injection waste management. waste management is a process not a technology issue alone it requires a...

Injection Waste

Management

• Waste Management is a process

• Not a technology issue alone

• It requires a change in way of thinking

Introduction• Waste management for Pediatricians

– At Hospital

– At PHC.

– Immunization clinic.

• Waste management at community level

Problem

• Hazardous needle waste generated at clinics &

hospitals needs to be secured and prevented from

being accessed.

• This is possible by:1.Bringing awareness among health workers, community about

potential hazards of sharp waste.

2.Minimizing, segregating, decontaminating (disinfecting) the

hazardous waste at site

3.Destroy (mutilate) used items to prevent their reuse.

Current Scenario• Segregation of hazardous needle waste in many health

facilities, is not well established

• In some cities, small towns & villages common facility for disposal or proper open land for digging deep pits does not exist.

• Needle waste is frequently dumped along with the municipal

garbage.

• Few large hospitals are have incinerators

• Some hospitals are segregating, disinfecting and mutilating and

disposing to authorized private vendors or in pits.

WHAT IS NEEDED?All Biomedical waste has to be

– Minimized.

– Segregated.

– Disinfected.

– Transported and

– Disposed off in a environmental friendly manner.

Biomedical waste should not be mixed with other

wastes.

75-90%Non Clinical Waste

10-25%Clinical Waste

Pharmaceutical

Hospital waste

Pathological Genotoxic

Pressurized containersNeedles

Infectious

ChemicalWaste with heavy Metal content

Radioactive waste

Challenges for Sharps Waste

Fear of HIV transmission

through Dirty needles

Funding for Curative injection equipment &

it’s Disposal

Mass immunization campaign

Environmental concerns

Over sharp waste disposal

Funding for Health Care Waste Disposal

Immunization sharps wasteWaste from hospital and clinical

1%

1%

3% 80%

15%

Pathological and infectious wasteSharps wastechemical pharmaceutical wasteSpecial waste (radioactive, cytostatic)non-infectious

• Needles represents 1% of Health Care Waste

• Immunization injections represents approximately 5 % of injections

• Immunization sharps waste has to be integrated into the overall Health care Waste management

Source: Safe Management of wastes from Health Care activities (geneva, WHO, 1999)

General principles

Major Considerations

• Minimization

• Segregation

• Transport

• Collection

• Storage

• Treatment

• Disposal

Segregation

• Needles should be segregated at source.

• Clinical staff is responsible for segregating the waste at

source.

• Appropriate container and different type of waste containers

have to be placed at different points as per the act. e.g.: in

the ward, OT, ICU’s, clinics.

• Awareness program is essential and posters for segregating

should placed at the site.

Color Coding of Waste Collection Bags / Container

Yellow Infectious Waste for Incineration, Non Plastic, contaminated with body fluids

Blue/ White Needles/Sharps/glass/blades

Red Infectious waste for autoclave/ Microwave, Rubber & Plastic catheters,tubes.

Black General/Domestic waste

Sanitary Landfill / for composting

Segregation – where?

• Containers should be placed at strategic

and easily accessible locations

• Blue /white translucent puncture proof

containers should be used.

Segregation – where? • Needles:

– Should not be re capped, mutilated by hand – Should be disinfected first – Needle should not be disconnected from the

syringe by hand

• Needle and syringe destroyer/Hubcutter should be used at the site of generation

– To disinfect – To reduce the bulk– To prevent reusing

HANDLING • Containers with needle waste should be picked up

and carried by the handle provided.

• They should not be supported at the bottom with

hands or carried on the back.

• They should not be dropped/thrown

• Containers should be labeled with Biohazard Symbol

• Vehicles used should be authorized.

CONTAINERS • Sharp decontaminating units (SDU’s) for

syringes and needles are plastic ,puncture

proof containers with handles

– To be filled 1/3 with hypochlorite solution

– Needles after chemical disinfection should be

transferred to puncture proof containers for

shredding

– Should be labeled as sharps only.

