Health Care WasteHealth Care WasteHospital wasteHospital waste

Dr. Ardini S Dr. Ardini S Raksanagara,dr.,MPH.Raksanagara,dr.,MPH.

Public Health DepartmentPublic Health Department

Faculty of MedicineFaculty of Medicine

SPECIFIC LEARNING OBJECTIVES SPECIFIC LEARNING OBJECTIVES The student will be able :The student will be able :– to define the health care-wasteto define the health care-waste– to describe the classification of health care- waste to describe the classification of health care- waste – to describe the sources of health care wasteto describe the sources of health care waste– to describe risks associated with health care wasteto describe risks associated with health care waste– to describe the health impacts of health care wasteto describe the health impacts of health care waste– to describe the handling, storage and to describe the handling, storage and

transportation of health care waste transportation of health care waste

- to describe the treatment and disposal - to describe the treatment and disposal technologies technologies

for health care waste for health care waste

ReferencesReferences

Prüss A, Giroult E, Rushbrook P, eds. Safe Prüss A, Giroult E, Rushbrook P, eds. Safe Management of Wastes from Health-care Management of Wastes from Health-care Activities. Geneva: World Health Activities. Geneva: World Health Organization, 1999.Organization, 1999.

WHO,Pruss,Giroult,Rushbrook, ed., Safe WHO,Pruss,Giroult,Rushbrook, ed., Safe Management of wastes from health-care Management of wastes from health-care activities, Geneva, 1999,. Chapter:2,3,7,8activities, Geneva, 1999,. Chapter:2,3,7,8

Health care waste and its safe Health care waste and its safe management : management : http://http://www.healthcarewastewww.healthcarewaste

1. Definition the health care-1. Definition the health care-waste waste

Health care waste includes all the waste Health care waste includes all the waste generated by health care establishment, generated by health care establishment, research facilities, and laboratoriesresearch facilities, and laboratories

- 10-25 % of health care waste is - 10-25 % of health care waste is regarded as hazardous and may create regarded as hazardous and may create a variety of health riska variety of health risk

2. the classification 2. the classification of health care- waste of health care- waste

The 10-25 % hazardous fraction of health care The 10-25 % hazardous fraction of health care waste are usually classified into the following waste are usually classified into the following waste groups : waste groups : (Categories of health care waste)(Categories of health care waste)

1.1. Infectious wasteInfectious waste2.2. Pathological wastePathological waste3.3. SharpsSharps4.4. Pharmaceutical wastePharmaceutical waste5.5. Genotoxic/cytotoxic wasteGenotoxic/cytotoxic waste6.6. Hazardous Chemical wasteHazardous Chemical waste7.7. Waste with high content of heavy metalsWaste with high content of heavy metals8.8. Pressurized containersPressurized containers9.9. Radioactive wasteRadioactive waste10.10. Highly infectious wasteHighly infectious waste

Categories of health care Categories of health care wastewaste

NoNo Waste Waste categorycategory

Description and exampleDescription and example

11 Infectious wasteInfectious waste Waste suspected to contact Waste suspected to contact pathogens. Exp. Lab culture, pathogens. Exp. Lab culture, tissues, material or equpimenttissues, material or equpiment

22 Pathological Pathological wastewaste

Human tissues or fluidHuman tissues or fluid

e.g body parts, blood, body fluidse.g body parts, blood, body fluids

33 SharpsSharps Sharp wasteSharp waste

Eg. Needles, infusion sets, Eg. Needles, infusion sets, scalpels, knives, broken glass.scalpels, knives, broken glass.

44 Pharmaceutical Pharmaceutical wastewaste

Waste containing pharmaceuticalWaste containing pharmaceutical

Eg. phar. Expired.Eg. phar. Expired.

55 Highly infectious Highly infectious wastewaste

Consists in microbial culture and Consists in microbial culture and stock of highly infectious agent stock of highly infectious agent from medical analysis laboratories. from medical analysis laboratories. Eg. Body fluidsEg. Body fluids

66 Genotoxic Genotoxic wastewaste

Waste containing substances Waste containing substances with genotoxic propertieswith genotoxic propertiese.g waste containing cytotoxic e.g waste containing cytotoxic drugs, genotoxic chemicalsdrugs, genotoxic chemicals

77 Chemical wasteChemical waste Waste containing chemical Waste containing chemical substancessubstancese.g. reagents, desinfectant, e.g. reagents, desinfectant, solventssolvents

88 Waste with high Waste with high content of content of heavy metalsheavy metals

Bateries, broken Bateries, broken thermometre, blood pressure thermometre, blood pressure gaugesgauges

