HOSPITAL WASTE MANAGEMENTPROJECT

TRAINING FOR MEDICAL OFFICER

By: Alamgeer MemonProject Manager

Mashriq Foundation Hyderabad 24th March 2010

Mashriq Mashriq FoundationFoundation

Mashriq Foundation is an NPO and has a multi-dimensional Mashriq Foundation is an NPO and has a multi-dimensional focus on Environment and community health activities. focus on Environment and community health activities.

Based in Hyderabad, Mashriq Foundation is currently Based in Hyderabad, Mashriq Foundation is currently executing following two projectsexecuting following two projects

1.1. Hospital Waste Management (HWM) Project at 4 Hospital Waste Management (HWM) Project at 4 Taluka hospitals of Hyderabad District with Taluka hospitals of Hyderabad District with collaboration of UNDP GEF SGPcollaboration of UNDP GEF SGP

2.2. Hospital Waste Management (HWM) Project at DHQ Hospital Waste Management (HWM) Project at DHQ Hospital Sanghar with collaboration of BP PakistanHospital Sanghar with collaboration of BP Pakistan

How We conceived How We conceived this projectthis project

DisposalDisposal

Movie

Disposal End …..Disposal End …..

Project Nexus Project Nexus

► Burning of HW – dioxin formation Burning of HW – dioxin formation

► Exposure of hepatitis B & C through needle Exposure of hepatitis B & C through needle pricks pricks

HOSPITAL WASTE HAZARDSHOSPITAL WASTE HAZARDS

(i)(i) Occupational RiskOccupational Risk

► Medical as well as sanitary workers & scavengers are at Medical as well as sanitary workers & scavengers are at risk. Sharps are the most dangerous category. risk. Sharps are the most dangerous category.

► Scavengers at the municipal storage and dumpsites and Scavengers at the municipal storage and dumpsites and those dealing with reuse/recycling activities those dealing with reuse/recycling activities

(ii) Risk to the Population(ii) Risk to the Population

► Through unauthorized reuse and recycling practice, Through unauthorized reuse and recycling practice, particularly of disposable syringesparticularly of disposable syringes

(iii) Indirect Risk via Environment(iii) Indirect Risk via Environment

► Contamination of drinking & irrigational water. Contamination of drinking & irrigational water. ► Contamination of soil and underground waters. Contamination of soil and underground waters. ► Air pollution through uncontrolled burningAir pollution through uncontrolled burning

Injection safety Injection safety practicespractices

The reference definition of a safe injection The reference definition of a safe injection

► In order not to harm the patient, the injection should be In order not to harm the patient, the injection should be administered with a sterilized syringe and needle, using the administered with a sterilized syringe and needle, using the right medication, etc.right medication, etc.

► In order not to expose the provider to any avoidable risk, the In order not to expose the provider to any avoidable risk, the needle should be placed in a puncture-proof container needle should be placed in a puncture-proof container immediately after use.immediately after use.

► In order not to result in any waste that is dangerous for other In order not to result in any waste that is dangerous for other people, sharps waste should be discarded appropriatelypeople, sharps waste should be discarded appropriately

Why this project:Why this project:

► According to WHO, contaminated needles and syringes represent a According to WHO, contaminated needles and syringes represent a particular particular threat as these are scavenged from dump sites and be reused. threat as these are scavenged from dump sites and be reused.

► WHO has estimated that, in year 2000, injections with contaminated WHO has estimated that, in year 2000, injections with contaminated syringes caused:syringes caused:

21 million hepatitis B virus (HBV) infections (32% of all new 21 million hepatitis B virus (HBV) infections (32% of all new infections);infections);

2 million hepatitis C virus (HCV) infections (40% of all new infections);2 million hepatitis C virus (HCV) infections (40% of all new infections);

260 000 HIV infections (5% of all new infections)260 000 HIV infections (5% of all new infections)

► Epidemiological studies indicate that a person who experiences one Epidemiological studies indicate that a person who experiences one needle-stick injury from a needle used on an infected source patient has needle-stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively to become infected with HBV, risks of 30%, 1.8%, and 0.3% respectively to become infected with HBV, HCV and HIV. HCV and HIV.

