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OVERVIEW

MANAGING WASTE
FROM
HEALTH CARE
ACTIVITIES

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Health care facility
waste

Regular waste
Health care waste
(home like)

Hazardous health-care Non-Hazardous


health-care
waste waste

Infectious/anatomic/sharp/chemicals/drugs/heavy metals/
pressurizes containers/radioactive/.
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DEFINITIONS

Health-care waste
All waste from all health care activities

Hazardous health-care waste


20 - 25% is hazardous

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Are these major sources of health
care related waste
Hospitals
Clinics
Laboratories
Immunization campaigns
Animal Research
Blood banks
Nursing Homes
Autopsy centres

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Minor sources of waste
Physicians office Psychiatric clinics
Dental clinics Cosmetic piercing,
Home health-care tattooing
Nursing homes Institutions for the
Acupuncturists disabled

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Why does this waste matter?
Impacts patients, workers, community.
Volume and permanence of waste
Health care institutions generate about 3.5
kg of waste per bed per day (range 0.2 kg
to 10 kg).
May contain infectious organisms,
including drug resistant ones.

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Why does this waste matter?
May place cancer causing agents into
air or ground water.
May cause radiation-related illnesses.

May cause injury (sharps, explosion).

May cause congenital defects or

stillbirth, prematurity, infertility.

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How much does this waste matter?
Risk assessment
While there are many hazards in hospital waste,
what is the probability that people will be exposed
to harmful levels, and the severity of consequences
that will result?

START WITH THE COMMON SEVERE


HAZARDS FOR WHICH KNOWN MEASURES
OF PROVEN EFFICACY EXIST: INFECTIOUS
WASTE

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Risks depend on
Severity of acute or chronic exposure :-
Duration of exposure
Frequency of exposure
Concentration agent (1% versus 50%)
Individual vulnerability : pregnancy
Route of exposure (skin, respiratory, oral etc)
Mitigating circumstances (PPE, etc)

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Types of Hazards to Consider
Flammable Toxic- mutagenic,
Explosive cytotoxic, teratogenic,
Infectious etc
Radioactive
Corrosive, caustic
Allergen, contact
sensitizer

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Who is at risk?
Doctors :- anesthesia, pathologists,
Nurses :- oncology nurses, OR nurses, ER
Hospital :- support staff- X-ray assistants,
pharmacy, and lab staff
Cleaning staff- mixing chemicals
General public

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Steps to Manage Hazardous
Wastes Before Disposal
1. Keep an inventory to know
what you have.
2. Purchase smallest quantity
needed, dont purchase
hazardous materials if safe
alternative exists.
3. Limit use and access to trained
persons with personal protective
gear

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Steps to Manage Hazardous
Wastes Before Disposal cont,
4. Get rid of unnecessary stuff :-
Dont accumulate unneeded products
Dont let peroxides and oxidizing agents turn into
bombs

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Steps to Manage Hazardous
Wastes Before Disposal cont,
5. Label with agent, concentration and
hazard warnings :-
Examples of Canadian hazard labels

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Steps to Manage Hazardous
Wastes Before Disposal cont,
6. Recycle Products When Possible :-

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Steps to Manage Hazardous
Wastes Before Disposal cont,
7. Have written policies on waste disposal Sharps and infectious
waste :-
Chemotherapy (cancer)
Heavy metals
Chemicals
8. Track exposures
Critical event analysis is a method of objectively looking at an accident to
identify preventable causes. It looks for systematic causes and not to blame
individuals.

Discuss exposures confidentially in Infection Control Committee meetings

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Steps to Manage Hazardous
Wastes Before Disposal cont,
9. Conduct walk-around interviews
Ask about the hazardous substances they work
with, how they think they should dispose of them,
and what they need to be able to dispose of them
properly, problem solve.

Janitors can be key re inforcers of sharps waste


disposal by reporting sharps in garbage.

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Steps of waste management
disposal
segregation

Collection - Handling

Storage
Transportation
Out of HCF

treatment

Final disposal
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Waste segregation
Key to less waste.
Reduces costs of hazardous waste disposal.
Should be done according to local legal disposal
requirements.
Done at point of use.
Best if consistent plan all over the country.
Segregation from production until disposal /destruction.
Color Code Waste Consistently WHO recommends:
Yellow- for infectious waste
Brown- for chemical and pharmacy waste

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Waste segregation (cont.,)
Sharp waste segregated in safety boxes.
Safety boxes should be at place of work to avoid
carrying sharps for long distant.
Safety box should be unbreakable, anti-leak (Waste
bags and boxes should be sealed).
Only 3/4 full sharp box.
Janitors report sharps in garbage to supportive,
higher authority and ward supervisor with card.
Hazardous containers and bags should be labeled.

