seminar in health care waste management
TRANSCRIPT
05012023 1
WELCOME TO SEMINAR
05012023 2
05012023 3
Discovered during a waste audit a leg destined for disposal via the municipal system (NakarmiHECAF)
05012023 4
05012023 5
Contdhellip
One extreme case from Brazil demonstrated a carcinogenic impact on the general population from an unintended exposure to radioactive waste from a health-care facility While moving to a new site a radiotherapy institute left a sealed radioactive source in equipment at its old premises An individual who gained access to these premises removed the sealed source took it home and broke open the casing to reveal the radioactive material As a consequence 249 people were exposed of whom several died or suffered severe health problems (International Agency for Research on Cancer (IARC1988)
05012023 6
HEALTHCARE WASTE MANAGEMENT
Pabitra Sharma
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 2
05012023 3
Discovered during a waste audit a leg destined for disposal via the municipal system (NakarmiHECAF)
05012023 4
05012023 5
Contdhellip
One extreme case from Brazil demonstrated a carcinogenic impact on the general population from an unintended exposure to radioactive waste from a health-care facility While moving to a new site a radiotherapy institute left a sealed radioactive source in equipment at its old premises An individual who gained access to these premises removed the sealed source took it home and broke open the casing to reveal the radioactive material As a consequence 249 people were exposed of whom several died or suffered severe health problems (International Agency for Research on Cancer (IARC1988)
05012023 6
HEALTHCARE WASTE MANAGEMENT
Pabitra Sharma
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 3
Discovered during a waste audit a leg destined for disposal via the municipal system (NakarmiHECAF)
05012023 4
05012023 5
Contdhellip
One extreme case from Brazil demonstrated a carcinogenic impact on the general population from an unintended exposure to radioactive waste from a health-care facility While moving to a new site a radiotherapy institute left a sealed radioactive source in equipment at its old premises An individual who gained access to these premises removed the sealed source took it home and broke open the casing to reveal the radioactive material As a consequence 249 people were exposed of whom several died or suffered severe health problems (International Agency for Research on Cancer (IARC1988)
05012023 6
HEALTHCARE WASTE MANAGEMENT
Pabitra Sharma
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 4
05012023 5
Contdhellip
One extreme case from Brazil demonstrated a carcinogenic impact on the general population from an unintended exposure to radioactive waste from a health-care facility While moving to a new site a radiotherapy institute left a sealed radioactive source in equipment at its old premises An individual who gained access to these premises removed the sealed source took it home and broke open the casing to reveal the radioactive material As a consequence 249 people were exposed of whom several died or suffered severe health problems (International Agency for Research on Cancer (IARC1988)
05012023 6
HEALTHCARE WASTE MANAGEMENT
Pabitra Sharma
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 5
Contdhellip
One extreme case from Brazil demonstrated a carcinogenic impact on the general population from an unintended exposure to radioactive waste from a health-care facility While moving to a new site a radiotherapy institute left a sealed radioactive source in equipment at its old premises An individual who gained access to these premises removed the sealed source took it home and broke open the casing to reveal the radioactive material As a consequence 249 people were exposed of whom several died or suffered severe health problems (International Agency for Research on Cancer (IARC1988)
05012023 6
HEALTHCARE WASTE MANAGEMENT
Pabitra Sharma
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 6
HEALTHCARE WASTE MANAGEMENT
Pabitra Sharma
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 7
General objective
At the end of the session the participants will be able to explain Health care waste management
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 8
Specific Objectives
bull define wastebull define health care wastebull state the types of health care wastebull identify sources of health care wastebull explain impact of health care wastebull state the types of infection by Health Care Wastebull list the principles of health care waste managementbull explain the steps of health care waste
management
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 9
Specific Objectives Cont
identify different organization in health care waste management identify the legislation regarding Health Care Waste Management in Nepal
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 10
Waste Definition
bull Waste (also known as rubbish trash refuse
garbage junk litter) is unwanted or useless
materials
bull ldquoSubstances or objects which are disposed of or
are intended to be disposed of or are required to
