15 infectious waste management

Infectious Waste Infectious Waste ManagementManagement

Dr. Faisal N. Kordy, MD, CICDr. Faisal N. Kordy, MD, CIC

Consultant, Pediatric Infectious Diseases and Infection ControlConsultant, Pediatric Infectious Diseases and Infection Control

Introduction

• Over the years, a considerable amount of concern and confusion has existed regarding the risks associated with the disposal of hospital wastes.

• Absence of a specific definition of ‘‘infectious waste,’’

Introduction

• What is the definition of “infectious waste”?

NO specific definition of ‘‘infectious waste’’

Introduction

• CDC published the following statement: – There is no epidemiologic evidence to suggest that most hospital waste

is any more infectious than residential waste.

– There is no epidemiologic evidence that hospital waste disposal practices have caused disease in the community;

– Identifying wastes for which special precautions are indicated is a matter of judgment about relative risks of disease transmission.

Introduction

• Microbiological waste, blood/ body fluids, sharps, pathological wastes, and certain wastes from patients who are placed in isolation for specific diseases have always been treated as occupational hazards within healthcare facilities. This may help to explain the absence of transmission in the community.

Introduction

• biomedical waste,

• medical waste,

• infectious waste

Definitions

‘‘Infectious wastes are all the types of wastes produced by hospitals, clinics and other medical and research facilities.”

Definitions

‘‘any solid waste which is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals.’’

Pathogenesis• For a waste to be capable of causing infection, the following

specific factors are necessary:– There must be the presence of a pathogen.


specific factors are necessary:– The pathogen must be virulent.


specific factors are necessary:– The pathogen must also be present in sufficient dose.


specific factors are necessary:– The organisms must have a portal of entry.


specific factors are necessary:– There must be a susceptible host. (unimmunized, careless,

unfamiliar…)

Where do we find germs in the hospital?

Where do we find germs in the hospital?

• Bed linens,

• soiled diapers,

• unwashed hands,

• Key boards,

• Door knobs,

• Bedrails,

• Patients’ charts

• ……

What wastes are we interested in?

1. Contaminated sharps. All discarded sharps (e.g., needles, scalpels) that have come into contact with infectious materials should be considered infectious waste.

2. Microbiologic cultures.


3. Animal wastes.


4. Blood and blood products.


5. ‘‘Selected’’ isolation wastes. (Ebola, Dengue, …)


6. Pathology wastes. (They do not usually fit the definition of infectious waste outlined above. There is an absence of a portal of entry; most of these materials have been soaked in alcohol or formaldehyde and seldom contain pathogens).


• Wastes from surgery and dialysis, with the exception of contaminated sharps, bulk blood, and blood-tinged suction fluids, need not be considered infectious wastes. Once they are properly contained, they are no more infectious than any residential waste.

• For the same reason isolation trash is not considered infectious waste.


Remember

• Most persons with infectious diseases are not hospitalized.

Infectious Waste Management Plan

• Once a facility has a working definition of what constitutes ‘‘infectious waste,’’ a prudent next step to take is to develop a program or plan for managing these materials.


• Written plan for infectious waste management include:- Objectives:

- rendering infectious waste safe for disposal, - insuring that there is minimal risk to patients, personnel,

visitors and the community from exposure to pathogenic organisms associated with waste generated in the hospital,

- educating the healthcare staff regarding the management plan and the real versus the perceived risk associated with ‘‘infectious waste.’’


• Written plan for infectious waste management include:- Designation,

- Segregation,

- Packaging,

- Storage,

- Transport,

- Treatment or disposal,

- Contingency planning,

- Staff training.


• Designation– Designate waste as infectious or noninfectious.


• Segregation – segregate infectious waste at the point of origin.– waste should then be placed into appropriate

designated containers.


• Packaging– Infectious waste must be packaged properly to

protect patients, staff, visitors and the public from potential exposure to infectious materials and to facilitate the proper handling, storage, treatment and /or disposal of the waste.


• Packaging– Selection of the packaging must be appropriate for

the type of waste being contained to maintain the integrity of the packaging during collection, transport and storage.


• Packaging– Sharps be placed in

rigid puncture-proof containers.


• Packaging– Infectious waste must be properly identified as a

biohazard.


• Packaging– Infectious waste containers should be labeled


• Packaging– Potentially infectious liquid wastes can be

carefully poured down the drain.


• Storage– Storage areas should have limited access and a

universal biohazard symbol should be posted so it is readily visible to anyone with access to the area.


• Storage– A system for immediate spill containment and

clean up should be available in the storage area (e.g., hose connected to steam line, etc.).


• Transport– The systems used for the transportation of

infectious waste internally and externally must maintain the integrity of the packaging.


• Transport– Leak-proof carts which are readily cleanable or

which can be lined with plastic are generally used for transportation of infectious waste.


• Transport– Some commercial companies have been licensed

to transport and treat infectious wastes.


• Treatment.– The treatment selected should be based upon the

type of waste generated and the suitability of available options.


• Disposal– The direct disposal of infectious waste at a

properly sited landfill does not in fact present a threat to public health and safety, according to many experts, and is still acceptable in many areas.


• Disposal– However, perceived risk concerns and the

nationwide movement away from land disposal have resulted in widespread landfill prohibitions on the disposal of untreated infectious waste in landfills.


• Disposal– After treatment, medical waste are usually

disposed of in a sanitary landfill.


• Contingency planning– Systems should be in place to address unforeseen

events, which may disrupt the normal treatment, transportation and disposal of these materials.


• Contingency planning– Emergency spill procedures should also be in place

for both on-site and off-site emergencies.


• Training– Training of all personnel involved in:

• generation, • handling, • transporting, • treatment or disposal of infectious waste.


• Training of staff– Needles– Sharps– Broken glass– Wires


• Training of staff– Materials

contaminated with blood or body fluids.


• Training of staff










• Training of staff– Materials

contaminated with blood or body fluids.



Infection Control Implications

In most healthcare facilities, the infection control professional is responsible for developing and overseeing the infectious waste management plan.


The role of the infection control professional is to develop a safe and effective infectious waste management plan and to assure that it is based on sound scientific information and is consistent with MOH regulations.


• Rutala et al. have recently published several important facts that should be kept in mind during the development of infectious waste policies or rules and regulations.

Rutala WA, Odette RI, Samsa GP.Management of infectious waste by United States hospitals. JAMA 1989;262:1635–1640Rutala WA. Disinfection, sterilization and waste disposal—medical waste. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams and Wilkins;1993:483–487


• Several of these facts include:– Hospitalized patients generate approximately 6.8

kilograms of hospital waste per day.


• Several of these facts include:– About 15% of the total hospital waste by weight is

considered ‘‘infectious waste’’.


• Several of these facts include:– The cost of disposing infectious waste is 5–20

times that of other hospital wastes.


• Several of these facts include:– With the exception of ‘‘sharps’’ such as needles,

which have caused disease only in an occupational setting, there is no scientific evidence that medical waste has caused disease in the hospital or in the community.

• Several of these facts include:– Household waste contains on average 100 times as

many human pathogens than medical waste.


• Several of these facts include:– The beach wash-ups of syringe related materials

which created nationwide concern about medical waste were found to come from illegal drug use and home healthcare.



• When regulations are not based on sound science, ICPs are encouraged to become involved in assisting regulators by providing scientific input as well as basic ‘‘common sense.’’

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15 infectious waste management