WASTE MANAGEMENT IN A PRIVATE HOSPITAL Dr.Shanta Nagarajan

1. WASTE MANAGEMENT IN A PRIVATE HOSPITAL Dr.Shanta Nagarajan ROCKLAND HOSPITAL

2. INTRODUCTION Anything not intended for use is waste All waste liquid solid generated by health care system are bio medical waste .

3. In Delhi there are about 72 hospitals under Govt. sector ,550 registered nursing homes and 936 dispensaries.In addition to this there are about 1560 underegistered establishments with different names like Nursing homes,Medical Centres,Dental Hospitals,MTP centres etc.About 40000 hospital beds are available in the public & private sector in Delhi excluding the Laboratory .

4. Historical Background Hospital waste means’any solid,fluid or liquid . Hospital waste includes garbage,refuse,rubbish and Bio Medical waste.

5. HOSPITAL WASTE DISPOSAL Waste is unwanted trash generated near human or animal habitation. Its quality & quantity are location specific, dependant on food habits,culture,tradition & socio-economic conditions. 75% of the above refuge in India consists of bio degradable & the rest 25% is inert material It is of high density,varaiable moisture content(i.e. 15 – 40%) and partly combustible(i.e.50- 75%) It has poor calorific value 2500KCAL/KG & have low carbon- nitrogen ratio.

6. HOSPITAL WASTE The daily waste collected per patient is 2 – 5 kgs.There are statistics which say it could be between 5 – 15 kgs.

7. The hospital waste can spread disease to the community through microbial contamination- viz….- Dressings,bandages,swabs,plaster caste,lancets,scalpels etc… Human tissues from OT. Clinical specimens like blood ,urine,faces,aspirated fluids etc, Blood Bags Blood products,placenta etc, Laboratory waste.

8. HOSPITAL MUST HAVE A FIXED POLICY FOR WASTE SEGREGATION OF LIQUID AND SOLID WASTE. COLLECTION OF SOLID WASTE IN THICK THIGHTLY CLOSED LEAK PROOF BAGS SHARPS IN PUNCTURE PROOF CONTAINER. TRANSPORTATION FROM HOSPITAL TO SITE IN CLOSED WHEEL – BARROWS. TREATED WASTES ARE DISPOSED OFF TO LANDFILL BY MUNICIPALITY IN COVERED TRUCKS. CONTINGENCY ARRANGEMENTS MUST BE AVAILABLE IF REGULAR SYSTEM FAILS E.G BURNING,BURIAL WITH 1% BLEACH OR DUMPING IN LINE PIT.

9. Decanting to be done in separate room or safety cabinet to avoid aerosols. Microbiology culture &specimens must be decontaminated separately & collected in leak proof bags before discarding.The bags should be tightly closed. Sharp items to be collected in puncture proof container to avoid pricks. Tissue from path section is seggregated & sent for disposal burning or incenerartion Blood sera decontaminated before washing usable containers.

10. Seggregation Hospital waste is seggregated area wise in four colour bags: Yellow Bag( Waste for incineration)Human & animal tissues/organs,body parts,non plastic contaminated or soiled waste ,plaster casts,dressing,swabs,bandages,microbiological & pathological/lab waste etc.

11. Seggregation 2.Red Bag (Waste for autoclave,microwave,chemical disinfectionfollowed by shredding or mutilation)All plastic disposables contaminated with blood or human secretion,syringes,iv sets,plastic culture plates,tubes,cathethers,canulaes,urobags,blood bags,surgical gloves etc.

12. Seggregation Blue bag ( Waste for autoclaving,Microwaving,Chemical Treatment & destruction/shredding) sharps like needles,scalpels,\blades,broken glass/ampules etc. that may cause punture and cuts , all sharp disposal to be in puncture proof containers.

13. Segregation Black bag ( waste for disposal in municipal dust bins) office stationeries, General waste like papers,wrappers,cardboard,kitchen waste etc.

14. Every ward is provided with the three types of bags placed in closed bucket. Near the nurses station. Puncture proof containers are also provided All syringes are burnt before discarding into the container All plastics are shredded before placing in red container.

15. These bags are closed and labelled before transportation to the common site Transportation is by closed wheel barrow in every shift. Critical care area waste is transported in similar way to the common storage space.

16. Soiled linen Soiled linen from wards and O.T. ,I.C.U and Dialysis unit are transported by H.K. staff to wash area , Soaked in a covered labelled drum filled with detergent solution. Washed and transported to laundry A register is maintained.

17. Final disposal The hospital area has a separate zone where collected waste is given to pollution control body. The waste is weighed, before disposal And record maintained. The area is kept clean and locked.

