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Hospital waste management

Hospital acquired infections come from health care wastes, so we need to understand and practice its management.

rivinus
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Hospital waste management

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  1. Session 15:Hospital Waste and Hazardous Material Instructor: Mr.Lazaro, Rivinus

  2. Learning objectives By the end of this session, students are expected to be able to: • Describe the management of health care wastes and hazardous materials • Explain the handling techniques and disposal methods of health care wastes • Explain the methods of disposing of a dead human body

  3. Plan of presentation • Definitions • Situation of hospital waste in Tanzania • Categories of hospital wastes • Health care management system • Handling of hospital care wastes • Treatment and disposal of health care wastes • Methods of disposing of human dead body

  4. Definitions Wasteisalmostanythingthathasserveditsoriginalintendedpurposeandisbeingdiscardedorstoredpriortobeingdiscarded. Healthcare(Hospital)wasteincludesallthewastegeneratedbyhealth-careestablishments,researchfacilities,andlaboratories. TASK: Mention few you know…………….???

  5. Introduction: HCW in Tanzania. • The management of healthcare waste is of great importance to the welfare of the people and country at large due to its potential environmental hazards and public health risks. • Tanzania like other developing countries faces the problem of healthcare waste management (HCWM).

  6. Introduction: HCW in Tanzania. The Ministry of Health and Social Welfare (2007) estimated that, • Annual generation rate for hospital is around 0.41 kg/occupied bed/day. • And that for HC and dispensaries is estimated to be 0.03 kg/patient/day • The challenge is that Most of the HCW generated is not properly managed especially when it comes to waste segregation, collection, storage and disposal or treatment.

  7. Categories of hospital wastes • Hospitalwastesarecategorizedaccordingtotheirweight,densityandconstituents. • TheWorldHealthOrganization(WHO)hasclassifiedmedicalwasteintodifferentcategories.Theseare:

  8. Categories of hospital wastes • Infectious:material-containingpathogensinsufficientconcentrationsorquantitiesthat,ifexposed,cancausediseasese.g.laboratorycultures;wastefromisolationwards;tissues(swabs),materials,orequipmentthathavebeenincontactwithinfectedpatientsexcreta. • Sharps:disposableneedles,syringes,infusionsets,saws,blades,brokenglasses,nailsoranyotheritemthatcouldcauseacut. • Pathological:tissues,organs,bodyparts,humanflesh,fetuses,bloodandbodyfluids;

  9. Categories of hospital wastes • Pharmaceuticals:drugsandchemicalsthatarereturnedfromwards,spilled,outdated,contaminated,orarenolongerrequired(bottles,boxes). • Chemicalwaste:wastecontainingchemicalsubstancese.g.laboratoryreagents;filmdeveloper;disinfectantsthatareexpiredornolongerneeded;solvents • Pressurizedcontainers:Gascylinders;gascartridges;aerosolcans;

  10. Categories of hospital wastes • Radioactive:solids,liquidsandgaseouswastecontaminatedwithradioactivesubstancesusedindiagnosisandtreatmentofdiseasese.g.unusedliquidsfromradiotherapyorlaboratoryresearch;contaminatedglassware,packages,orabsorbentpaper; • Wasteswithhighcontentofheavymetals:batteries;brokenthermometers;blood-pressuregauges;etc. • Others:wastefromtheoffices,kitchens,rooms,includingbedlinen,utensils,paper,etc.

  11. Sources of HCW • Medicalwards:mainlyinfectiouswastesuchasdressings,bandages,stickingplaster,gloves,disposablemedicalitems,usedhypodermicneedlesandintravenoussets,bodyfluidsandexcreta,contaminatedpackaging,andmealscraps. • Operatingtheatresandsurgicalwards:mainlyanatomicalwastesuchastissues,organs,fetuses,andbodyparts,otherinfectiouswaste,andsharps.

  12. Sources of HCW • Relatedlaboratoriesandresearchcenters • Medicalandbiomedicallaboratories • Biotechnologylaboratoriesandinstitutions • Medicalresearchcenters • MortuaryandautopsycentersAnimalresearchandtesting • Bloodbanksandbloodcollectionservices • Nursinghomesfortheelderly

  13. Management of Hospital wastes • Health care waste (HCW) management includes all activities involved in handling, transportation, storage, pre-treatment, final treatment and disposal of waste. • Healthcare waste management also addresses waste minimization aspects, including good housekeeping.