be disposed of by the provisions of the lawrdquo
(Basel Convention2003)
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 11
Health Care Waste (HCW)
Health-care waste includes all the waste
generated by health-care establishments research
facilities and laboratories In addition it includes
the waste originating from ldquominorrdquo or ldquoscatteredrdquo
source such as that produced in the course of
health care undertaken in the home (dialysis
insulin injections etc) (WHO1999)
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 12
HCW Contd
Medical waste means the hazardous waste
produced and discharged from hospitals clinics
pharmacies dispensaries blood banks pathology
laboratories veterinary institutions and health
research centers (Solid Waste Management Act
2011Nepal)
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 13
HCW Contd
HCW
80 general non hazardous 15 hazardous
(10 infective waste
5 non- infectious but hazardous1
is sharp
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 14
Classifications of waste
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 15
Categorization of HCW
a) Based on UNEPSBCWHO (United Nation Environment
ProgrammeSecretariat Basal Convention2004)
1 Non-risk HCW
2 HCW requiring special attention
3 Infectious and highly infectious waste
4 Other hazardous waste
5 Radioactive waste
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 16
1) Non risk HCW
Non-risk health care waste (Comparable to the
domestic waste)
11 Recyclable HCW - paper card board non-
contaminated plastic or metal cans or glass
12 Biodegradable HCW ndash waste that can be
composted
13 Other non-risk HCW ndash clay equipment
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 17
HCW which needs special attention for disposal
21 Human anatomical waste -human body parts
organs and tissues
22 Sharp Waste-
23 Pharmaceutical waste
- Non- hazardous pharmacological waste- Normal
saline Dextrin or Cough syrup etc
2 Health care waste requiring special attention
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 18
HCW with special attention contd
- Potentially hazardous pharmaceutical
waste- Date expired medicine
- Hazardous pharmaceutical waste-
unidentifiable pharmaceuticals as well as heavy
metal containing disinfectants
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 19
Contdhellip
A dog finds some pathological waste on a Kathmandu street (NakarmiHECAF)
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 20
Contdhellip
In China 21 dead babies were found in a lake
some had hospital identity tags and one was
wrapped in plastic and labeled ldquomedical wasterdquo
(human right and medical waste 2011)
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 21
HCW Require Attention Contd
24 Cytotoxic pharmaceutical waste - alkylated
substances antimetabolites antibiotics plant
alkaloids hormones and others
25 Blood and body fluids waste
human or animal blood secretions and excretions
Eg dressing material s1113090wabs syringes without
needle infusion equipment
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 22
3 Infectious and highly infectious Waste
31 Infectious waste- potential of transmitting
infectious agents to humans or animals Eg isolation
wards dialysis wards or centers for patients infected
with hepatitis viruses (yellow dialysis) pathology
departments operating theatres etc
32 Highly infectious waste- All microbiological
cultures and 1113090laboratory waste
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 23
4 Other Hazardous Waste
Include chemicals heavy metals pressurized containers
discarded gaseous liquid and solid generated during diagnostic
and experimental 1113090disinfecting procedures cleaning processes
and house-keeping with features of
o Toxic
o Corrosive acids
o Flammable
o Reactive explosive shock sensitive
o Cytotoxic or genotoxic properties
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 24
5 Radioactive Waste
bull Include materials contaminated with
radio1113090nuclides which arise from the medical or
research use of radio-nuclide
bull Sealed radiation source liquid and gaseous
material contaminated 1113090with radionuclide
excreta of patients etc
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 25
WHO Classification
a) Hazardous health-care waste bull Sharps waste bull Infectious waste bull Pathological waste bull Pharmaceutical waste bull cytotoxic waste bull Chemical waste bull Radioactive waste b) Non-hazardous or general health-care waste
(WHO2014)
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 26
Categorizations According to BMW Schedule 2011
bull Category 1- Human Anatomical
bull Category 2- Animal
bull Category 3- MicrobiologyBiotechnology
bull Category 4- Sharp
bull Category 5- Discarded Medication and Cytotoxic
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 27
BMW Categorization Contd
bull Category 6- Soiled Water
bull Category 7- Solid Waste
bull Category 8- Liquid Waste
bull Category 9- Incinerator Ash
bull Category 10- Chemical Waste
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023
Categorization in Nepal
Based on UNEPSBSWHO1) Non risk HCW
bull Biodegradable
bull Non-biodegradable
28NHCWM Guideline2014