99 Pressurized Pressurized containerscontainers

Gas cylinders, gas cartridge, Gas cylinders, gas cartridge, aerosol cansaerosol cans

1010 Radioactive Radioactive wastewaste

Waste containing radioactive Waste containing radioactive substancesubstancee.g unused liquids from e.g unused liquids from radiotherapyradiotherapy

3. The sources of health care 3. The sources of health care wastewaste

The sources of health care waste can be The sources of health care waste can be classified asclassified as

1.1. Major sources of health care wasteMajor sources of health care waste

2.2. Minor sources of health care wasteMinor sources of health care waste

Major sources of health care Major sources of health care wastewaste

1.1. HospitalHospital2.2. Other health care establishmentOther health care establishment3.3. Related laboratories and research Related laboratories and research

centrescentres4.4. Mortuary and autopsy centresMortuary and autopsy centres5.5. Animal research and testingAnimal research and testing6.6. Blood banks and blood collection Blood banks and blood collection

servicesservices7.7. Nursing home for elderlyNursing home for elderly

Other health care establishmentOther health care establishment

Emergency medical care servicesEmergency medical care services Health care centres and dispensariesHealth care centres and dispensaries Obstetric and maternity clinicsObstetric and maternity clinics Outpatient clinicsOutpatient clinics Dialysis centresDialysis centres First aid posts and sick baysFirst aid posts and sick bays Long term health care establishment and Long term health care establishment and

hospiceshospices Transfusion centresTransfusion centres Military medical servicesMilitary medical services

Related laboratories and research centresRelated laboratories and research centres

Medical and biomedical laboratoriesMedical and biomedical laboratories Biotechnology laboratories and Biotechnology laboratories and

institutionsinstitutions Medical research centresMedical research centres

Minor sources of health care Minor sources of health care wastewaste

1.1. Small health care establishmentsSmall health care establishments Physicians officePhysicians office Dental clinicsDental clinics AcupuncturistAcupuncturist ChiropractorsChiropractors

2.2. Specialized health care establishments and Specialized health care establishments and institutions with low wasteinstitutions with low waste

Convalescent nursing homesConvalescent nursing homes Psychiatric hospitalsPsychiatric hospitals Disabled persons institutionsDisabled persons institutions

3.3. Non health activities involving intravenous or Non health activities involving intravenous or subcutaneous interventionssubcutaneous interventions

Cosmetics ear piercing and tattoo parloursCosmetics ear piercing and tattoo parlours Illicuit drug usersIllicuit drug users

4.4. Funeral servicesFuneral services5.5. Ambulance ServicesAmbulance Services6.6. Home treatmentHome treatment

Risk associated withRisk associated with Health Care Waste Health Care Waste

All individuals exposed to healthcare All individuals exposed to healthcare waste are potentially at risk of being waste are potentially at risk of being injured or infected. injured or infected. They include :They include :

1.1. Medical staff : doctors, nurses, sanitary Medical staff : doctors, nurses, sanitary staff and hospital maintenance personnelstaff and hospital maintenance personnel

2.2. In and out patients receiving treatment in In and out patients receiving treatment in health care facilities as well as visitorshealth care facilities as well as visitors

3.3. Workers in support services : laundries, Workers in support services : laundries, waste handling and transportation serviceswaste handling and transportation services

4.4. Workers in waste disposal facilitiesWorkers in waste disposal facilities5.5. The general public , children playing with The general public , children playing with

the items they can find in the waste the items they can find in the waste outside the healthcare facilities.outside the healthcare facilities.

The general public can be infected by health The general public can be infected by health care waste directly or indirectly through several care waste directly or indirectly through several routes of contaminationsroutes of contaminations

- recycling - recycling reuse of syringe reuse of syringe

- unsafe injection practices- unsafe injection practices

- sale of recovered drugs in the informal sector- sale of recovered drugs in the informal sector

( elimination of expired drugs is uncontrolled)( elimination of expired drugs is uncontrolled) The dumping of health care waste in The dumping of health care waste in

uncontrolled areas can have a direct uncontrolled areas can have a direct environmental effect by contaminating soils and environmental effect by contaminating soils and underground watersunderground waters

4. The health impacts of health 4. The health impacts of health care wastecare waste

Person at risk of health care wastePerson at risk of health care waste Medical doctors, nurses, health care Medical doctors, nurses, health care

auxiliaries, and hospital maintenance auxiliaries, and hospital maintenance personnelpersonnel

Patients in health care establishment or Patients in health care establishment or receiving home carereceiving home care

