WASTE MANAGEMENT IN A PRIVATE WASTE MANAGEMENT IN A PRIVATE HOSPITALHOSPITAL

Dr.Shanta NagarajanDr.Shanta Nagarajan

ROCKLAND HOSPITALROCKLAND HOSPITAL

INTRODUCTIONINTRODUCTION

Anything not intended for use is waste Anything not intended for use is waste

All waste liquid solid generated by health All waste liquid solid generated by health care system are bio medical waste .care system are bio medical waste .

In Delhi there are about 72 hospitals under In Delhi there are about 72 hospitals under Govt. sector ,550 registered nursing Govt. sector ,550 registered nursing homes and 936 dispensaries.In addition to homes and 936 dispensaries.In addition to this there are about 1560 underegistered this there are about 1560 underegistered establishments with different names like establishments with different names like Nursing homes,Medical Centres,Dental Nursing homes,Medical Centres,Dental Hospitals,MTP centres etc.About 40000 Hospitals,MTP centres etc.About 40000 hospital beds are available in the public & hospital beds are available in the public & private sector in Delhi excluding the private sector in Delhi excluding the Laboratory .Laboratory .

Historical BackgroundHistorical Background

Hospital waste means’any solid,fluid or liquid .Hospital waste means’any solid,fluid or liquid .

Hospital waste includes garbage,refuse,rubbish Hospital waste includes garbage,refuse,rubbish and Bio Medical waste.and Bio Medical waste.

HOSPITAL WASTE DISPOSALHOSPITAL WASTE DISPOSAL

Waste is unwanted trash generated near human Waste is unwanted trash generated near human or animal habitation.or animal habitation.Its quality & quantity are location specific, Its quality & quantity are location specific, dependant on food habits,culture,tradition & dependant on food habits,culture,tradition & socio-economic conditions.socio-economic conditions.75% of the above refuge in India consists of bio 75% of the above refuge in India consists of bio degradable & the rest 25% is inert materialdegradable & the rest 25% is inert materialIt is of high density,varaiable moisture It is of high density,varaiable moisture content(i.e. 15 – 40%) and partly content(i.e. 15 – 40%) and partly combustible(i.e.50- 75%)combustible(i.e.50- 75%)It has poor calorific value 2500KCAL/KG & have It has poor calorific value 2500KCAL/KG & have low carbon- nitrogen ratio.low carbon- nitrogen ratio.

HOSPITAL WASTEHOSPITAL WASTE

The daily waste collected per patient is 2 – The daily waste collected per patient is 2 – 5 kgs.There are statistics which say it 5 kgs.There are statistics which say it could be between 5 – 15 kgs.could be between 5 – 15 kgs.

The hospital waste can spread disease to the The hospital waste can spread disease to the community through microbial contamination- community through microbial contamination- viz….- Dressings,bandages,swabs,plaster viz….- Dressings,bandages,swabs,plaster caste,lancets,scalpels etc…caste,lancets,scalpels etc…Human tissues from OT.Human tissues from OT.Clinical specimens like Clinical specimens like blood ,urine,faces,aspirated fluids etc,blood ,urine,faces,aspirated fluids etc,Blood BagsBlood BagsBlood products,placenta etc,Blood products,placenta etc,Laboratory waste.Laboratory waste.

HOSPITAL MUST HAVE A FIXED HOSPITAL MUST HAVE A FIXED POLICY FOR WASTEPOLICY FOR WASTE

SEGREGATION OF LIQUID AND SOLID WASTE.SEGREGATION OF LIQUID AND SOLID WASTE.COLLECTION OF SOLID WASTE IN THICK THIGHTLY COLLECTION OF SOLID WASTE IN THICK THIGHTLY CLOSED LEAK PROOF BAGSCLOSED LEAK PROOF BAGSSHARPS IN PUNCTURE PROOF CONTAINER.SHARPS IN PUNCTURE PROOF CONTAINER.TRANSPORTATION FROM HOSPITAL TO SITE IN TRANSPORTATION FROM HOSPITAL TO SITE IN CLOSED WHEEL – BARROWS.CLOSED WHEEL – BARROWS.TREATED WASTES ARE DISPOSED OFF TO TREATED WASTES ARE DISPOSED OFF TO LANDFILL BY MUNICIPALITY IN COVERED TRUCKS.LANDFILL BY MUNICIPALITY IN COVERED TRUCKS.CONTINGENCY ARRANGEMENTS MUST BE CONTINGENCY ARRANGEMENTS MUST BE AVAILABLE IF REGULAR SYSTEM FAILS E.G AVAILABLE IF REGULAR SYSTEM FAILS E.G BURNING,BURIAL WITH 1% BLEACH OR DUMPING BURNING,BURIAL WITH 1% BLEACH OR DUMPING IN LINE PIT.IN LINE PIT.