  14. Steps in Healthcare Waste Management • Waste classification/survey • Waste segregation • Waste minimization • Handling and collection • On-site transport and storage • Off –site transportation • Treatment and disposal

  15. Waste survey • Wastesurveyisanimportantcomponentofthewastemanagementscheme.Asurveyhelpsinevaluationboththetypeandquantityofwastegeneratedinhospitals. And help to determine means of their disposal

  16. Waste segregation • Segregationreferstothebasicseparationofdifferentcategoriesofwastegeneratedatsourceandtherebyreducingtherisksaswellascostofhandlinganddisposal. • Segregationisthemostcrucialstepin healthcare wastemanagement. • Segregate wastes from each other beginning at the point of generation, and maintaining the separation during storage and transport, until treatment

  17. Sample of an Educational Segregation Poster

  18. Waste segregation • Check the problems with waste segregation in the picture below……….

  19. What is wrong with this picture? • A lot of waste that is segregated as “infectious” Photo shows sterile packaging in infectious (red) bag. It also includes sharps which should be in sharps containers. • y be clean • Sterile packaging, uncontaminated gloves and masks, and other clean waste should be treated as general waste WHAT IS WRONG WITH THIS PICTURE?

  20. Problems of Segregation-what is wrong? WHAT IS WRONG WITH THIS PICTURE? • Sharps waste should not be discarded in Photo shows sharps in infectious (yellow) bag. Sharps should be in sharps containers. • on-sharps containers • Infectious waste should not be discarded with general waste

  21. What is Wrong With This Picture? Black bag wrongly used for general waste (drinking cups, food scraps, discarded food packaging, paper, empty blister pack, empty food wrapper) and for sharps waste (syringes). This photo was taken in a country with the following color code: Yellow = infectious waste; Black = discarded medicines, cytotoxic and chemical waste

  22. What is Wrong With This Picture? Black bag wrongly used for general waste (empty water bottle, packaging, discarded cloth) and also for infectious waste (bloody bandages, contaminated gloves). This photo was taken in a country with the following color code: Yellow = infectious waste; Black = discarded medicines, cytotoxic and chemical waste

  23. What is Wrong With This Picture? Black bag wrongly used for infectious waste (bloody bandages), sharps waste (syringes, presumably the needle from the intravenous (IV) set), and general waste egbanana and lemon peels This photo was taken in a country with the following color code: Yellow = infectious waste; Black = discarded medicines, cytotoxic and chemical waste

  24. What is Wrong With This Picture? General waste (sterile packaging) discarded in the infectious waste bag. Sharps discarded in the infectious waste bag. This photo was taken in a country with the following color code: Yellow = infectious waste

  25. Problem of Overfilling and Mixing Colors WHAT IS WRONG WITH THIS PICTURE? Red bag is overfilled. It is placed inside a black bag (probably because of leaks). Leaking infectious waste bags should be put in bags with the infectious waste color. This photo was taken in a country with the following color code: Red = infectious waste, Black = general waste

  26. WasteMinimization • it includesthefollowing: • Sourcereduction:measuressuchaspurchasingrestrictionstoensuretheselectionofmethodsorsuppliesgeneratelesshazardouswaste. • Recyclableproducts:useofmaterialsthatmayberecycled,eitheron-siteoroff-site. • Goodmanagementandcontrolpractices:applyparticularlytothepurchaseanduseof

  27. Waste collection • Wastesshouldnotbeallowedtoaccumulateatthepointofproduction • Nobagsshouldberemovedunlesstheyarelabeledwiththeirpointofproduction(hospitalandwardordepartment)andcontents • Asupplyoffreshcollectionbagsorcontainersshouldbereadilyavailableatalllocationswherewasteisproduced

  28. Waste collection • •Thecollectionof healthcare wasteinvolvesuseofdifferenttypesofcontainer. • Thecontainers/binsshouldbeplacedinsuchawaythat100%collectionis • achieved. • Sharpsmustalwaysbekeptinpuncture-proofcontainerstoavoidinjuriesandinfectiontotheworkershandlingthem.

  29. Waste storage • Astoragelocationforhealth-carewasteshouldbedesignatedinsidethehealth-careestablishment. • Thewastesshouldbestoredinaseparatearea,room,orbuildingofasizeappropriatetothequantitiesofwasteproducedandthefrequencyofcollection. • Each waste shall be stored in receptacles corresponding to its coded colour

  30. Waste storage- storage Bins

  31. Infectious Waste Containers • Ideal infectious waste containers are those that have • Lids that remain closed except when waste is discarded • Pedal-operated devices to open the lids • Color-coded bags inside the containers

  32. Waste storage: Minimum Requirements for Waste Bins and Receptacles • Be leak-proof with well fitted lid • Made of non-corrosive material (reusable polypropylene bins) • Disinfected and washable after each use • Lined with colour-coded non-PVC plastic (disposable polyethylene liner-begs) • Portable (fixed with handle ) • Receptacles and lining for radioactive waste shall be made of material which prevents emission of radiation • safety boxes are used for keeping sharps, usually 5 litres

  33. Healthcare waste transportation • On- site waste transportation is done using a designated trolley or wheelbarrow and shall be marked HCW.