Visitors to health care establishmentsVisitors to health care establishments Workers in support services allied to Workers in support services allied to

health care establishments, such as health care establishments, such as laundries, waste handling, transportationlaundries, waste handling, transportation

Workers in waste disposal facilities Workers in waste disposal facilities (landfills or incinerator)(landfills or incinerator)

Hazards from infections waste and Hazards from infections waste and sharpssharps

Type infectionsType infections1.1. Gastrointestinal infectionsGastrointestinal infections2.2. Respiratory infectionsRespiratory infections3.3. Ocular infectionOcular infection4.4. Genital infectionGenital infection5.5. Skin infectionSkin infection6.6. AnthraxAnthrax7.7. AIDSAIDS8.8. Haemorhagic feverHaemorhagic fever9.9. SepticaemiaSepticaemia10.10. BacteriaemiaBacteriaemia11.11. CandidaemiaCandidaemia12.12. Hepatitis, A, B,CHepatitis, A, B,C

Hazards from chemical and Hazards from chemical and pharmaceutical wastepharmaceutical waste

ToxicToxic GenotoxicGenotoxic CorrosiveCorrosive FlammableFlammable ReactiveReactive ExplosiveExplosive Shock sensitiveShock sensitive

They may cause :They may cause :- IntoxicationsIntoxications- Acute or chronic exposureAcute or chronic exposure- InjuriesInjuries- BurnBurn

Hazards from genotoxic Hazards from genotoxic wastewaste

Occur during preparation or Occur during preparation or treatmenttreatment

The main pathway are inhalation, The main pathway are inhalation, absorption (skin), ingestionabsorption (skin), ingestion

Exposure occur through contact with Exposure occur through contact with the bodily fluids and secretions of the bodily fluids and secretions of patients undergoing chemotherapypatients undergoing chemotherapy

Hazards from radioactive Hazards from radioactive wastewaste

Health care workers, waste handling Health care workers, waste handling or cleaning personnel or cleaning personnel at risk at risk

Public Health impact of health Public Health impact of health care wastecare waste

Impact of infectious waste and sharpImpact of infectious waste and sharp Impact of chemical and Impact of chemical and

pharmaceutical wastepharmaceutical waste Impact of genotoxic wasteImpact of genotoxic waste Impact of radioactive wasteImpact of radioactive waste

5. the handling, storage and 5. the handling, storage and transportation of health care waste transportation of health care waste

1.1. Waste segregation and packagingWaste segregation and packaging2.2. On site collectionOn site collection3.3. TransportTransport4.4. Storage of wasteStorage of waste5.5. Off site transportationOff site transportation

- Regulation and control system- Regulation and control system- Special packaging requirements for off site - Special packaging requirements for off site transporttransport- Labelling- Labelling- Labelling for radioactive waste- Labelling for radioactive waste- Preparation for transportation- Preparation for transportation- tranporation vehicles or containers- tranporation vehicles or containers- Routing- Routing

The management of wasteThe management of waste

Step 1 : waste managementStep 1 : waste managementStep 2 : health care waste generationStep 2 : health care waste generationStep 3 : segregation and Step 3 : segregation and

containerizationcontainerizationStep 4 : intermediate storageStep 4 : intermediate storageStep 5 : internal transportStep 5 : internal transportStep 6 : centralized storageStep 6 : centralized storageStep 7 : external transportStep 7 : external transportStep 8 : treatment and final disposalStep 8 : treatment and final disposal

Unsafe healthcare waste management leads to death and disability

Healthcare waste management may also represent a risk to health

6. 6. the treatment and disposal the treatment and disposal technologies technologies

for health care waste for health care waste

1.1. IncinerationIncineration

2.2. Chemical disinfectionChemical disinfection

3.3. Wet and dry thermal treatmentWet and dry thermal treatment

4.4. Microwave irradiationMicrowave irradiation

5.5. Land disposalLand disposal

6.6. InertizationInertization

Hospital waste managementHospital waste management

Hospital waste is a potential reservoir Hospital waste is a potential reservoir of pathogenic micro organism and of pathogenic micro organism and requires appropriate safe and reliable requires appropriate safe and reliable handlinghandling

The main risk associated with infection The main risk associated with infection is sharps contaminated with bloodis sharps contaminated with blood

There should be a person or persons There should be a person or persons responsible for the organization and responsible for the organization and management of waste collection, management of waste collection, handling, storage and disposalhandling, storage and disposal

Principle of waste managementPrinciple of waste management

Steps in the management of hospital Steps in the management of hospital waste include :waste include :

GenerationGeneration Segregation / separationSegregation / separation CollectionCollection TransportationTransportation StorageStorage TreatmentTreatment Final disposalFinal disposal