managing medical waste session 5: infection control basics
TRANSCRIPT
5: Managing Medical Waste Slide 2
Learning Objectives
Understand that most hospital waste materials are not more dangerous than household waste, but keeping used sharps and needles from staff and public access is a priority
Learn ways to minimise waste
Know the criteria for safe management of sharps
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Definitions of Waste
Health care waste
All types of waste from all health care activities
Hazardous health care waste
Waste that presents a health hazard of some kind
Note: Most health care waste is no more hazardous than household waste
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Types of Hazards to Consider
Flammable
Toxic - mutagenic, cytotoxic, teratogenic, etc
Reactive
Allergen, contact sensitiser
Explosive
Infectious
Radioactive
Corrosive
Caustic
Alcohol
Cancer chemotherapy, tar-based products
Sulphuric acid, chlorine powder
Glutaraldehyde
Picric acid, fertiliser, ammonia
TB cultures
Barium enema, X-rays
Bleach
Lye
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Hazardous Health Care Waste
Infectious hazard:
Anatomic waste
Laboratory cultures
Sharps
Live viruses
Corrosive, teratogenic, reproductive hazard:
Heavy metals
Pesticides
Cleaning products
Pressurised containers
Mercury
Cancer therapy
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Is Health Care Waste an Important Source of Infectious Disease?
Yes!
IF needles and syringes are scavenged and re-used, then many diseases can be spread
Keep used sharps and syringes out of public access
No! Most medical waste does
not have more germs than household waste
It causes visual pollution, generates fear, but unless re-use of sharps occurs, medical waste causes little disease
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Then Why does this Waste Matter?
Sharps injuries may harm workers and communities
Medical waste potentially impacts patients, workers, community, and economy because of the volume and permanence of waste
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Health Care Institutions Generate about 3.5 kg of Waste per Bed per Day
Health care waste may:
Contain infectious organisms, including drug resistant ones
Place cancer causing agents into air or ground water
Cause radiation-related illnesses
Contribute to global warming harm atmosphere (CFC containing refrigerant gas)
Cause injury (sharps, explosion)
Cause congenital defects or stillbirth, prematurity, infertility
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Which Waste to Address First?
IC Committees should START with infectious waste, especially used sharps and microbiological culture waste
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How to Safely Dispose of Infectious Sharps
Do not recap sharps before disposal
Dispose of sharps at the point of use in a leak proof puncture proof container
Avoid handling, emptying or transferring used sharps between containers
Autoclave highly infectious waste before disposal
Control public access to syringes and medical equipment
Shred, encapsulate and bury according to national legislation
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For Non-Infectious Hazardous Waste, the Risks Depend on: Severity of acute or chronic exposure
Duration of exposure
Frequency of exposure
Concentration agent (1% versus 50%)
Individual vulnerability including pregnancy, weight
Route of exposure (skin, respiratory, oral, etc.)
Steps taken to protect (PPE, relieved from immediate contact etc.)
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Who is at Risk?
Doctors - anesthesiologists, pathologists
Nurses - oncology nurses, OT, ER
Hospital support staff - X-ray assistants, pharmacy, morgue, and lab staff
Cleaning staff - those cleaning sewage lines
General public - those using sharps found in the waste
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Common Hazards
Anesthetic gases
Glutaraldehyde
Formaldehyde/formalin
Cancer therapeutic agents
Ethylene Oxide
Radiation
Asbestos
Blood contaminated sharps
Bleach
Solvents (xylene, toluene, acetone, ethanol)
Pesticides, fungicides
Heavy metals (mercury, chronium, cobalt, cadmium, arsenic, lead)
Latex
Strychnine and cyanide
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12 Steps to Manage Hazardous Wastes before Disposal 1. Know what hazards you
have
2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists
**Use mercury-free thermometers
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12 Steps to Manage Hazardous Wastes (cont’d)
3. Limit use and access to trained persons with personal protective gear
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4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards
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5. Get Rid of Unnecessary Stuff
Don’t accumulate unneeded products
Don’t let peroxides and oxidising agents turn into bombs
Photo of bomb robot called into hospital to dispose of picric acid.
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6. Label with Agent, Concentration and Hazard Warnings Examples of hazard labels:
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7. 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
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Group Discussion: Recycling
Why should recycling be promoted?
Which products can be safely and cost effectively recycled in your facility?