Sharp Containers

UnsafeUnsafeUnsafeUnsafe SafeSafeSafeSafe

•Do not transfer contents to other container

•Do not overfill

Sharp Containers various innovations

• Leak-proof • Closable with narrow neck

• Puncture- Resistance

• Clearly labeled with warning (easy for the community to understand)

Selection of Puncture Proof Container (PPC)

The principle

– Diameter of the puncture proof container should be less than

half the length of the smallest syringe’

– This is crucial for preventing needle stick injuries.

– The syringes getting collected (needle pointing down) in the

PPC should not fall horizontally.

– The lid should close tightly and the container should be leak

proof.

MUTILATION / DESTRUCTION / SHREDDING

• This will reduce the bulk of the waste.

• What types of waste required to be mutilated?

– Needles/syringes

– Plastic disposable

• Hub cutters and Needle/syringe destroyers

mechanical or electrical

Hub Cutter & Needle Puller Hub Cutter & Needle Puller AdvantagesAdvantages

Reduce needle waste tremendously by separating needles from syringesAllow more flexibility of downstream disposal of sharps

Improve environmental safety

Reduce needle-stick injuries during handling and transport of used syringesReduce numbers of safety boxes for syringe disposal

Further prevent syringe reuse

MUTILATION / DESTRUCTION / SHREDDING

Specification of electrical destroyers:

1. Should be low voltage electrical equipment

2. Temperature range of 1600 – 1700 c so that

needle is turned to ash in 1-2 sec

3. Should have a receptacle to collect use

4. Should have a cutter to cut the needle of syringe

TREATMENT & DISPOSAL

• To prevent hazardous to human health &

environment, it is necessary to treat certain wastes

before disposal.

• Onsite treatment is preferred than Offsite

• Chemical disinfectants like 1% Hypochlorite solution

can be used to treat the needle wastes.

TREATMENT & DISPOSAL • How to disinfect?

– Syringe with needle should be dropped in to

Sharps Disposal Unit, so that both parts are

completely immersed in disinfectant.

– Give a contact time of 30 mins

– When Sharps Disposal Unit is 1/3 full the syringes

and needles are shifted to puncture proof

containers for shredding.

Disposal at Small Health Units* Disposal at Small Health Units* (SC/PHC/Private Clinics)(SC/PHC/Private Clinics)

Disposable Syringes/Needle/ADSDisposable Syringes/Needle/ADS

Hubcutter/Needle puller

Hubcutter/Needle puller

Needle with HubNeedle

with HubMutilated SyringeMutilated Syringe

Disinfection with 1% Hypochlorite

Disinfection with 1% Hypochlorite

Disinfection with 1% HypochloriteDisinfection with 1% Hypochlorite

Sharps pit / Waste collection agency

Sharps pit / Waste collection agency

Waste collectorsWaste collectors

*GOI&CPCB guidelines

Terminal Disposal

• Metal equipment – recycle.

• Shredded plastic – recycle

• Plastic Syringes – Mutilate and recycle

GUIDELINES FOR CLINICS AND CONSULTANTS

• Health waste management at Individual Clinics :– Minimize the use of injections

– Segregate at source

– Treat with disinfectant

– Dispose off to Authorized Waste Management agency

• All health clinics in cities should have proper health waste management.

• The doctors, nurses and attender’s should have awareness and motivated to follow the guidelines to prevent health hazard.

DO’S 1. Do minimize use of Injections

2. Do segregate infectious sharps waste

3. Do collect in a blue /white transparent colour coded container

4. Do decontaminate all sharp & plastic waste

5. Do train & educate all categories of staff in proper

segregation & handling of waste.

6. Do use Hub cutters & needle destroyers

7. Do use authorized persons/agencies to handle/dispose the

needles.

Dont’s 1. Don’t mix the infectious & non infectious waste.

2. Don’t throw sharps in the trash/ non puncture proof

containers

3. Don’t recap the needle

4. Don’t disconnect the needle from syringe by hand

5. Don’t use open buckets for infectious waste /sharps

Be Needle SmartDo NOT recapDo NOT bendDo NOT removeDo NOT transportDo NOT re-use