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    Manual On Hospital Waste Management Pages 1-26 PDF

    Hochgeladen von

    Frances Oscar Gaviola

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    © All Rights Reserved
    Als PDF herunterladen oder online auf Scribd lesen
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    ‘|’ MANUAL ON HOSPITAL WASTE MANAGEMENT ENVIRONMENTAL HEALTH SERVICE DEPARTMENT OF HEALTH Manila aF Proper management of hospital waste is a prioity concern of the Dopartment of Health, as it strives to ensure a health-promoting ‘environment ina rapidly urbanizing clot. ‘The MANUAL ON HOSPITAL WASTE MANAGEMENT, as doveloped ‘bythe Envronmenial Heath Sorvice in consatalion wth tho privata sector fand tho academe, #5 a guide that should be usolul to. hospital ‘administrators and managers of heath programs who must take tho ‘ecponcibilty for disposal of special types of waste materials thal af ‘tential hazards to the communities that we sorve, tis hoped that this manual wil serve as a tako-of point for furthor ‘scussion and planning for tho improvement of managemant of hospital waste al the national and local levos of hoalth caro all over the county. is ago hoped that every effort is exortod to ehare tho contents of {his manual among a particularly vulnerable group. OUR HEALTH WORKERS, whose lives wo must also protec rom tha hazards and isk ‘rom hospital wast, ‘Towards healt in tho hands of the people TABLE OF CONTENTS 4 WTRODUCTION PAGE 2 HOSPITAL/MEALTH CARE SERVICES WASTE 2.1. The Wasto Generators. 2.2. Waste Catogorios & Thoir Sources 2.9. Occupational Hazards & Health Risk. 24. Measuto to Minimize Heath Risk, 25. Impact of Health Care Wasto on Human and the Envionmont 6 3 HOSPITALMEALTH GARE SERVICES WASTE MANAGEMENT COMPORENT 3.1. Handling, Storage and Transport of Waste 7 8.4.1 Waste Handing. 7 3.12 Storage Sot 3.12.1 Waste Recoptaclo and Buk Storage 7 3122 Color Coding of Various Catoaary : ° 3.128 Storage Areas 0 8.1.8 Proreatment Requiremants 0 3.1.9.1 Catogory of Hospital Waste that Fooqutes Pro-Toatment Process, " 3.19.2 Codingydonitication of Toatod Waste... 13 3.14 Collection and Transportation System 8 314.1 Collocton System Preparation ol 3.44.2 Selection sl Appropriate Collection & Transporation Syston. 15 34143 Collection System Implementation 18 3.18 Disposal systom = 3.18.1 Selection ot Appropriate Disposal system. 3.1.2. Disposal Area Considerations 4 TRAINING COMPONENT 4.1 Tralning Neods 4.2 Hospital StalPorsennel Tisining Program 43. IEC Suppor Stat 5 LEGALASPECTS 5.1. Spocitic Laws i 5.2 Exoting Rolatod Laws and Regulations fon Waste Management... 5. Technical Requirements 5.4 Future Executive Agenda 6 ADMINISTRATIVE ASPECTS 6 Grganieation sort Functions, 6.2. Planning the Hospital Waste Managoment Programme : 6.3 Rocording and Ropeting ANNEXES Seenagson~ 1 12. 13. ‘anno 14. - Glossary of Common Terme Hu BB BEY 28 8 29 ey MANUAL ON HOSPITAL WASTE MANAGEMENT 4 wTRODUCTION Inthe Phitppnes, thar sa growing awareness othe noed to improve sirctor contre ever tho disposal of wast goneratod by hospitals ard or ath cao sorvices institutions, This sn Kno wth the von of tha Sec tary of Heath that the hospital shou integrate promo and preventive rograms ino tei systems, ‘The hospitals and othe hea care institutions aro waste gonoraor. It 's commonty acknowlodged tal certain categories of wastes fom those incitutions are the most hazardous and potentially dangerous ofall wastes atising in tho community. As Bo vane and campleity of haakh caro wast {ncrese, resuting rom thor Increasing uaization ofthe paople te ok ot {ransmting diseases Va unéalstoctry handing, storage, rarport aes ‘posal practices also increases. + Tho increasing tnd of AIDS and Hepatitis inthe Phaippines cpons the possibilty of infoction of percarnal handing Dwso wastes !n the Philippines, studies have shown that majonty of hospitals aro sposing wor cinical wastes twough unsalistacory methods, Hazardous ‘nd Not Hazardous wastes noed tobe handed and disposed ot ina con, ballad manner to ensue heath and ervrormenial protection. Tis can Be ‘Schiewod by tho uso onlorceablo codes and guidlinos or manuals al {a8pecls of handing, storage, anspor, wealment and dpesal of those wastes, 2 HOSPITALMEALTH CARE SERVICES WASTE 24. The Wastes Generators Heath caro waste generators include hospitals; ccs o.9 ‘medkcal, votrinary, dental, maternity, Wing); lbboatori: bod banks; esearch ofices; drug manulactners and thor institut, tho sehocs, colleges and univers an the ke producing fats caro waa. 2.2 Waste Catogoris and their Sources oath cave waste can be lassiiod ino eight main calego- "es: general waste, pathological waste, rackoactve wast, cham ‘al wast, infects and potentially ifoctious wast, sharps, pha rmacoutical was and pressurized containers. 