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9. Segregate Hazards at the Source
Separate sharps and infectious waste where they are used
This prevents injuries that can occur when people sort the trash after it is disposed
Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members
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10. Have Written Policies on Waste Disposal
Sharps and infectious waste
Chemotherapy (cancer)
Heavy metals (batteries)
Chemicals
Post brief, colorful instructions on walls to remind workers
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11. Minimise the Handling of Wastes
Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly
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12. Conduct Walk-Around Interviews
Ask about the hazardous substances staff work with, how they dispose of them, and what they need to be able to dispose of them properly
Have a no-blame philosophy that strives to solve problems, NOT to assign blame
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Options for Specific Types of Waste
Pharmaceutical
Cytotoxic
Other chemical wastes
Heavy metals
Pressurised containers
Radiation
Infectious
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Pharmaceutical Waste
Small amounts:
Disperse in landfill sites, encapsulate or bury on site
Discharge to sewer
Incinerate
Large amounts
Incinerate at high temperatures or encapsulate
LANDFILL IS NOT RECOMMENDED
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Cytotoxic Waste
NEVER LANDFILL or DISPOSE TO SEWER
Disposal Options:
Return to supplier
Incinerate at high temperature
Chemical degradation
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Chemical Waste - Further Recommendations
Keep different hazardous chemicals separate
Do not dispose into the sewers or street
Do not encapsulate large amounts of disinfectants as they are corrosive and flammable
Do not bury large amounts of chemicals
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Wastes with Heavy Metals
Wastes with mercury, cadmium, lead, arsenic, strychnine, are poisonous (e.g., thermometers, batteries, lead paints, dyes)
Never incinerate or burn
Never dispose of in municipal landfills
Best solution: Avoid purchase
OR
Recycle in specialised cottage industry or export to countries with specialised facilities
Encapsulation
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Pressurised Gas Containers
NEVER INCINERATE
Return undamaged gas cylinders and cartridges to the manufacturer for reuse
Damaged containers: empty completely and crush, landfill
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Radioactive Waste
Use requires a national strategy including:
Appropriate legislation
A competent regulatory organisation
Trained radiation protection officer to monitor exposures
Return to the manufacturer
Safe handling and disposal of radioactive waste requires a rigorous and relatively complex management scheme
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Simple Chemical Disinfection
Requires shredding of waste
May introduce strong chemicals into the environment (chorine bleach turns into dioxin when burned)
Efficiency varies
Only the surface is disinfected
Does not disinfect human tissue
Special disposal required to avoid pollution
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Waste Disposal Options Include
Disinfection – Autoclaving/ Microwaving, treatment, shredding
Land Disposal
Burial
Encapsulation
Incineration
Inertisation
Managed Land-fill
On-site disposal
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Infectious Waste: Autoclaving
Pressure and temperature
Holding time
Sterility indicators
Type of waste
Followed by shredding / burial / recycled
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Commercial Disinfection Systems
Shred waste, treat chemically, encapsulate
Possible advantages:
Encapsulated residue can be placed in landfill
Environmentally friendly
Easy to operate
Possible disadvantages:
Requires specialised operators
May be expensive
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Burying Inside Hospital Premises
Apply the following rules:
Access to the site restricted and controlled
If waste is retained on site, ensure rapid burial to isolate from animal or human contact
Only hazardous HC Waste to be buried
Management controls on what is dumped
Each deposit covered with soil
Site lined with low permeable material-concrete
Groundwater pollution must be avoided
Not recommended for untreated hazardous waste
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Disposal to Land by Encapsulation
Fill metal or plastic containers to 3/4, add:
plastic foam
bituminous sand
cement mortar
clay material
When dry, label and seal containers and landfill
May be used for sharps, chemicals, drugs etc.
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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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Do not Incinerate
Do not incinerate the following:
Plastics especially halogenated plastics (e.g. PVC)
Pressurised gas containers
Large amounts of reactive chemical waste
Radioactive waste
Silver salts or radiographic waste
Mercury or cadmium
Ampoules of heavy metals
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Advantages of Incineration of HC Waste:
Good disinfection efficiency
Drastic reduction of weight and volume
Good for chemical + pharmaceutical waste
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Disadvantages of Incineration of HC Waste:
Doesn’t destroy chemical waste at lower temperature for rotary kiln
Toxic air emissions if no control devices in place
Maintaining temperature levels (and efficiency) in field incinerators is difficult, need to balance loads with non-hazardous materials
High costs for high temperature incineration
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Land-fill in Municipal Landfills
If hazardous health-care waste cannot be treated or disposed elsewhere:
Designate a site for hazardous HC Waste
Limit access to this place
Bury the waste rapidly to avoid human or animal contact
Investigate more suitable treatment methods
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Because no Disposal Method is Easy or Completely Safe…
Prevention is best!
Eliminate purchase by buying safer alternatives
Recycle
Use smallest quantities possible, use with engineering controls and Personal Protective Equipment
Segregate hazards into separate waste streams at source
Supervise disposal using best available ecologic option
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For More Information:
Safe Management of wastes from health-care activities. Edited by A Prüss, E Giroult, P Rushbrook. Geneva World Health Organisation. 1999. 228 p. Available online. Includes a teachers guide
www.healthcarewaste.org. A website managed by the working group on waste
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More Free References
http://www.healthcarewaste.org, Health Care Waste Management at a Glance
“First, do no harm.” WHO/V&B/02.26
Available at www.healthcarewaste.org/linked/onlinedocs/4-bd-704.pdf. Contains information about the disposal options for sharps