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 29
Categorization Contd
2) Risk health care wastes
bull Pathological Waste
bull Infectious waste Sharp Waste
bull Cytotoxic Waste
bull Pharmaceutical Waste
bull Other hazardous Waste
NHCWM Guideline2014
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 30
Categorization by NHRC
bull Non hazardous waste general waste
bull Hazardous contaminated waste
bull Sharp( infected or not infected)
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 31
Research
Worldwide an estimated 16 billion injections are
administered every year Not all needles and
syringes are disposed of safely creating a risk of
injury and infection and opportunities for reuse
I am Committed for Safe Injection
(BMWS2011)
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 32
Production of HCW
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 33
Production of HCW
A) Globally
bull Developed countries - 1- 5kgbedday
bull Developing countries - 1-2kgday
- The waste generation rate (kgbedday) hospital
USA - 45 Netherlands 27 and France 25
(WHO2014)
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 34
- Average HCW - 1-45 kgbedday in Latin
American countries( eg Chile Brazil Argentina
and Venezuela )
- Hazardous waste - 5 in Denmark 28 in
USA
(Monreal 1991)
Production Contdhellip
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 35
B) Production of Waste in South East Region (by 2001)
Country Waste(kgbedday) Annual wasteBangladesh 08-167 930755 tons
Bhutan 027 73 tonsIndia 10- 20 033 million tonsMaldives NA 146 tonsNepal 05 2018 tonsPakistan 163-369 025 million tonsSrilanka 036 6600 tons
WHO2001
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 36
Production Contdhellip
C) In Nepal
bull Kathmandu Metropolitan City have organized a
study on biomedical waste in hospital located
Kathmandu
- (Results- 172kg waste day patients)
- Out of which26 waste was infectious and
hazardous
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 37
Production in Nepal Contdhellip
bull Estimated at 0533 kgbed day Out of which
0256 kgbed day is general
0147 kgbedday -biodegradable waste
0120 kgbed-day- infectious waste sharps
0009 kgbed-day - hazardous
chemicalpharmaceutical waste
(UNEP 2012)
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 38
Hospital No Total bed
HCW ton
HCWR (ton)
Government teaching including MoHP
92 6601
3080 90554Government hospital under other ministry
3 1036
Private hospital 157 9207719249 211544
Private teaching hospital 14 8626
Mission hospital 8 612 246 72
Country hospital 274 26082 105119 3093
Source MoHP Poster Presentation in first HCWM International Workshop Nepal 2012
Total health care facilities with bed and corresponding waste generation
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 39
Contdhellip
Assessment study at Civil Service Hospital(CSH)
Kathmandu Waste generation
- 6458 kg per day with occupancy rate of 5565 (173
kg per bed per day)
- Pre-separation scenario (71 is risk waste and 29 is
non-risk) Post-separation scenario (25 risk and non-
risk is around 29) (CSH2011)
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023
Production in Nepal Contdhellip
Hospitals Average productions (kgd)
General (kgd)
Hazardous (kgd)
Sharp (kgd)
Patan 5940 kg 377 (635)
165 (278) 52 (88)
Koshi Zonal 44114 kg 302 (684)
125 (284) 14 (31)
National kidney center
28 kg 14 (50) 5 (17) 9 ( 33)
(JHNRCvol 112013)
Out of 24 health care institution from only 3 HCI information available
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023
bull Enayetullah et al (2011) stated average HCW
generation in Pokhara city is est - 122 kgbed
- From outdoor facility is est 034kgday
bull From all HCF facilities (Pokhara) - 28 tonday
(22 HCWs is hazardous and infectious and the
rest general waste )
(JHNRCvol 112013)
Contdhellip
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 42
Sources of HCW
a) Major sources of health-care waste
Hospitals
bull University hospital
bull General hospital
bull District hospital
(SBS2004
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 43
Sources Contd
b) Medium Sources
Medical centers OPD Mortuary Autopsy center
Hospices Abortions clinics Medical laboratories
Medical research facilities Animal hospital Blood
bank and transfusions vices etc
(SBS2004)
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 44
Sources Contd
c) Small Sources
General medical practitioners Convalescent homes
Nursing and remedial homes Medical consulting rooms
Dental practitioner Animal boarding Tattooists
Acupuncturist Veterinary practitioner Pharmacies
Cosmetic piercers etc
(SBS2004)
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 45
Possible Impact
Sanitation workerMedical paramedical staff
Patients and visitorssurroundings environment
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 46
Route of infection
Hazards
Ingestion
Inhalation
Mucous membra
nes
Skin cut injury
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 47
A study done by Adhikari et al
showed that 535 had NSI only 468 had
reported to concerned authority whereas all
students were aware of the fact that HIV and HBV
is transmitted through needle stick injuries
Contdhellip