  34. specifications for the wheelbarrow • Easy to push • Shall not be used for any other purposes • Have smooth surfaces, leak proof, made of plastic or metal • Easy to load and unload

  35. Healthcare waste transportation • Off-site waste shall be removed using designated vehicles for transportation of HCW.

  36. Vehicles should have the following features • Sealed body with lockable compartment doors • Marked with appropriate hazards symbols • Lifting equipment • Be equipped with features to secure bins during transportation • Be rigid, leak proof and easy to clean • The vehicle must be cleaned and disinfected at the end of each working day. Use Sodium hypochlorite

  37. Treatment and disposal (a) on site treatment/disposal This is done at the health facility. See methods which are being applied………

  38. 1. Burning Pit • Width should be 1 to 2 metres • Pits shall be dug 1-2 metres wide and to depth of 2-5 metres, but at least 1.5 metres above the water table • The pit shall be fenced and located away from public areas

  39. 2. Burying • Burying is placing waste into a pit and covering it with earth. • When the level of waste reaches to within 30 to 50 metres of the surface of the ground, fill the pit with soil and dig another pit • Expired vaccines shall be encapsulated and buried, and not burned

  40. 3. Incineration • high temperature in burning waste (starting at 800°C). • reduces the volume of the waste and eliminates pathogens. • Recommended health facility incinerator is De Montfort Incinerator (Mark 111) Model.

  41. WastesSuitableForIncineration • Lowheatingvalue:above2000kcal/kg(8370kJ/kg) • Combustiblematterabove60%. • Non-combustiblesolidsbelow5%. • Moisturebelow30%.

  42. Wastetypesnottobeincinerated • Pressurizedcontainers;Explosionmayoccurandcausedamagetotheequipment. • Halogenatedplastics(e.g.PolyVinylCarbon)releasegasesthatcontainhydrogenchlorideandmaycontaindioxins.eg bottle cap • Wasteswithhighcontentofheavymetals(e.g.thermometers,batteries).Incinerationwillcauseemissionoftoxicmetals(e.g.lead,cadmium,mercury)intotheatmosphere. • Radioactivewaste:treatmentdoesnotaffectradioactivepropertiesandmaydisperseradiation. Eg X-ray or photographic materials

  43. Disposal of human dead body Everyoneisafraidofdeadbodies Disposal of the dead is the process of getting rid of corpse in a sanitary manner

  44. Disposal methods • There are many methods of disposing of the dead • These methods vary among the tribes in our country • The methods used are intimately connected with religious beliefs, superstitions and sentiments • It is important to consider these religious beliefs, superstitions and sentiments when planning for disposal of the dead

  45. Disposalofdeadisdonebyvariousmethods 1.Incineration 2.Burial 3.Watersubmersion 4.Cannibalism 5.Bodydonation 6.Bodyworlddisplay 7.Lefttobeeatenawaybyvultures/Arielburial 8.Hydrolysis/dissolution

  46. Buddhismteachthat 7 • Thedeadbodiesshouldbeburnttoreleasethesoulwhichisbadwiththehopethattheywillbereincarnatedintoabetterone….. • Incinerationisthemodeofdisposal

  47. Christianity,especiallytheorthodoxchurch • TeachesthatthehumanbodywillriseatthesecondcomingoftheLord,toattaintheblessednessoftheheavenlykingdomtogetherwithsoulortosuffertheresultofrejectingGod. • Thereforewemustrespectthebodyevenafterdeath • Respectisshownbyburyingthebodyandnotburningit. 8

  48. Afterburningtheremainsarespreadoutintherivers-waterdisposal 2/7/201410

  49. Zoroastrians(knowninIndiaasParsis) • Regardskyburials,inwhichthebodiesareexposedtonaturalelementsincludingvulturesinopen-topped ͞TowersofSilence,͟ . 12

  50. Cannibalism • ItisprevalentinBrazil,AfricaandpartsofIndia. • Thedeadbodyiseatenwhileburning, • 2/7/2014 13

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