Decanting to be done in separate room or safety Decanting to be done in separate room or safety cabinet to avoid aerosols.cabinet to avoid aerosols.Microbiology culture &specimens must be Microbiology culture &specimens must be decontaminated separately & collected in leak decontaminated separately & collected in leak proof bags before discarding.The bags should proof bags before discarding.The bags should be tightly closed.be tightly closed.Sharp items to be collected in puncture proof Sharp items to be collected in puncture proof container to avoid pricks.container to avoid pricks.Tissue from path section is seggregated & sent Tissue from path section is seggregated & sent for disposal burning or incenerartionfor disposal burning or incenerartionBlood sera decontaminated before washing Blood sera decontaminated before washing usable containers.usable containers.

SeggregationSeggregation

Hospital waste is seggregated area wise Hospital waste is seggregated area wise in four colour bags:in four colour bags:

1.1. Yellow BagYellow Bag( Waste for ( Waste for incineration)Human & animal incineration)Human & animal tissues/organs,body parts,non plastic tissues/organs,body parts,non plastic contaminated or soiled waste ,plaster contaminated or soiled waste ,plaster casts,dressing,swabs,bandages,microbiocasts,dressing,swabs,bandages,microbiological & pathological/lab waste etc.logical & pathological/lab waste etc.

SeggregationSeggregation

2.Red Bag2.Red Bag (Waste for (Waste for autoclave,microwave,chemical autoclave,microwave,chemical disinfectionfollowed by shredding or disinfectionfollowed by shredding or mutilation)All plastic disposables mutilation)All plastic disposables contaminated with blood or human contaminated with blood or human secretion,syringes,iv sets,plastic culture secretion,syringes,iv sets,plastic culture plates,tubes,cathethers,canulaes,urobags,plates,tubes,cathethers,canulaes,urobags,blood bags,surgical gloves etc.blood bags,surgical gloves etc.

SeggregationSeggregation

Blue bagBlue bag ( Waste for ( Waste for autoclaving,Microwaving,Chemical autoclaving,Microwaving,Chemical Treatment & destruction/shredding) Treatment & destruction/shredding) sharps like needles,scalpels,\sharps like needles,scalpels,\blades,broken glass/ampules etc. that may blades,broken glass/ampules etc. that may cause punture and cuts , all sharp disposal cause punture and cuts , all sharp disposal to be in puncture proof containers. to be in puncture proof containers.

SegregationSegregation

Black bag Black bag ( waste for disposal in ( waste for disposal in municipal dust bins) office stationeries, municipal dust bins) office stationeries, General waste like General waste like papers,wrappers,cardboard,kitchen waste papers,wrappers,cardboard,kitchen waste etc.etc.

Every ward is provided with the three Every ward is provided with the three types of bags placed in closed bucket.types of bags placed in closed bucket.

Near the nurses station.Near the nurses station.

Puncture proof containers are also providedPuncture proof containers are also provided

All syringes are burnt before discarding into All syringes are burnt before discarding into the containerthe container

All plastics are shredded before placing in All plastics are shredded before placing in red container.red container.

These bags are closed and labelled before These bags are closed and labelled before transportation to the common sitetransportation to the common site

Transportation is by closed wheel barrow Transportation is by closed wheel barrow in every shift.in every shift.

Critical care area waste is transported in Critical care area waste is transported in similar way to the common storage space.similar way to the common storage space.

Soiled linenSoiled linen

Soiled linen from wards and O.T. ,I.C.U Soiled linen from wards and O.T. ,I.C.U and Dialysis unit are transported by H.K. and Dialysis unit are transported by H.K. staff to wash area ,staff to wash area ,

Soaked in a covered labelled drum filled Soaked in a covered labelled drum filled with detergent solution.with detergent solution.

Washed and transported to laundryWashed and transported to laundry

A register is maintained.A register is maintained.

Final disposalFinal disposal

The hospital area has a separate zone The hospital area has a separate zone where collected waste is given to pollution where collected waste is given to pollution control body.control body.

The waste is weighed, before disposalThe waste is weighed, before disposal

And record maintained.And record maintained.

The area is kept clean and locked. The area is kept clean and locked.

