-rays

Bleach

Lye


Hazardous Health Care Waste

Infectious hazard:

Anatomic waste

Laboratory cultures

Sharps

Live viruses

Corrosive, teratogenic, reproductive hazard:

Heavy metals

Pesticides

Cleaning products

Pressurised containers

Mercury

Cancer therapy


Is Health Care Waste an Important Source of Infectious Disease?

Yes!

IF needles and syringes are scavenged and re-used, then many diseases can be spread

Keep used sharps and syringes out of public access

No! Most medical waste does

not have more germs than household waste

It causes visual pollution, generates fear, but unless re-use of sharps occurs, medical waste causes little disease


Then Why does this Waste Matter?

Sharps injuries may harm workers and communities

Medical waste potentially impacts patients, workers, community, and economy because of the volume and permanence of waste


Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day

Health care waste may:

Contain infectious organisms, including drug resistant ones

Place cancer causing agents into air or ground water

Cause radiation-related illnesses

Contribute to global warming harm atmosphere (CFC containing refrigerant gas)

Cause injury (sharps, explosion)

Cause congenital defects or stillbirth, prematurity, infertility


Which Waste to Address First?

IC Committees should START with infectious waste, especially used sharps and microbiological culture waste


How to Safely Dispose of Infectious Sharps

Do not recap sharps before disposal

Dispose of sharps at the point of use in a leak proof puncture proof container

Avoid handling, emptying or transferring used sharps between containers

Autoclave highly infectious waste before disposal

Control public access to syringes and medical equipment

Shred, encapsulate and bury according to national legislation


For Non-Infectious Hazardous Waste, the Risks Depend on: Severity of acute or chronic exposure

Duration of exposure

Frequency of exposure

Concentration agent (1% versus 50%)

Individual vulnerability including pregnancy, weight

Route of exposure (skin, respiratory, oral, etc.)

Steps taken to protect (PPE, relieved from immediate contact etc.)


Who is at Risk?

Doctors - anesthesiologists, pathologists

Nurses - oncology nurses, OT, ER

Hospital support staff - X-ray assistants, pharmacy, morgue, and lab staff

Cleaning staff - those cleaning sewage lines

General public - those using sharps found in the waste


Common Hazards

Anesthetic gases

Glutaraldehyde

Formaldehyde/formalin

Cancer therapeutic agents

Ethylene Oxide

Radiation

Asbestos

Blood contaminated sharps

Bleach

Solvents (xylene, toluene, acetone, ethanol)

Pesticides, fungicides

Heavy metals (mercury, chronium, cobalt, cadmium, arsenic, lead)

Latex

Strychnine and cyanide


12 Steps to Manage Hazardous Wastes before Disposal 1. Know what hazards you

have

2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists

**Use mercury-free thermometers


12 Steps to Manage Hazardous Wastes (cont’d)

3. Limit use and access to trained persons with personal protective gear


4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards


5. Get Rid of Unnecessary Stuff

Don’t accumulate unneeded products

Don’t let peroxides and oxidising agents turn into bombs

Photo of bomb robot called into hospital to dispose of picric acid.


6. Label with Agent, Concentration and Hazard Warnings Examples of hazard labels:


7. Communicate about Workplace Hazards

Job description

Posters on doors

Labels on hazards

Give feedback on use of PPE and disposal in evaluation

Role model safe use and disposal

Contact point who is responsible


8. Recycle Products When Possible



Group Discussion: Recycling

Why should recycling be promoted?

Which products can be safely and cost effectively recycled in your facility?


9. Segregate Hazards at the Source

Separate sharps and infectious waste where they are used

This prevents injuries that can occur when people sort the trash after it is disposed

Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members


10. Have Written Policies on Waste Disposal

Sharps and infectious waste

Chemotherapy (cancer)

Heavy metals (batteries)

Chemicals

Post brief, colorful instructions on walls to remind workers


11. Minimise the Handling of Wastes

Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly


12. Conduct Walk-Around Interviews

Ask about the hazardous substances staff work with, how they dispose of them, and what they need to be able to dispose of them properly

Have a no-blame philosophy that strives to solve problems, NOT to assign blame

Part II: Waste Management Methods


Options for Specific Types of Waste

Pharmaceutical

Cytotoxic

Other chemical wastes

Heavy metals

Pressurised containers

Radiation

Infectious


Pharmaceutical Waste

Small amounts:

Disperse in landfill sites, encapsulate or bury on site

Discharge to sewer

Incinerate

Large amounts

Incinerate at high temperatures or encapsulate

LANDFILL IS NOT RECOMMENDED


Cytotoxic Waste

NEVER LANDFILL or DISPOSE TO SEWER

Disposal Options:

