Biomedical Waste

What is waste?Who are responsible and who are

the victims?Why safe disposal is essential?

How waste can be safely disposed?

What is waste?

Every system in nature progresses towards disintegration

And this disintegrated product contributes to creating waste

Categorization of Waste

Two main categories — municipal waste and special hospital waste

Municipal waste/ordinary garbage

Municipal waste -includes all solid waste without infectious, chemical, or radioactive waste

Biodegradable wastes

Biodegradable waste means any waste that is capable of undergoing

anaerobic or aerobic decomposition, such as food and garden waste, and paper and paperboard.

It also includes waste from households, which because of its nature and composition is similar to biodegradable waste from households.

Non biodegradable wastes

Non biodegradable wastes are the wastes that cannot be decomposed by bacteria e.g. plastics, bottles and tins.

Special hospital wasteThe special hospital waste -

consists of several different sub-categories including

infectious discarded materials from health-care activities on humans or animals

which have the potential of transmitting infectious agents to humans

Hospital Waste

A modern hospital is a complex multidisciplinary system

It consumes thousand of items for delivery of medical care and is part of physical environment.

All products consumed in hospitals have some unusable left over i.e. Hospital Waste.

This waste is great threat to ecological balance by polluting environment

Hospital Waste

Hospital wastes Hospital waste that poses serious threat to

environment, occupational and public health requires special treatment prior to its final disposal

• 15-20% hospital waste is hazardous

Hospital Waste

Non-hazardous Waste 80-85%

Hazardous Waste 15-20%

Infectious Waste Non-infectious Waste

Sharps Non-Sharps Chemicals & Pharmaceuticals

Others

Solid Liquid

Any waste which consists wholly or partly of

human or animal tissue, blood or any other body fluids, excretions, drugs or other pharmaceutical

products, swabs or dressings, or syringes,

needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it

Hazardous waste

Infectious wasteInfectious waste Infectious waste Infectious waste

are all those are all those substances which substances which cannot be cannot be resterilized or resterilized or reused within or reused within or brought into patient brought into patient carecare

(Rearly, 1972)

• The Basel convention classified hospital waste as the most hazardous waste after nuclear waste.

Hospital wastes

MAGNITUDE OF THE PROBLEMGLOBALLY- Developed countries generate 1 to 5

kg/bed/day

Developing countries: meager data, but figures are lower.

1-2kg/pt./day

WHO Report: 85% non hazardous waste : 10% infective waste

: 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive)

Quantum of waste

The scale of the problem is significant

Generation of medical wastes varies from an average of 3-5 kg per bed per day

A 100 bedded hospital will generate 300 – 500 kg of hospital waste/day.

It is estimated that only 5 – 10% of this comprises of hazardous/infectious waste (5 – 10kgs/day)

• Environmental pollution caused by hospital waste in Dhaka City has emerged as a serious concern

• The danger of hospital waste has so far been neglected on a wide scale

• In recent time magnitude of the problem has increased many folds

• Because number of public and private hospitals, clinics and diagnostic centers have increase in enomous number

Situation in Bangladesh

• According to a study of World Bank in 2003 - quantity of hospital waste in Bangladesh is estimated to be 36000 tons a year

• According to another source - the estimated quantity of daily generated hospital waste in Dhaka City alone is 200 tons

• According to WHO classification, 15-20% hospital waste is hazardous.

Situation in Bangladesh

Why safe disposal is essential?

Proper disposal of biomedical waste is of paramount importance because of its infectious and hazardous characteristics.

Improper disposal can result in the following:

· Organic portion ferments and attracts fly breeding

· Injuries from sharps to all categories of health care personnel and waste handlers

· Increase risk of infections to medical, nursing and other hospital staff

Hazards of improper disposal

Injuries from sharps to health workers and waste handlers

Poor infection control can lead to nosocomial infections in patients

Increase in risk associated with hazardous chemicals and drugs being handled by persons handling wastes

Hazards of improper disposal

· Poor waste management encourages unscrupulous persons to recycle disposables and disposed drugs for   repacking   and reselling

· Development of resistant strains of microorganisms

Hazards of improper disposal

WaterAir

Soil

DirectAnimal

Hospital WasteSource of infection

Food

Disease

Disability

Death

PovertyCommunity

The total generated waste is disposed off to municipal dustbins/open spaces without segregation.

Contamination of total municipal solid waste.

Air pollution, soil pollution, underground & surface water contamination.