THE REFUGE SHOULD NOT BE STORED ,IF THE REFUGE SHOULD NOT BE STORED ,IF IT HAS TO BE STORED THEN THE AREA IT HAS TO BE STORED THEN THE AREA SHOULD BE SEGGREGATED CLEANED AND SHOULD BE SEGGREGATED CLEANED AND VENTILATED EVEN THEN IT SHOULD NOT VENTILATED EVEN THEN IT SHOULD NOT BE KEPT FOR MORE THAN 72 Hrs.BE KEPT FOR MORE THAN 72 Hrs.NEEDLES AND SYRINGES SHOULD BE NEEDLES AND SYRINGES SHOULD BE BROKEN AND COLLECTED IN ANTISEPTIC BROKEN AND COLLECTED IN ANTISEPTIC SOL. BEFORE DISPOSAL.SOL. BEFORE DISPOSAL.THE AREA MUST BE INACCESSABLE TO THE AREA MUST BE INACCESSABLE TO OUTSIDERS.IN OUR LAB WASTE IS NOT OUTSIDERS.IN OUR LAB WASTE IS NOT STORED IT IS SEGGREGATED IN WASTE STORED IT IS SEGGREGATED IN WASTE ROOM & SENT FOR DISPOSAL(6 – 8 Hrs.)ROOM & SENT FOR DISPOSAL(6 – 8 Hrs.)

Laboratory wasteLaboratory waste

Laboratory is a potential source of infection measures Laboratory is a potential source of infection measures are taken for self protection and community protection by are taken for self protection and community protection by following:following:

Educating Staff.Educating Staff.CleanlinessCleanlinessProper use of antisepticsProper use of antisepticsPrevention of dry sweeping.Prevention of dry sweeping.Proper treatment of all specimens.Proper treatment of all specimens.Standard precautionsStandard precautionsProper disposal of needles & syringesProper disposal of needles & syringesProcessing in laminar flowProcessing in laminar flowSterilization techniques.Sterilization techniques.

AIMSAIMS

Self Protection From InfectionSelf Protection From Infection

Other HazardsOther Hazards

Control of spread on infection to community.Control of spread on infection to community.

Environmental protection, Laboratory being a Environmental protection, Laboratory being a potential source, proper scientific management potential source, proper scientific management of waste is essential. This includes.of waste is essential. This includes.

Decontamination,seggregation , collection and Decontamination,seggregation , collection and transporation,co-ordination with the hospital transporation,co-ordination with the hospital disposal as per policy of the hospital.disposal as per policy of the hospital.

STANDARD PRECAUTIONS STANDARD PRECAUTIONS (Blood & Body Fluid Precautions)(Blood & Body Fluid Precautions)All health care workers should use appropriate barriers.All health care workers should use appropriate barriers.Precautions to prevent skin and mucous membrane Precautions to prevent skin and mucous membrane exposure.exposure.Hands and skin surface should be washed immediately.Hands and skin surface should be washed immediately.Precautions against pricks by sharps.Precautions against pricks by sharps.Health care workers having lesions on skin, hands Health care workers having lesions on skin, hands should refrain from handling pathological materials.should refrain from handling pathological materials.Pregnant workers should take special precautions Pregnant workers should take special precautions Proper education in handling of waste on site.Proper education in handling of waste on site.Environmental Monitoring.Environmental Monitoring.

Laboratory a critical area,Laboratory a critical area,

Observation of aseptic antisepsis Observation of aseptic antisepsis procedures.procedures.

No dry sweepingNo dry sweeping

Antiseptic sol. in req %Antiseptic sol. in req %

Disinfection before discarding waste.Disinfection before discarding waste.

Spillage managementSpillage management

Laboratory Has The Following Laboratory Has The Following types of Wastetypes of Waste

Cultures and stocks of infectious agents.Cultures and stocks of infectious agents.Blood and body fluids.Blood and body fluids.Pathological waste.Pathological waste.

- ExcretaExcreta- UrineUrine- Pus etcPus etc- Organs & TissuesOrgans & Tissues Highly infectious waste e.g Cholerae stool,culture Highly infectious waste e.g Cholerae stool,culture

of other communicable diseases.of other communicable diseases.

Treatment of Infectious waste Treatment of Infectious waste before disposalbefore disposal

All infectious waste need to be treated before All infectious waste need to be treated before sending it to land filling. All pathological waste is sending it to land filling. All pathological waste is treated with chemical, then autoclaved before treated with chemical, then autoclaved before final disposal.final disposal.The various methods of disposals are:The various methods of disposals are:

AutoclavingAutoclavingChemical treatment:1% sodium hyppochloride.Chemical treatment:1% sodium hyppochloride.Grinding & decontamination with chlorine bleachGrinding & decontamination with chlorine bleachMicrowave irradiationMicrowave irradiationNeedle/syringe disposalNeedle/syringe disposalIncineration- To burn to reduce to ashes.Incineration- To burn to reduce to ashes.

CLEANLINESS IN THE CLEANLINESS IN THE LABORATORYLABORATORY

Avoid dry sweeping.Avoid dry sweeping.Desk tops to be cleaned before starting work and after work.Desk tops to be cleaned before starting work and after work.Prompt attention of spillage.Prompt attention of spillage. 2 – 4% Phenolic Agents2 – 4% Phenolic Agents 1% Hypochloride Sol. 20 To 30 mins. 1% Hypochloride Sol. 20 To 30 mins.