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 48
bull One cross-sectional study in GMC-TH
showed that 7079 health care workers had
experienced Needle Stick Injury (NSI) among them
- 525 suffered from NSI with unused needles
- 475 NSI from used needles and
- 6842 of NSI sufferer of used needles reported the
incident (NHCW guideline 2014)
Contdhellip
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 49
A study on Incidence Of NSI among PCL Nursing
Students In KTM
bull 469 had NSI 447 experienced gt 1 time
bull Out of total 298 injuries- 678 during
medication 41 while drawing medicine 20
recapping the needle
(International Journal of Scientific amp Technology
Research2013)
Contdhellip
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 50
A study by Sorsa et al 1985 in Finland found an
excess of spontaneous abortions during
pregnancy and malformations in children of
females with a history of working with anticancer
agents (WHO2014)
Contdhellip
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 51
Waste Hazards (eg)
Infectious waste and sharps Infection like HIV hepatitis resistant to antibiotic
Chemical and pharmaceutical Burn injury intoxication even death
Genotoxic Secondary neoplasma skin eye irritation
Radioactive Headache dizziness vomiting
Public sensitivity Public is very sensitive to visual impacts of health care waste specially anatomical waste
Effects of HCW
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 52
Infection By HCW Contdhellip
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 53
Infection By HCW Contdhellip
(WHO1999)
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 54
Samples taken from different areas of Bir Hospital
bull The mercury level was found to be highest in the
Dental OPDMedical ward (378 μgm3)
bull The mercury in water highest in the floor wash
sample of the Dental Ward (0045 mgl)
bull The mercury concentration in soil sample (area
near maintenance) - (272mgkg)
Interim report on HCWMBir Hospital 2068
Contdhellip
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 55
Survival of pathogenic microorganisms in the environment
The hepatitis B virusbull Is very persistent in dry airbull can survive for up to 1 week - in discarded
needle antiseptics like 70 ethanolbull Viable for 10 hours at 60 degC
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 56
Survival of microorganism Contd
HIV Virus
- Survives for no more than 15 min if exposed to
70 ethanol and only three to seven days at
ambient(20degC) temperature
- It is inactivated at 56 degC
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 57
Overview
In 2010 unsafe injections were still responsible for
33 800 new HIV infections 17 million hepatitis B
infections and 315000 hepatitis C infections
(WHO2014)
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 58
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 59
Need Health care waste management
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 60
Guiding Principles of HCWM
bull The ldquoPolluer Paysrdquo Principle
bull The ldquoPrecautionaryrdquo Principle
- (adopted under the Rio Declaration on
Environment and Development (UNEP 1972) )
bull The ldquoDuty of Carerdquo Principle
bull The ldquoProximityrdquo Principle
bull The ldquoPrior Informed Consent Principlerdquo
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 61
Steps for the Waste Management
bull Waste Minimization
bull Waste Segregation
bull Waste Collection and Storage
bull Waste Transportation
bull Waste Treatment and Disposal
(Solid Waste Management Act 2011 )
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 62
Waste Minimization
bull Waste minimization is defined as the prevention
of waste production and or its reduction at a
source
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 63
Waste Minimization ContdWaste minimization can be achieved through
bull Avoidence
bull Reduction
- Product Substitution
- Product Changes
- Procedural Changes
bull Re-Use
bull Recycling
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 64
Waste Segregation
bull Waste segregation refers to the process of separation
of waste at the point of generation and keeping them
apart during handling collection interim storage and
transportation
bull Segregation of the waste at source is the key principle
of successful and safe waste minimization and is the
most important step for a successful management of
HCW
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 65
Color Coding in Segregation Types of Waste WHO HCWG 2014 Symbol Non-risk waste Biodegradables
Black Green
Non-risk waste Recyclable Dark blue
Other non-risk HCW Light blue
Pathological waste (Danger Pathological waste
Yellow with biohazard symbol
Red
Hazardous Sharps Danger contaminated sharps Do not open
yellow with sharp
Red
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 66
Types of Waste WHO HCWG 2014
Symbol
Pharmaceuticals (cytotoxic) Danger Hazardous Infectious waste
Brown With symbol
Red
Danger Hazardous Infectious waste
Brown
Danger Highly infectious waste
Yellow Brown
Other hazardous waste Danger To be discarded by au- thorized staff only
Color Coding contd
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 67