HW MANAGEMENT – SELF ASSESSMENTHW MANAGEMENT – SELF ASSESSMENTS. NoS. No Statement Statement Your score Your score

Is there a designated person in charge of waste Is there a designated person in charge of waste management in the facility?management in the facility?

Is there a written standard operating procedure Is there a written standard operating procedure (SOP) for waste management in the facility?(SOP) for waste management in the facility?

Is there a system for segregation of waste in place?Is there a system for segregation of waste in place?

Are the staff aware of risks associated with Are the staff aware of risks associated with improper waste handling?improper waste handling?

Are auto-disable syringes used for injection?Are auto-disable syringes used for injection?

Are syringes discarded with their needles attached?Are syringes discarded with their needles attached?

Is there a secured waste storage area on site?Is there a secured waste storage area on site?

Is safety boxes, bins, waste bags transportation Is safety boxes, bins, waste bags transportation system safe?system safe?

Do you see hospital waste littered outside?Do you see hospital waste littered outside?

Is there a specific budget for waste management?Is there a specific budget for waste management?

There  was  an  overall  sense  of  increased  safety There  was  an  overall  sense  of  increased  safety  from  the  staff  doing  the  injection.   from  the  staff  doing  the  injection.  

They  also  reported  a  real  saving  in  the  time They  also  reported  a  real  saving  in  the  time  they  spend  in  taking  care  of  the  used  they  spend  in  taking  care  of  the  used  injection  material.   injection  material.  

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Waste Transport Waste Transport

Hospital Waste Types:Hospital Waste Types:

Carriers Carriers

Segregation/collectionSegregation/collection

► The most important component of HWM is segregation.The most important component of HWM is segregation.

► Segregation is the process of separating different waste Segregation is the process of separating different waste streams while keeping in view the type of treatment and streams while keeping in view the type of treatment and disposal options.disposal options.

► Risk waste will be separated at source from non-risk waste at Risk waste will be separated at source from non-risk waste at the ward bedside, operation theatre, laboratory etc. the ward bedside, operation theatre, laboratory etc.

► Risk waste includes all infectious waste e.g.. soaked Risk waste includes all infectious waste e.g.. soaked bandages, pus, blood and bloody material, used bandages, pus, blood and bloody material, used syringe/needles etcsyringe/needles etc

► Non-risk waste includes Paper, carton, used drips, empty glass Non-risk waste includes Paper, carton, used drips, empty glass bottles, used vials/ampoules and Garbagebottles, used vials/ampoules and Garbage

Collection & Collection & TransportationTransportation

► Collection will be on daily basis from specific color Collection will be on daily basis from specific color coded waste bins coded waste bins

► Risk waste from Red-bins and non risk waste from Risk waste from Red-bins and non risk waste from Blue-bins placed at bed side, will be collected Blue-bins placed at bed side, will be collected separately in the LARGE bins of same color schemeseparately in the LARGE bins of same color scheme

► Transportation of waste from wards to Central Transportation of waste from wards to Central Storage Facility will be done by covered drums Storage Facility will be done by covered drums

HW StorageHW Storage

► Mashriq Foundation suggests Central storage room Mashriq Foundation suggests Central storage room facility with Incinerator.facility with Incinerator.

► CSF locations to store waste temporarily before CSF locations to store waste temporarily before Incineration and Land filling/DumpingIncineration and Land filling/Dumping

► These CSF will be covered and having large These CSF will be covered and having large containers for the waste storagecontainers for the waste storage

HW Disposal:HW Disposal:

► Incineration for Risk/ Infectious wasteIncineration for Risk/ Infectious waste

► Land filling for Non-risk wasteLand filling for Non-risk waste

► Packing papers, plastic bags, empty bottles and Packing papers, plastic bags, empty bottles and other pharmaceutical waste of non-infectious type other pharmaceutical waste of non-infectious type back to supplierback to supplier

Story of Incinerator Story of Incinerator

What is IncinerationWhat is Incineration

► Technologies using high-heat thermal process generally Technologies using high-heat thermal process generally operate at around 1000 °F to 15,000 °F or even higher. operate at around 1000 °F to 15,000 °F or even higher.

► High heat process involves chemical and physical changes High heat process involves chemical and physical changes in both organic and inorganic materials resulting in total in both organic and inorganic materials resulting in total destruction of waste. destruction of waste.