Frequent injuries by sharp wastes, chemical wastes, spread of infections

Disease-disability-death-loss of working hours-economic loss- poverty

The only solution to this is proper managementThe only solution to this is proper management

Within HospitalWithin Hospital Outside HospitalOutside Hospital

Service providersService providersWaste HandlersWaste Handlers

PatientsPatientsAttendantsAttendants

Scavenger (Tokai)Scavenger (Tokai)Conservancy StaffConservancy StaffGeneral PublicGeneral Public

Hospital Waste (Source of Infection)

PROPER

MANAGEMENT

SAFE

PUBLIC

HEALT

Safe Health

Working ability

Better Life

Safe Water

Safe Air

Safe Soil

Safe Food

Safe Habitat

Awareness & Skill Training

Mnagement facility / Infrastructure

How waste can be safely disposed?

1983, WHO European office convened a working group at

Bergen

They concluded that proper management of hospital waste requires a system approach involving: - Awareness Segregation Source reduction

Training

All staff and students who are required to handle or move Clinical Waste should receive appropriate training which has been organised by the Department.

Training

The training should include local arrangements for implementing the procedures outlined in this document.

Training should also be given on what action to take in the event of accidents, incidents and spillages.

Containment All Clinical Waste

containers should be capable of containing the waste without spillage or puncture, especially during transport and handling

Nursing and other clinical staff in hospitals ensure that waste bags are tightly closed or sealed when they are about three-quarters full

Collection

Clinical Waste bags should be handled with care and by the neck only.

Bags should never be thrown or dropped

This could cause bags to split or burst, exposing handlers to contaminated waste

Handling

Waste segregation

The key to minimization and effective management of health-care waste is segregation and identification of the waste.

Waste Separation

Appropriate handling, treatment, and disposal of waste by type reduces costs and does much to protect public health.

Waste Separation

Segregation is always the

responsibility of the waste producer

it should takes place close to where the waste is generated and is maintained in storage areas and during transport

Effective waste segregation is the obligation of hospital staff.

The most common way of identifying the categories of health-care waste is by sorting them into impermeable colour-coded plastic bags or containers in addition to the colour coding of waste containers

Waste Separation

Waste Separation

Separation of waste in hospitals should occurs almost immediately — at the time the waste is produced

For example, when an injection is

given, or when packaging is

removed from supplies and equipment.

Waste Separation

Waste Separation

Each hospital is obliged to designate a person responsible for waste management

Costs for safe treatment and disposal of hazardous health-care waste are typically more than 10 times higher than those for general waste

Disposable syringe separation

When a disposable syringe is used, for example, the packaging should be placed in the general waste bin and the used syringe in the expensive sharps container.

Dispose of waste in the wards according to the colour code

Do not use yellow bags for uninfected domestic waste

They are expensive and need to be appropriately used

Disposal of Waste

Incineration

Proper incineration is the high technological approach .

adequately treats all types of special hospital waste

is the preferred option for cytotoxins and other pharmaceuticals.

Autoclaving

Autoclaving is also an efficient wet thermal disinfection process

Special hospital waste is heated with steam in an enclosed container, constructed of thick-walled steel, at high pressure

Waste management autoclaves generate a wastewater stream and requires a boiler with stack emissions.

Bag / Waste Colour Codes Display the colour coding chart for waste disposal in a prominent

place and on sack-holder lids. Do not tie up bags, use label ties which indicate source of the

waste. Black: Domestic waste (not infected or contaminated) Yellow:

Clinical or infected waste (to be incinerated) Clear or White plastic: Used linen Clear alginate bag inside a red plastic bag: Soiled and infected linen* Pink/Blue: Food discard. Grey: Patient's clothes and property.*These bags are laundered whole and the alginate dissolves in the washing machine to release the contents.

Linen Used Linen

Linen Used Linen Put into a clear plastic bag and seal Soiled and Infected Linen and from

infected patients Double bag first in red (alginate stitched) and

then in clear plastic bag Tie each bag securely Label with ward label

Disposal of SharpsAll sharp instruments,blades, knifes, needles and glass ampoules must be discarded in the approved Sharps containers supplied It is sensible to take a Sharps bin to the bedside when an invasive procedure (e.g. phlebotomy) is being done Do not carry used Sharps around in receivers Used needles must not be resheathed; they must not be left for others to clear up Sharps boxes should be attached to phlebotomy trolleys and to the wall in outpatients They must not be left on the floor where they are a risk to inquisitive children Do not overfill Sharps bins; seal and put them out for collection when three-quarters full Write on the box the source ward/unit, date and the name of the responsible person Larger broken glass items should be discarded into a labelled cardboard box Ward/floor labels or clips should be available to stick onto or to seal plastic bags, and to Sharps Bins so that the source can be identified if there is any problem about contents Do NOT put sharps of any kind or glass into plastic bags. If you do this, you are putting yourself and others at risk

http://www.esgindia.org/campaigns/biomedical/images/onlocation.html