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Waste Collection
Physically separate clean and dirty areas.
Easy to swap 3/4 full sharp box.
Collect ward waste every shift or at least daily.
Waste bags and boxes should be sealed.
Hazardous containers and bags should be labeled.
Janitors report sharps in garbage to supportive,
higher authority and ward supervisor with card.

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Waste Collection
Never put hands in waste containers.
Never empty boxes or bags in another bigger ones.
Janitors should wear heavy duty gloves, foot wear
when dealing with wastes.
The transportation trolley in HCF should be easy
movement, easy clean, has tight cover.
Registries should be available in departments &
temporary storage room to register wastes.

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Waste storage facilities
Impermeable, surface.
Good drainage.
Cleanable surfaces.
Water supply accessible with high volume.
Readily accessible to staff.
Secure and lockable.
Good lighting and ventilation.
Rodent, insect, bird proofed.

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WHO Waste Storage Periods
Maximum Storage Times
Temperate Climate Or Warm Climate :

48 Hours in cool season

24 Hours in hot season

Off-Site Transport
Hazardous Waste Accompanied by a Consignment

Note.
Transporter known to the Regulatory Authority.

Disposal facility permitted by Regulatory Authority.

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Off-site Vehicle Design
Dedicated Vehicle of :-
suitable size body.

Bulkhead between driver and load.

System to secure the load.

Separate compartment for emergency equipment.

Internal finish to allow for steam cleaning

International hazard sign displayed.

Or: Container to be lifted on vehicle


Used for storage and replaced when full

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Treatment
1. By incineration :-
Combustible waste turned to ash at temps
>800 C.
2. Without Incineration :-
Chopping & sterilization

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Treatment
By incineration
Combustible waste turned to ash at temps >800 C.
Reduces volume and weight.
Residues are transferred to final disposal site.
Treatment efficiency depends on incineration
temperature and type of incinerator.
Not all wastes can be incinerated.
Costs vary greatly according to type of
incinerator.
Produces combustion gases.

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Wastes not to be incinerated
Pressurized gas containers.
Large amounts of reactive chemical waste.
Radioactive waste.
Silver salts or radiographic waste.
Halogenated plastics (e.g. PVC).
Mercury or cadmium.
Ampoules of heavy metals.

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Advantages and disadvantages
of incineration of HC Waste:
Advantages:
Good disinfection efficiency.
Drastic reduction of weight and volume.
Good for Chemical + pharmaceutical waste.
Disadvantages
Doesnt destroy chemical waste at lower temp.
Toxic air emission to air if no control devices.
Maintaining temperature levels (and efficiency) in field incinerators is
difficult, balance waste.
High costs for high temperature incineration.

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Final disposal
1.Final disposal of solid waste :
Bury solid wastes in sanitary landfill.

2.Final disposal of liquid waste :


Pour liquid in dedicated sinks,

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Because there is no easy or
completely safe disposal method
Prevention is best
Eliminate purchase and use whenever possible.
Recycle.
Use smallest quantities possible with
engineering controls and PPE.
Segregate hazards.
Supervise disposal using best available ecologic
option.

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Establishing
a Hospital
Waste Team & Plan

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Good waste management
depends on
A dedicated Waste Management Team.
Legislation and Enforcement.
A deliberate plan and strategy.
Adequate financing.
Full participation by trained staff.

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Duties of the Head of the
Establishment
Form a waste management team.
Designate the Waste Manager.
Allocate financial resources and manpower.
Ensure that monitoring procedures are carried
out.
Ensure adequate communication with key staff
members.
Support teams decisions when dissent arises.

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Waste Managers Duties
Control internal waste collection.
Ensure correct storage.
Coordinate transport and disposal on and off-site.
Encourage limited access to hazards (chemo, rad).
links with department heads to ensure
communication about waste is carried out.
Monitor and communicate waste generation,
disposal, problems costs and public health aspects
(e.g. injuries) of waste.

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The Waste Management Plan
Assess
Waste survey : identify hazard in the hosp.
Determine employees at risk.
Identify what can be minimized, reused, recycled.
Identify separation, handling, treatment and disposal options.
Plan
Write priority goals and objectives.
Arrange supplies, equipment, personal protective equipment, record
system, communication materials, advocacy.

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The Waste Management Plan
Implementation of the plane
Distribution of supplies.
Change behavior of HCWs ( posters, reminder
signs, role of models, supervision, Janitors
reports ).
Training.
Monitoring process of segregation, collection,
storage, off-site transport.

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