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    Add as FriendManaging Medical Waste

    by: Rogers

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    1 : Managing Medical Waste Session 5: Infection Control Basics
    2 : 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
    3 : Part I: Health Care Waste Overview
    4 : 5: Managing Medical Waste Slide 4 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
    5 : 5: Managing Medical Waste Slide 5 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
    6 : 5: Managing Medical Waste Slide 6 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
    7 : 5: Managing Medical Waste Slide 7 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
    8 : 5: Managing Medical Waste Slide 8 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
    9 : 5: Managing Medical Waste Slide 9 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
    10 : 5: Managing Medical Waste Slide 10 Which Waste to Address First? IC Committees should START with infectious waste, especially used sharps and microbiological culture waste
    11 : 5: Managing Medical Waste Slide 11 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
    12 : 5: Managing Medical Waste Slide 12 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.)
    13 : 5: Managing Medical Waste Slide 13 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
    14 : 5: Managing Medical Waste Slide 14 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
    15 : 5: Managing Medical Waste Slide 15 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
    16 : 5: Managing Medical Waste Slide 16 12 Steps to Manage Hazardous Wastes (cont’d) 3. Limit use and access to trained persons with personal protective gear
    17 : 5: Managing Medical Waste Slide 17 4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards
    18 : 5: Managing Medical Waste Slide 18 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.
    19 : 5: Managing Medical Waste Slide 19 6. Label with Agent, Concentration and Hazard Warnings Examples of hazard labels:
    20 : 5: Managing Medical Waste Slide 20 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
    21 : 5: Managing Medical Waste Slide 21 8. Recycle Products When Possible
    22 : 5: Managing Medical Waste Slide 22
    23 : 5: Managing Medical Waste Slide 23 Group Discussion: Recycling Why should recycling be promoted? Which products can be safely and cost effectively recycled in your facility?
    24 : 5: Managing Medical Waste Slide 24 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
    25 : 5: Managing Medical Waste Slide 25 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
    26 : 5: Managing Medical Waste Slide 26 11. Minimise the Handling of Wastes Try to eliminate steps that require hazardous wastes to be touched, sorted, transferred from containers, or handled directly
    27 : 5: Managing Medical Waste Slide 27 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
    28 : Part II: Waste Management Methods
    29 : 5: Managing Medical Waste Slide 29 Options for Specific Types of Waste Pharmaceutical Cytotoxic Other chemical wastes Heavy metals Pressurised containers Radiation Infectious
    30 : 5: Managing Medical Waste Slide 30 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
    31 : 5: Managing Medical Waste Slide 31 Cytotoxic Waste NEVER LANDFILL or DISPOSE TO SEWER Disposal Options: Return to supplier Incinerate at high temperature Chemical degradation
    32 : 5: Managing Medical Waste Slide 32 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
    33 : 5: Managing Medical Waste Slide 33 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
    34 : 5: Managing Medical Waste Slide 34 Pressurised Gas Containers NEVER INCINERATE Return undamaged gas cylinders and cartridges to the manufacturer for reuse Damaged containers: empty completely and crush, landfill
    35 : 5: Managing Medical Waste Slide 35 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
    36 : 5: Managing Medical Waste Slide 36 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
    37 : 5: Managing Medical Waste Slide 37 Waste Disposal Options Include Disinfection – Autoclaving/ Microwaving, treatment, shredding Land Disposal Burial Encapsulation Incineration Inertisation Managed Land-fill On-site disposal
    38 : 5: Managing Medical Waste Slide 38 Infectious Waste: Autoclaving Pressure and temperature Holding time Sterility indicators Type of waste Followed by shredding / burial / recycled
    39 : 5: Managing Medical Waste Slide 39 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
    40 : 5: Managing Medical Waste Slide 40 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
    41 : 5: Managing Medical Waste Slide 41 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.
    42 : 5: Managing Medical Waste Slide 42 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
    43 : 5: Managing Medical Waste Slide 43 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
    44 : 5: Managing Medical Waste Slide 44 Advantages of Incineration of HC Waste: Good disinfection efficiency Drastic reduction of weight and volume Good for chemical + pharmaceutical waste
    45 : 5: Managing Medical Waste Slide 45 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
    46 : 5: Managing Medical Waste Slide 46 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
    47 : 5: Managing Medical Waste Slide 47 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
    48 : 5: Managing Medical Waste Slide 48 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 A website managed by the working group on waste
    49 : 5: Managing Medical Waste Slide 49 More Free References, Health Care Waste Management at a Glance “First, do no harm.” WHO/V&B/02.26 Available at Contains information about the disposal options for sharps
    50 : Thank You!

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