18. THE REFUGE SHOULD NOT BE STORED ,IF IT HAS TO BE STORED THEN THE AREA SHOULD BE SEGGREGATED CLEANED AND VENTILATED EVEN THEN IT SHOULD NOT BE KEPT FOR MORE THAN 72 Hrs. NEEDLES AND SYRINGES SHOULD BE BROKEN AND COLLECTED IN ANTISEPTIC SOL. BEFORE DISPOSAL. THE AREA MUST BE INACCESSABLE TO OUTSIDERS.IN OUR LAB WASTE IS NOT STORED IT IS SEGGREGATED IN WASTE ROOM & SENT FOR DISPOSAL(6 – 8 Hrs.)

19. Laboratory waste Laboratory is a potential source of infection measures are taken for self protection and community protection by following: Educating Staff. Cleanliness Proper use of antiseptics Prevention of dry sweeping. Proper treatment of all specimens. Standard precautions Proper disposal of needles & syringes Processing in laminar flow Sterilization techniques.

20. AIMS Self Protection From Infection Other Hazards Control of spread on infection to community. Environmental protection, Laboratory being a potential source, proper scientific management of waste is essential. This includes. Decontamination,seggregation , collection and transporation,co-ordination with the hospital disposal as per policy of the hospital.

21. STANDARD PRECAUTIONS (Blood & Body Fluid Precautions) All health care workers should use appropriate barriers. Precautions to prevent skin and mucous membrane exposure. Hands and skin surface should be washed immediately. Precautions against pricks by sharps. Health care workers having lesions on skin, hands should refrain from handling pathological materials. Pregnant workers should take special precautions Proper education in handling of waste on site. Environmental Monitoring.

22. Laboratory a critical area, Observation of aseptic antisepsis procedures. No dry sweeping Antiseptic sol. in req % Disinfection before discarding waste. Spillage management

23. Laboratory Has The Following types of Waste Cultures and stocks of infectious agents. Blood and body fluids. Pathological waste. Excreta Urine Pus etc Organs & Tissues Highly infectious waste e.g Cholerae stool,culture of other communicable diseases.

24. Treatment of Infectious waste before disposal All infectious waste need to be treated before sending it to land filling. All pathological waste is treated with chemical, then autoclaved before final disposal. The various methods of disposals are: Autoclaving Chemical treatment:1% sodium hyppochloride. Grinding & decontamination with chlorine bleach Microwave irradiation Needle/syringe disposal Incineration- To burn to reduce to ashes.

25. CLEANLINESS IN THE LABORATORY Avoid dry sweeping. Desk tops to be cleaned before starting work and after work. Prompt attention of spillage. 2 – 4% Phenolic Agents 1% Hypochloride Sol. 20 To 30 mins. Care of mops Separate mops masks section wise. Usage of gloves and masks. Cleaning of incubators,ovens Autoclave and Refrigerators. Immunisation Care of sharps and Disposables.

26. RECEIVING AREA Reception of samples before transportation to the different sections. Biochemistry Haematology Blood,Serum,plasma Serology Immunology

27. RECEIVING AREA conti.. Bacteriology Tuberculosis Special care Stool Specimen Spillage if any to be treated immediately. (Chemical Disinfection)

28. PROPHYLAXIS AND CONTROL OF SPREAD OF INFECTION Health education to all Staff members. Regular courses of discussion with Nursing Staff,Nursing Aids,Sanitary attendants, House keeping. Immunisation of staff as per policy of the hospital.

29. WASH ROOM Blood related products Reusable Disposable Separate containers with 1% hypochloride solution is provided to these sections . Reusable glass tubes after decontamination for 2- 4 hrs are decanted into sink with flowing hot water where they are washed. All pathological waste is collected in yellow bags for inceneration.

30. WASH ROOM Bacteriology Mycology Special Care Tuberculosis Stool Specimen Spillage if any to be treated immediately (Chemical Disinfection) .

31. SPILLAGE MANAGEMENT SMALL SPILLAGE – Place double the amount of 1% Hypochloride Sol.for 20 Mins. . Blot dry Mop –This mop should be washed and dried before reuse. BIG SPILLAGE- Cover with antiseptic sol. And clean as per protocol.

32. CONCLUSION ALL HOSPITAL WASTE TO BE TREATEDAS HAZARDOUS POLICY OF WASTE MANAGEMENT MUST BE FOLLOWED RIGIDLY BIG HOSPITALS SHOULD HAVE ITS OWN SYSTEM OF WASTE TREATMENT AND DISPOSAL./zonalarrangement to be enforced COLLECTION BAGS TO BE GOOD QUALITY UNAUTHORISED PERSON SHOULD NOT HAVE ACCESS TO THE COLLECTION SITE. EMPLOYEES HEALTH HAZARDS TO BE TAKEN CARE OF BY PROPER EDUCATION,IMMUNISATION ETC.

33. The decontaminated & segregated waste filled in yellow,blue,red black respectively transported in a covered wheel barrow to the common hospital waste disposal site. Thus Lab helps in prevention & spread of infection.