Occupational Health Risks of

Biomedical Waste Management

– An overview

by

Dr. Vidhya Venugopal

Professor Department of Environmental Health Engineering

Sri Ramachandra University Porur, Chennai - 600 116

In India- 1-2 kg/bed/day with variation among Govt. and Private establishments.

Approximately 506.74 tons/ day wastes generated

Out of which only 57% waste undergoes proper disposal

Biomedical waste Statistics

Categories of Bio-Medical Wastes

Cytotoxic drugs

Genotoxic waste

Chemical waste

Pharmaceutical Waste

Sharp Waste

Gas cartridges

Gas cylinders

Aerosol cans

PRESSURISED CONTAINERS

5

Waste with high content of heavy metals

Worn out batteries

Blood pressure guages 6

Radioactive waste

7

OCCUPATIONAL HAZARD Who is at risk?

Health-care & house-keeping personnel,

waste workers

Doctors, nurses and technicians

Waste recyclers and rag pickers

Visitors

In- and out-patients

General public

Real time Statistics

Sharps (Annual injury rate)

House-keeping personnel & nurses - 10-20/1000

Cleaning dept. and waste handlers - 180/1000

Needle stick injuries

Risk of Hepatitis B – ROT = 6-30%.

Risk of HIV infection – Avg. TR = 0.3% (3/1000)

TYPES OF OCCUPATIONAL HAZARDS

Physical

Chemical

Biological

Ionising/non-ionising radiation

Psychosocial

Ergonomical

From Hazard to Disease

EXPOSURE UPTAKE EFFECT DISEASE

H A

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R D

Occupational

Environmental Environmental

Exposure Assessment Health Surveillance

OCCUPATIONAL HAZARDS (Physical)

Types:

Noise, Vibration, Radiation, Heat, Physical

injuries, Lifting heavy objects

EFFECT:

Hearing loss, nervous problems, backache,

physical disability, heat exhaustion, Musculo skeletal disorders, genetic damage, cancers etc.,

OCCUPATIONAL HAZARDS (Chemical)

SOURCE: Chemical cleaners, sterilizers, anaesthetic chemicals, expired pharmaceuticals, gluteraldehye, latex, Mercury, heavy metals, volatiles and plastics.

EFFECT: Irritation to sensory organs, headaches, nausea, vomiting, systemic illnesses, Neurological and GI disorders, cardiovascular disorders, immune dysfunction, reproductive & personality disorders, disability and possibly death

OCCUPATIONAL HAZARDS (Ergonomical)

SOURCE:

Repetitive motions, awkward postures,

twisting, ergonomically unfriendly working

conditions, bending and lifting weights

EFFECT:

Osteoarthritis of wrist, epicondylitis elbow,

back pain, low back pain, shoulder

tightening (temporary and permanent)

OCCUPATIONAL HAZARDS (Radiation)

SOURCE:

Radiotracer in therapy, cancer treatment,

radiopharmaceutical waste, waste from

radio medical procedures, discarded laser

equipments

EFFECTS:

Burns, Radiation sickness, cataract,

reduction in blood cells, Chromosomal

aberrations, tumours, skin erthyrema/

cancers, sterility.

OCCUPATIONAL HAZARDS (Biological)

SOURCE:

Bioaerosols, body fluids, soiled linen, bandages sharps, needle stick, Biowaste

EFFECT:

H1N1, Hepatitis B, HIV, Infections due to other pathogens, Common infections, compromised immune system due to repeated exposures, disability and/or death in acute cases.

OCCUPATIONAL HAZARDS (Psychosocial)

SOURCE:

Fatigue, Workload demand, Problematic

interpersonal relationships, Limited career

opportunities, poor remuneration, Monotony of

the job, Stress due to fear, Poor/limited training

in BMW.

EFFECT:

Personality disorders, low self-esteem, Anxiety,

low motivation, imbalanced work-life balance,

Depression, alcohol/drug abuse, Violence

Laws of Biomedical Waste Management

On 20th July 1998

Ministry of Environment and Forests (MoEF),

Govt. of India, Framed a rule known as ‘Bio-

medical Waste (Management and

Handling) Rules, 1998,’

Provides uniform guidelines and code of

practice for Bio-medical waste management.

Government initiatives……

SAFETY/PRECAUTIONERY

MEASURES

VULNERABLE POPULATION

Pregnant Women

Work group above 45yrs

Disabled or with previous illness.

With respiratory illnesses

High exposures

Hazard Control Principles

Hierarchy of Controls

Source Controls

Substitution

Enclosure or Isolation

Adequate Safety Program

Audits

Pathway Controls

Housekeeping

Distance

Continuous Area Monitoring

Reduce exposure

Receiver (Worker) Controls

Training & Education

Rotation

Enclosure of Worker

Personal Protective Devices

Strong org. policies

SPILLAGE

3 MAJOR TYPES OF SPILLAGE

BLOOD SPILLAGE

MERCURY SPILLAGE

CHEMICAL SPILLAGE

PRECAUTION S FROM BLOOD

SPILLAGE

Wear Personal Protective Equipment

Mark the area.

Add 5%sodium hypo chlorite to the

spillage and keep it for 10-15 minutes.

Collect the spillage using waste cloth

or cotton.

MERCURY SPILLAGE

Wear personal protective Equipment

With the help of two cardboard pad,

collect the spillage and with an ink filler

absorb mercury

It is then transferred to a water filled

container.

It is then transferred to a seal proof bag

and taken to clinical pharmacist

DO NOT BROOM OR VACCUM

No take home Mercury

CHEMICAL SPILLAGE

Whenever a chemical spillage occurs, remove

contaminated clothing.

Flush eyes/skin with water at least for 15-30

mins. Use soap for cleaning.

Protect yourself and remove injured persons

(if any) to fresh air.

Notify concerned personnel

If flammable vapors are involved, do not

operate electrical switches.

Do not touch the spill without PPE.

If unknown chemical evacuate room and

wait for spill team

OTHER TIPS FOR BASIC OSH

Safe Hand washing Techniques

Personal hygiene and habits

Never eat, drink or apply cosmetics in the work area

Avoid touching your face, mouth or eyes

Never suck pens or chew pencils

Separate area for eating and drinking

Visual remainders of hazards

Do’s and Don’ts pictorial

Hand

Washing

Pictorial Labels with Agent, Concentration &

Hazard Warnings

Examples of hazard labels:

Communicate about Workplace Hazards

Job description

Posters on doors

Labels on hazards

Give feedback on use of PPE and disposal in evaluation

Role model safe use and disposal

Contact point who is responsible

Successful prevention requires:

Information on the causal relationship between risk factor and health outcome,

Knowledge of the mechanism of action of hazardous factors and conditions,

Knowledge of how the causal relationship can be broken,

Resources and tools for the implementation of measures,

Political, managerial and target group support for a preventive programme.

R

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Preventive health (OEH)

Ground reality I - Risk Assessment

Ground reality II- Risk perception

Let the waste of the “sick” not contaminate the

lives of “The Healthy”

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