Return to supplier

Incinerate at high temperature

Chemical degradation


Chemical Waste - Further Recommendations

Keep different hazardous chemicals separate

Do not dispose into the sewers or street

Do not encapsulate large amounts of disinfectants as they are corrosive and flammable

Do not bury large amounts of chemicals


Wastes with Heavy Metals

Wastes with mercury, cadmium, lead, arsenic, strychnine, are poisonous (e.g., thermometers, batteries, lead paints, dyes)

Never incinerate or burn

Never dispose of in municipal landfills

Best solution: Avoid purchase

OR

Recycle in specialised cottage industry or export to countries with specialised facilities

Encapsulation


Pressurised Gas Containers

NEVER INCINERATE

Return undamaged gas cylinders and cartridges to the manufacturer for reuse

Damaged containers: empty completely and crush, landfill


Radioactive Waste

Use requires a national strategy including:

Appropriate legislation

A competent regulatory organisation

Trained radiation protection officer to monitor exposures

Return to the manufacturer

Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme


Simple Chemical Disinfection

Requires shredding of waste

May introduce strong chemicals into the environment (chorine bleach turns into dioxin when burned)

Efficiency varies

Only the surface is disinfected

Does not disinfect human tissue

Special disposal required to avoid pollution


Waste Disposal Options Include

Disinfection – Autoclaving/ Microwaving, treatment, shredding

Land Disposal

Burial

Encapsulation

Incineration

Inertisation

Managed Land-fill

On-site disposal


Infectious Waste: Autoclaving

Pressure and temperature

Holding time

Sterility indicators

Type of waste

Followed by shredding / burial / recycled


Commercial Disinfection Systems

Shred waste, treat chemically, encapsulate

Possible advantages:

Encapsulated residue can be placed in landfill

Environmentally friendly

Easy to operate

Possible disadvantages:

Requires specialised operators

May be expensive


Burying Inside Hospital Premises

Apply the following rules:

Access to the site restricted and controlled

If waste is retained on site, ensure rapid burial to isolate from animal or human contact

Only hazardous HC Waste to be buried

Management controls on what is dumped

Each deposit covered with soil

Site lined with low permeable material-concrete

Groundwater pollution must be avoided

Not recommended for untreated hazardous waste


Disposal to Land by Encapsulation

Fill metal or plastic containers to 3/4, add:

plastic foam

bituminous sand

cement mortar

clay material

When dry, label and seal containers and landfill

May be used for sharps, chemicals, drugs etc.


Incineration

Combustible waste turned to ash at temps >800 C

Reduces volume and weight

Residues are transferred to final disposal site

Treatment efficiency depends on incineration temperature and type of incinerator

Not all wastes can be incinerated

Costs vary greatly according to type of incinerator

Produces combustion gases


Do not Incinerate

Do not incinerate the following:

Plastics especially halogenated plastics (e.g. PVC)

Pressurised gas containers

Large amounts of reactive chemical waste

Radioactive waste

Silver salts or radiographic waste

Mercury or cadmium

Ampoules of heavy metals


Advantages of Incineration of HC Waste:

Good disinfection efficiency

Drastic reduction of weight and volume

Good for chemical + pharmaceutical waste


Disadvantages of Incineration of HC Waste:

Doesn’t destroy chemical waste at lower temperature for rotary kiln

Toxic air emissions if no control devices in place

Maintaining temperature levels (and efficiency) in field incinerators is difficult, need to balance loads with non-hazardous materials

High costs for high temperature incineration


Land-fill in Municipal Landfills

If hazardous health-care waste cannot be treated or disposed elsewhere:

Designate a site for hazardous HC Waste

Limit access to this place

Bury the waste rapidly to avoid human or animal contact

Investigate more suitable treatment methods


Because no Disposal Method is Easy or Completely Safe…

Prevention is best!

Eliminate purchase by buying safer alternatives

Recycle

Use smallest quantities possible, use with engineering controls and Personal Protective Equipment

Segregate hazards into separate waste streams at source

Supervise disposal using best available ecologic option


For More Information:

Safe Management of wastes from health-care activities. Edited by A Prüss, E Giroult, P Rushbrook. Geneva World Health Organisation. 1999. 228 p. Available online. Includes a teachers guide

www.healthcarewaste.org. A website managed by the working group on waste


More Free References

http://www.healthcarewaste.org, Health Care Waste Management at a Glance

“First, do no harm.” WHO/V&B/02.26

Available at www.healthcarewaste.org/linked/onlinedocs/4-bd-704.pdf. Contains information about the disposal options for sharps

Thank You!

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Managing Medical Waste Session 5: Infection Control Basics