Segregation contdhellip
Types of waste
WHO HCWG 2014 Symbol
Radioactive Waste (Danger Radioactive waste )
radiation symbol
Black
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 68
Color Coding (BMW)
Colour Category
Yellow 1255
Red 347 ( earlier soiled water are in red)
Blue 8
Black Municipal waste
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 69
bull The study conducted by MoHP help from WHO
concluded that HCWM is poor and 387
hospitals adopted correct segregation of HCWs
HCW were disposed at Okharpauwa dumping
site without any pre-treatment (MoHP2012)
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 70
Waste Collection and Storage
bull In order to avoid accumulation of the waste it
must be collected and transported to a central
storage area within the HCF on a regular basis
before being treated or removed
bull This area must be marked with warning sign
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 71
Collection Contd
bull Bags should be fill not more than 34th
bull Label of ward
bull Types of waste
bull Symbol properly
bull Weight
bull Record register
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 72
Storage Contdhellip
bull Waste security and restriction of access to authorized
persons
bull Easy access for waste collection vehicle water
bull Protection from sun rain strong winds and floods
bull Temperature
- ( Cold area)ndash max- 72 hour(winter) 48 hour
(summer)
- Hot area max-48 hr(winter) 24 hr(summer)
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 73
Storage Contd
bull Anatomical Waste - 3deg C to 8deg C
bull Infectious waste (if store gt week) 3deg C to 8deg C
bull Cytotoxic waste store separately
bull Radioactive waste should be stored in
containers (lead shielding) with labeling bull Chemical waste
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 74
Waste Transport
bull Suggested collection frequency on room to room
basis is once every shift
bull No bags should be removed unless they are
labeled with their point of production
bull The bags or containers should be replaced
immediately with new ones of the same type
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 75
Transportation Contd
Follow the guideline strictly in bothbull On-site transport bull Off-site transport
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 76
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 77
Treatment and Disposal
HCW can be treated and disposed through the
following techniques
i) Biological procedure
ii) Autoclave
iii) Chemical disinfection
iv) Encapsulation
HCWMGuideline 2014
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 78
Treatment and Disposal Contd
v) Sanitary landfill
vi) Burial
vii) Septicconcrete vault
viii) Incineration
ix) Inertization
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 79
Biological Procedure
bull Biological process uses an enzyme mixture to decontaminate HCW
bull The technology requires regulation of temperature pH enzyme level and other variables
bull Composting falls in this category
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 80
Vermicomposting
The possible option is the vermicomposting In this
process the earthworm of species Eisnia foetida
is used for the composting process
Biological Procedure Contdhellip
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 81
Biological Procedure Contd
bull The Chainpur sub health post has been generating bio-gas from placentas
bull In Bir Hospital Infected gauze and cotton waste
are disinfected using autoclaved then adopt the process of vermicomposting
Health care Foundation Nepal(HECAF)2071)
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 82
Autoclave
bull Autoclave is a process of steam sterilization under pressure
bull Autoclaves are commonly used for the treatment of highly infectious waste such as microbial cultures or sharps Large volume of blood
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 83
Autoclave Contdhellip
For effective inactivation of vegetative micro-
organisms most bacterial spores in a small
amount of waste 1113090about 5-8 kg1113090 - 60 minute
cycle at 121degC (minimum) and 1 bar (100kpa)
(WHO 1999)
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 84
Autoclave Contdhellip
The effectiveness depends on time temperature
pressure load size stacking configuration and
packing density types and integrity of bags or
containers used physical properties of the
materials amount of residual air and the
moisture content in the waste (UNEP 2012)
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 85
Chemical Disinfection
bull Chemical disinfections are usually applied for the
treatment of infectious and highly infectious HCW
bull Aldehydes chlorine compounds phenolic
compounds are added to HCW to kill or inactivate
pathogens
bull Preferred treatment for liquid infectious wastes
but can also be used in treating solid waste too
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 86
Chemical Disinfection Contd
bull Useful in treating blood urine stools and sewage
bull Chemical systems use heated alkali to destroy
tissues organs body parts and other anatomical
waste
bull Chemotherapy waste including bulk cytotoxic