► Oxidation at high temperature converts organic compounds Oxidation at high temperature converts organic compounds in the waste into their CO2 and water. in the waste into their CO2 and water.

► Inorganic components are mineralized and converted into Inorganic components are mineralized and converted into ashash

► These conversions result in very significant reduction of These conversions result in very significant reduction of waste volume and weight, at times up to 95-99%.waste volume and weight, at times up to 95-99%.

► Incineration is the oldest and still the most commonly-used Incineration is the oldest and still the most commonly-used method for the HWM in most of the countries method for the HWM in most of the countries

DioxinDioxin► Dioxin belongs to a family of 419 chemicals with related properties Dioxin belongs to a family of 419 chemicals with related properties

and toxicity, but the term “dioxin” is often used to refer to the 29 and toxicity, but the term “dioxin” is often used to refer to the 29 that have similar toxicity.that have similar toxicity.

► Dioxin is one of the most toxic chemicals known to humankind. Its Dioxin is one of the most toxic chemicals known to humankind. Its toxicity is measured in monograms toxicity is measured in monograms

► WHO last year acknowledged dioxin’s cancer-causing potential when WHO last year acknowledged dioxin’s cancer-causing potential when they classified it as a known human carcinogenthey classified it as a known human carcinogen

► The U.S. EPA has determined that airborne dioxins settle onto soil The U.S. EPA has determined that airborne dioxins settle onto soil and plants. Dioxins enter the air from waste burning and other and plants. Dioxins enter the air from waste burning and other natural sourcesnatural sources

Incinerator – Incinerator – Opposite arguments Opposite arguments

► In the west, some environmental criticize In the west, some environmental criticize

incinerator on account of not meeting incinerator on account of not meeting

dioxin and furan limitsdioxin and furan limits

Disposal Methods Disposal Methods

Infectious WastesInfectious Wastes

► Infected HW can transmit diseases, especially if it finds portals of entry. Infected HW can transmit diseases, especially if it finds portals of entry.

► Main concern of infectious hospital waste is the transmission of HIV/ AIDS virus Main concern of infectious hospital waste is the transmission of HIV/ AIDS virus and more often of Hepatitis B or C virus (HBV) through injuries caused by and more often of Hepatitis B or C virus (HBV) through injuries caused by syringes contaminated by human blood.syringes contaminated by human blood.

► Potential risk of TB/ Throat infection, Typhoid, Dysentery, Diarrhea, Bacterial/ Potential risk of TB/ Throat infection, Typhoid, Dysentery, Diarrhea, Bacterial/ Viral diseases, ARV (Rabies), VDRL (Sexually transmitted disease), UTI/ all C/S, Viral diseases, ARV (Rabies), VDRL (Sexually transmitted disease), UTI/ all C/S, and Leprosy etc. as the pathological laboratories do all these analysis to and Leprosy etc. as the pathological laboratories do all these analysis to diagnose the diseasesdiagnose the diseases

Waste Waste not not to be Incineratedto be Incinerated► Pressurized gas containersPressurized gas containers► Large amounts of reactive chemical wasteLarge amounts of reactive chemical waste► Radioactive wasteRadioactive waste► Silver salts or radiographic wasteSilver salts or radiographic waste► Halogenated plastics (e.g. PVC)Halogenated plastics (e.g. PVC)► Mercury or cadmiumMercury or cadmium► Ampoules of heavy metalsAmpoules of heavy metals

HWM – Good and Bad practices HWM – Good and Bad practices

HWM – Good and Bad HWM – Good and Bad practicespractices

HWM – Good and Bad HWM – Good and Bad practicespractices

HWM – Good and Bad HWM – Good and Bad practicespractices

HWM – Good and Bad HWM – Good and Bad practicespractices

Color coding of Waste Color coding of Waste BinsBins

► Red colored waste bins for Risk/infectious wasteRed colored waste bins for Risk/infectious waste

► Blue colored waste bins for Non-risk wasteBlue colored waste bins for Non-risk waste

► Black colored dust bins for Garbage (fruits/food)Black colored dust bins for Garbage (fruits/food)

Screening & Vaccination of Screening & Vaccination of staffstaff

► There will be a regular program of Screening and There will be a regular program of Screening and Vaccination of Hepatitis B & C, for hospital staffVaccination of Hepatitis B & C, for hospital staff