Care of mops Separate mops masks section wise.Care of mops Separate mops masks section wise.Usage of gloves and masks.Usage of gloves and masks.Cleaning of incubators,ovens Autoclave and Refrigerators.Cleaning of incubators,ovens Autoclave and Refrigerators.ImmunisationImmunisationCare of sharps and Disposables.Care of sharps and Disposables.

RECEIVING AREARECEIVING AREA

Reception of samples before Reception of samples before transportation to the different sections.transportation to the different sections.

BiochemistryBiochemistry

Haematology Haematology Blood,Serum,plasmaBlood,Serum,plasma

Serology Serology ImmunologyImmunology

RECEIVING AREA conti..RECEIVING AREA conti..

Bacteriology Bacteriology

Tuberculosis Special careTuberculosis Special care

Stool SpecimenStool Specimen

Spillage if any to be treated immediately.Spillage if any to be treated immediately.

(Chemical Disinfection)(Chemical Disinfection)

PROPHYLAXIS AND CONTROL PROPHYLAXIS AND CONTROL OF SPREAD OF INFECTIONOF SPREAD OF INFECTION

Health education to all Staff members.Health education to all Staff members.

Regular courses of discussion with Regular courses of discussion with Nursing Staff,Nursing Aids,Sanitary Nursing Staff,Nursing Aids,Sanitary attendants, House keeping.attendants, House keeping.

Immunisation of staff as per policy of the Immunisation of staff as per policy of the hospital.hospital.

WASH ROOMWASH ROOM

Blood related productsBlood related productsReusableReusableDisposableDisposableSeparate containers with 1% hypochloride Separate containers with 1% hypochloride solution is provided to these sections .solution is provided to these sections .Reusable glass tubes after decontamination for Reusable glass tubes after decontamination for 2- 4 hrs are decanted into sink with flowing hot 2- 4 hrs are decanted into sink with flowing hot water where they are washed.water where they are washed.All pathological waste is collected in yellow bags All pathological waste is collected in yellow bags for inceneration.for inceneration.

WASH ROOMWASH ROOM

Bacteriology Bacteriology

Mycology Special CareMycology Special Care

TuberculosisTuberculosis

Stool Specimen Stool Specimen

Spillage if any to be treated immediately Spillage if any to be treated immediately (Chemical Disinfection) . (Chemical Disinfection) .

SPILLAGE MANAGEMENTSPILLAGE MANAGEMENT

SMALL SPILLAGE – Place double the SMALL SPILLAGE – Place double the amount of 1% Hypochloride Sol.for 20 amount of 1% Hypochloride Sol.for 20 Mins. .Mins. .

Blot dry Blot dry

Mop –This mop should be washed and Mop –This mop should be washed and dried before reuse.dried before reuse.

BIG SPILLAGE- Cover with antiseptic sol. BIG SPILLAGE- Cover with antiseptic sol. And clean as per protocol.And clean as per protocol.

CONCLUSIONCONCLUSION

ALL HOSPITAL WASTE TO BE TREATEDAS ALL HOSPITAL WASTE TO BE TREATEDAS HAZARDOUSHAZARDOUSPOLICY OF WASTE MANAGEMENT MUST BE POLICY OF WASTE MANAGEMENT MUST BE FOLLOWED RIGIDLYFOLLOWED RIGIDLYBIG HOSPITALS SHOULD HAVE ITS OWN SYSTEM BIG HOSPITALS SHOULD HAVE ITS OWN SYSTEM OF WASTE TREATMENT AND OF WASTE TREATMENT AND DISPOSAL./zonalarrangement to be enforcedDISPOSAL./zonalarrangement to be enforcedCOLLECTION BAGS TO BE GOOD QUALITYCOLLECTION BAGS TO BE GOOD QUALITYUNAUTHORISED PERSON SHOULD NOT HAVE UNAUTHORISED PERSON SHOULD NOT HAVE ACCESS TO THE COLLECTION SITE.ACCESS TO THE COLLECTION SITE.EMPLOYEES HEALTH HAZARDS TO BE TAKEN EMPLOYEES HEALTH HAZARDS TO BE TAKEN CARE OF BY PROPER EDUCATION,IMMUNISATION CARE OF BY PROPER EDUCATION,IMMUNISATION ETC.ETC.

The decontaminated & segregated waste The decontaminated & segregated waste filled in yellow,blue,red black respectively filled in yellow,blue,red black respectively transported in a covered wheel barrow to transported in a covered wheel barrow to the common hospital waste disposal site.the common hospital waste disposal site.

Thus Lab helps in prevention & spread of Thus Lab helps in prevention & spread of infection.infection.