agents can be treated by chemical decomposition
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 87
Chemical Disinfection Contdhellip
bull Sodium Hypochlorite (5) ndash 100mllit- for 24 hour (for Cytotoxic Waste)
bull Calcium Hypochlorite (70 chlorine) 7glit-bull Alkaline hydrolysis -process that converts animal
carcasses human body parts and tissues into a decontaminated aqueous solution
- (Later the contents are heated to between 110 degC and 127 degC for 6-8 hours)
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 88
Chemical Disinfection Contdhellip
bull Lime milk (calcium oxide) used in liquid wastes with high organic content (eg stool or vomit during a cholera outbreak)
bull lime milk in a ratio of 12for 6 hours Urine - 11 for 2 hours(Robert Koch Institute 2003)
bull Formaldehyde and ethylene oxide are no longer recommended for waste treatment due to significant hazards related to their use
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 89
Encapsulation
bull Involves the filling of the containers with waste
adding an immobilizing material and sealing the
container
bull When containers are three quarters filled with
sharps pharmaceuticals and chemical waste an
immobilizing agent poured on it
bull It is particularly suitable for sharps and
pharmaceutical waste
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 90
Encapsulation Contdhellip
The following are typical proportions (by weight) for
the mixture for encapsulation
bull 65 pharmaceutical waste
bull 15 lime
bull 15 cement
bull 5 water (WHO2014)
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 91
Sanitary landfill
bull Sanitary landfill is an engineered method
designed and constructed to keep the waste
isolated from the environment
bull It shouldnt contaminate the soil surface and
ground water and should limit air pollution
smells and direct contact with public
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 92
Sanitary landfill Contd
bull Disposing of certain types of HCW (infectious
waste and small quantities of pharmaceutical
waste) is acceptable
bull 1113090Should be at least 50 m away from water
sources
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 93
Burial
bull Hazardous waste can be buried in a special pit
bull Especially in remote locations in temporary
refugee encampments
bull Pit should be 11130902-5m deep and 1-21113090m wide
bull The bottom of the pit should be at least 2 m
above the water level
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 94
Burial Contdhellip
bull In outbreak of an especially virulent infection (as
Ebola virus)lime and soil cover may be added bull About 50m 11130901113090meters a1113090way from any 1113090water
body such as rivers or lakes1113090 bull After each waste load it should be covered 1113090with
a 11130901113090111309011130901113090 10-30 cm thick soil layer1113090
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 95
Burial Contd
bull 1113090large quantities 1113090higher than 11130901 kg1113090 of
chemical 1113090pharmaceutical waste should not be
buried
bull When the level of the waste reaches 11130901113090 to 30-50
11130901113090 cm to the surface of the ground fill the pit
1113090with dirt seal 1113090with concrete and dig another
pit
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 96
Septic concrete vault
bull This method can be used for the disposal of
used sharps and syringes
bull Dig a pit 111130901113090m x 11113090m x 11130901113090111309018m depth1113090
bull The site must be isolated and at least 111309011130901113090500
feet aw1113090ay from the ground water sources
bull Deposit the collected safety boxes filled with
used sharps and needles inside the
septicconcrete vault
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 97
Incineration
bull Incineration converts combustible materials into
non-combustible residue or ash
bull Incinerators can be oil1113090fired or electrically
powered or a combination of both
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 98
Incineration Contdhellip
bull Gases are ventilated through the incinerator
stacks and the residue or ash is disposed in a
sanitary landfill
bull In case of cytotoxic drug- 1200 degC ( but prefer
Autoclave)
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 99
Incineration contd
bull When 1113090incinerated at lo1113090w temperatures or
w1113090hen plastics that contain polyvinyl chloride
1113090PVC1113090 are incinerated dioxins furans and
toxic gases may be produced
bull This happens if 1113090waste are incinerated at
temperatures lt 800degC or wastes are not
completely incinerated1113090
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 100
Wastes that Should Never be Incinerated
bull Pressurized gas containers bull 1113090large amounts of reactive chemical 1113090waste bull 1113090Radioactive waste bull 1113090Silver salts or radiographic waste bull 1113090Halogenated plastics 1113090e1113090g1113090 PVC1113090 bull 1113090Mercury or cadmium bull 1113090Ampoules of heavy metals
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 101
Inertization
bull Inertization is usually suitable disposal method for