► Initially the Sanitary staff of Hospital is being Initially the Sanitary staff of Hospital is being given this facilitygiven this facility

► Step by step, other categories will also be Step by step, other categories will also be includedincluded

HW Regulations:HW Regulations:► The HWM Rules 2005 were notified by The HWM Rules 2005 were notified by

Pakistan EPAPakistan EPA

► HWM Rules 2005 describes organizational HWM Rules 2005 describes organizational process of hospital management along with process of hospital management along with prescribing n forming waste management prescribing n forming waste management responsibilities on the hospital administrationresponsibilities on the hospital administration

► In reality this is not being practiced in public In reality this is not being practiced in public sector hospitals but LUH is pioneer and has sector hospitals but LUH is pioneer and has started by formation of WMT started by formation of WMT

What is Waste What is Waste Management Plan Management Plan

EPA’s HWM Rules 2005 require all hospitals to develop and implement Waste EPA’s HWM Rules 2005 require all hospitals to develop and implement Waste Management Plan Management Plan

► A map of the hospital showing A map of the hospital showing the waste generation points for every ward and department, the waste generation points for every ward and department, indicating whether each point is for risk waste or non-risks waste, and indicating whether each point is for risk waste or non-risks waste, and showing the sites of the central storage facility for risk waste and showing the sites of the central storage facility for risk waste and the central storage facility for non-risk waste; the central storage facility for non-risk waste;

► Details of the types, numbers and estimated costs of containers, waste bags and trolley Details of the types, numbers and estimated costs of containers, waste bags and trolley required;required;

► Timetables including frequency of waste collection from each wards;Timetables including frequency of waste collection from each wards;

► Duties and responsibilities for people where waste is generated, and be involved in the Duties and responsibilities for people where waste is generated, and be involved in the management of the waste;management of the waste;

► Estimate of the number of staff members required for waste collection;Estimate of the number of staff members required for waste collection;

► Procedures for the management of waste requiring special treatment before final Procedures for the management of waste requiring special treatment before final disposal; disposal;

► Contingency plans for storage or disposal of risk waste in the event of breakdowns of Contingency plans for storage or disposal of risk waste in the event of breakdowns of incinerators, or of maintenance or collection arrangements;incinerators, or of maintenance or collection arrangements;

► Training courses and programs on waste management.Training courses and programs on waste management.

Monitoring & Ownership Monitoring & Ownership SystemSystem

► This whole program will be looked after and This whole program will be looked after and owned by “Waste Management Team”owned by “Waste Management Team”

► The Ward-Administrator and Incharge of Labs The Ward-Administrator and Incharge of Labs and other departments will play key roleand other departments will play key role

► Civil Surgeon, obviously, will be the head of Civil Surgeon, obviously, will be the head of whole activitywhole activity

Sustainability:Sustainability:

► HWM system will be considered as a routine HWM system will be considered as a routine business of hospital rather than one-time project business of hospital rather than one-time project activityactivity

► WMT will develop a comprehensive “Waste WMT will develop a comprehensive “Waste Management Plan”Management Plan”

► This Plan will be the actual document to achieve This Plan will be the actual document to achieve the desired goals under this HWM systemthe desired goals under this HWM system

Email Distribution Email Distribution GroupGroup

► We suggest to start a email based We suggest to start a email based discussion / information sharing group discussion / information sharing group

Injection SafetyInjection Safety

Are We ready for the change ??Are We ready for the change ??

Personal Commitment Personal Commitment For the improvements of HW Management, I, Dr. …………… For the improvements of HW Management, I, Dr. …………… personally commit to do following personally commit to do following

1.1. Nothing specific. I happy the way things are happening around me. Nothing specific. I happy the way things are happening around me. It is It is administration's worry administration's worry

2.2. Ensure that I always use syringe cutters wherever I use ..Ensure that I always use syringe cutters wherever I use ..

3.3. Understand and preach for better HW management Understand and preach for better HW management

4.4. To promise myself to leave at least one of the habits contributing in To promise myself to leave at least one of the habits contributing in mismanagement of “Hospital Waste”mismanagement of “Hospital Waste”

5.5. To adopt at least one measure of improving the “Hospital Waste To adopt at least one measure of improving the “Hospital Waste Management”Management”

The The EndEnd