the pharmaceuticals and incinerated ash 1113088with
heavy metal content (1113090WHO1999) 11130901113090111309011130901113090
bull HCW is mixed with cement111309011130901113090 lime cement
and 11130901113090water1113090
bull The formed mixture is allowed to set into cubes or
pellets the waste must be grinded
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 102
Treatment for Radioactive waste
bull ldquoDecay in storagerdquo which is the safe storage of
waste a general rule is to store the waste for at
least 10 times the half-life of the longest lived
radionuclide in the waste
bull Return to supplier
bull long-term storage at an authorized radioactive
waste disposal site
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 103
Treatment of liquid wastewater
bull Liquid wastes including hazardous chemicals and
laboratory wastes have not been addressed in
almost all institutions1113090
bull HCFs like Western Regional Hospital Bir Hospital
Civil Service Hospital Manipal Teaching Hospital
Shahid Gangalal National Heart Centre and some
other HCFs are practicing HCWM system
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 104
Contdhellip
A study (Center for Public Health and Environmental Development
(CEPHED) 2012) showed bull 9032 hospitals - not practice environment sound
waste treatmentbull 6129 hospitals have very poor source separation bull 8065 hospitals not practise separate waste
collectionbull 6742 hospitals have very poor transportation ( NHCWMG2014)
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 105
HCWM in Chitwan
bull Effective segregation of waste at sourcebull Used to transport and disposed by contractorbull Most hospital are using Incinerators burial
method for needlesharp waste managementbull Planning to produce biogas from placenta and
leftover food( Already started in Pithuwa hospital)
bull Planning under construction of waste water treatment plant
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 106
HCWM Team
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 107
Past to Current Legislation for addressing Health Care Waste Management
- The Constitution of Kingdom of Nepal
1990
The state shall give priority to protection
of the environment and also to the
prevention of its further damage
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 108
Past to Current Legislation for addressing Health Care Waste Management
bull Solid Waste Management and Resource Mobilization Act 1987
bull The Town Development Act 1988
bull The Labor Act 1991
bull Industrial Enterprise Act 1992
bull The Environment Protection Act 1997
bull The Local Self- Governance Act 1999
(fine anyone up to Rs 1500000 for haphazard dumping of solid
waste)
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 109
Past to Current Legislation for addressing Health Care Waste Management
bull The three year Interim Plan of Nepal Government
(206465- 206667) - mentioned the programs for
Health Care Waste Management
bull Interim Constitution of Nepal (2063) 2007 (with
amendment) right of healthy environment for all
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 110
Past to Current Legislation for addressing Health Care Waste Management
bull Health Care Waste Management Guidelines (20089
DoHS)
bull Urban Environmental Management Guidelines (2011)
bull Second Long Term Health Plan 2054-74 (1997- 2017)
bull Solid Waste Management Act (2011)
(Fine of Rs 50 000 to 100 000 for the first time and the
penalty will be double for the repetition
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 111
Organization in HCWM
bull Center for Public Health and Environmental Development
bull Epidemiology and disease Control Division bull Ministry of Environmentbull Ministry of Health and Populationbull Ministry of Science Technology and Environmentbull United Nations Development Programme
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 112
Organization in HCWM Contd
bull United Nations Environment Programme bull Ministry of Urban Developmentbull Private Hospital Associationbull WHObull UNbull Health Care Foundation Nepal
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 113
Bir hospital in HCWM
bull Health Care Foundation Nepal (HECAF) has been
working in the field of health care waste
management since 1999
bull when it installed the first non-burn medical waste
management system in the National Kidney Centre
bull Waste is segregated at source and infectious
materials are disinfected in an autoclave
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 114
Health and Safety Practices in HCWM
bull Infection Prevention bull Personal hygiene and hand hygiene bull Workerrsquos Protectiontraining bull Protective clothing bull Immunization bull Injection safety awaeness bull Response to injury and exposure
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 115
Conclusion
Everyday large amount of HCW generate having different characteristic To overcome from this need to proper manage of HCW as well as treatment of waste
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 116
Reference
Ananth P Prashanthini A and Visvanathan VC (2010) Healthcare waste management in Asia
Bir Hospital (2011) Interim Report of Health Care Waste Management System In Bir Hospital Kathmandu WHOCEPHED (2012) Waste Management Environmental Health Condition of
Hospitals in Nepal CDC (1988) Guideline for Handwashinng and Environmental ControlCSH (2013) Health Care Waste Management Policy Civil Service Hospital Minbhawan Kathmandu Enayetullah et al (2011) Feasibility Study for the Establishment and
Operation of CommonCentral Treatment Facility (CTF) for Hospital in Pokhara City JoshiHD (2013) Health Care Waste Management Practice in NepalJNHRC
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 117
Reference
MoE (2004) 1113090Final Report on Hazardous Waste Policy Study 1113090Nepal1113090 Ministry of EnvironmentMoH (2003) Health Care Waste Management in Nepal MoHP 1113090111309011130901113090a Revised Health Care Waste Management Guideline( 2014) Ministry of Health and Population Department of Health Services MoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCMoHP (2005) Infection Prevention Reference Manual for Clinical Service NHTCNHRC (2002) 1113090111309011130901113090B National Health Care Waste Management
Training Manual Nepal Health Research Council
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 118
Reference
MoHPWHONRCS (2013) Biosafety and Waste Management Blood Transfusion Services Nepal
National Planning Commission (2010) The Three Year Interim Plan of Nepal Government (206465- 206667) Retrieve on 15th Jan 2016 from httpwwwnpcgovnp Nepal Health Research Council (2007) Health Care Waste Management in Selected Health Care Institutions in Nepal Kathmandu Nepal Nepal Health Research Council Park K (2015) Parkrsquos Textbook of Preventive and Social Medicine (23rd ed) India MS Banarsids Bhanot
Poudel et al (Sep 2013) Incidence Of Needle Stick Injury Among Proficiency Certificate Level Nursing Students Kathmandu International Journal of Scientific amp Technology Research
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 119
Reference
MOHP (2011) Solid Waste Management Act MOHPUNEPSBCWHO (2004) Preparation of National Health- Care Waste Management Plans in Sub-Saharan Countries Guidance Manual Secretariat of the Basel Convention and World Health Organization Basel ConventionUNEP (2003) Technical Guidelines on the Environmentally Sound Management of Biomedical and Healthcare Wastes (Y1Y3) Secretariat of the Basel Convention WHO (2014) Safe Management of Wastes from Health- Care Activities ( 2nd ed) WHO WHO (2008) Policy Paper on Mercury in Health Care Department
of Protection of the Human Environment Water Sanitation and Health
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-
05012023 120
THANK YOU
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Contdhellip
- Slide 6
- General objective
- Specific Objectives
- Specific Objectives Cont
- Waste Definition
- Health Care Waste (HCW)
- HCW Contd
- HCW Contd
- Slide 14
- Categorization of HCW
- 1) Non risk HCW
- Slide 17
- HCW with special attention
- Contdhellip
- Contdhellip
- HCW Require Attention
- 3 Infectious and highly infectious Waste
- 4 Other Hazardous Waste
- 5 Radioactive Waste
- WHO Classification
- Categorizations According to BMW Schedule 2011
- BMW Categorization
- Categorization in Nepal
- Categorization Contd
- Categorization by NHRC
- Research
- Slide 32
- Production of HCW
- Slide 34
- B) Production of Waste in South East Region (by 2001)
- Production Cont
- Production in Nepal
- Slide 38
- Contdhellip (2)
- Production in Nepal (2)
- Slide 41
- Sources of HCW
- Sources Con
- Sources Contd
- Possible Impact
- Route of infection
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Survival of pathogenic microorganisms in the environment
- Survival of microorganism
- Overview
- Slide 58
- Slide 59
- Guiding Principles of HCWM
- Steps for the Waste Management
- Waste Minimization
- Waste Minimization Contd
- Waste Segregation
- Color Coding in Segregation
- Slide 66
- Segregation contdhellip
- Color Coding (BMW)
- Slide 69
- Waste Collection and Storage
- Collection Contd
- Storage Contdhellip
- Storage Contd
- Waste Transport
- Transportation
- Slide 76
- Treatment and Disposal
- Treatment and Disposal Contd
- Biological Procedure
- Slide 80
- Biological Procedure
- Autoclave
- Autoclave
- Autoclave Contdhellip
- Chemical Disinfection
- Chemical Disinfection
- Chemical Disinfection (2)
- Chemical Disinfection (3)
- Encapsulation
- Encapsulation Contdhellip
- Sanitary landfill
- Sanitary landfill
- Burial
- Burial Contdhellip
- Burial Cont
- Septic concrete vault
- Incineration
- Incineration C
- Incineration contd
- Wastes that Should Never be Incinerated
- Inertization
- Treatment for Radioactive waste
- Treatment of liquid wastewater
- Contdhellip
- HCWM in Chitwan
- Slide 106
- Past to Current Legislation for addressing Health Care Waste Ma
- Past to Current Legislation for addressing Health Care Waste Ma (2)
- Past to Current Legislation for addressing Health Care Waste Ma (3)
- Past to Current Legislation for addressing Health Care Waste Ma (4)
- Organization in HCWM
- Organization in HCWM
- Bir hospital in HCWM
- Health and Safety Practices in HCWM
- Conclusion
- Reference
- Reference (2)
- Reference (3)
- Reference (4)
- Slide 120
-