22.4 General waste includes domestic-type waste, packing m- leials, noninfectious aimal Bodding, wastowator tram lances 2s Uh stances as Go ne poe heel ating ae, ‘or hazard 19 human heath oo orvworenen. 22.2 Pathological waste consists ol tissues, exgans, body pas tom surgical operations, biopsy and autopsy, human lohatoe anc anima areas; and most baad and body hide, 22.3 Radioactive waste gonoralod rm nuclear madicine section, ‘agnostic and therapeutic procedures and tho paraphornaka od. “This iin the form o sold, quid anc gae contaminated wath rad rucides, exempiied by radiofodin technatium 9 and tdiam particular, excreta of pation who underwent radio eolopc thera peutic applicacn, the necaos and syringes, es hes and ap wate ‘washing o such paraphorai, 22.4 Chemical wasto campyisos discarded sol, auld and gase- ‘ous chemical, fr example om diagnostic and expormental wrk, sand cleaning. hosakooding and dsinoctig procadkres, Chemical waste may be hazardous ar nen-hazarcovs, Fr Ihe purpose ol choos Ing the most appropriate waste handling method, 2.2.4a Hazardous chemical wasio is considered tobe waste: vinen Is = taxi = corosive (acids of plc 2 & basas of pH» 12 Nommable, = reactive (explosive, water reactive, shock sonsive ) ‘onotosc (carcinogenic, mutagenic, teratogenic acother ‘wise capablo of altering gonotic male). for example, ‘ototoxic drugs. 2.2.40 Nomazardous chemical waslo consists of chem cals ather than those described above, such as sugars, mina ‘acids, and corlain erganic and inorgans sls 22.8 Infectious wast includes cultures and stocks of infoctious agent from tabortory work, wast fer surgory ancl autopsies on pation wih infectious diseases, wasto fom infected pation no: {ation wards, wast ram potently infectious eas, waste tal Mas been in contact with infocted patents undergoing homed. 23 sdatysis equipment such 35 tubing and tors, dspasable towels, (ns, corns, glows anc aboratry coats) and waste tat has oer ‘contact win armas nocitatod with an nfecious agent c ster Ing om an infectious cease 22.6 Sharps inchale needs, syinges, scalp, save, blades, bro on glass, nas and ary athe tome thal can cause a cuter pane 2.27 Pharmaceutical wast ncues pharmaceutical products hays ‘and chemicat that have boon returned from wards, have boon Spied, are outdated oF contaminated, or are bo discarded! bo. ‘cause thoy ae no konger required 22. Pressurized Containers nchide those wed for demons ton or instructional and other purposes, conaring innoeuous oi tga, and aexosa cans that may explode Wineineratod oF acc ‘ontaly punctured. ‘Occupational Hazards and Health Risk Thvee main categories of pap are Hable fo be exposed to ‘oath hazards associated wih ealh cave wate: ~ ales and personnal in heath cae establishments: Potsonnel in organizations providing support services on a Contact basis, such a launcies, incinerators, waste dsposal ses, ~ aliens and personne involved in home care oF primary ‘caro, such as heme cals Patients thigh risk ftom infections and ethor complications, ‘outing fom exposte to microbial pathogons and carps that may ‘ane rom breaks in tho waste cAspocal system chain, ae immunosuppressod_pationls or thase whose host dolence ‘mechanisms are otherwise altered (pation with AIDS bolong tot category alors with booing oF coting centers Paton on isis; «drug abusers. or addicts ( who should be kept away fmm waste that contains needles, syringes or dear dg) Theo health of personnel working in or associatod with health 24 ‘caro establshmonts can be at rsk, andi portant that thoy be ‘madi awaro ofthe sks and be trained in precautionary measures and disposal peccedures, The risks or particitar groupe of person ‘a ae 28 follow. Personnel naneing wats We certains blood eked ojos tram pationts in dayls units must be protacted agaist tho Wane mmission of hapastis B. Special arrangements are neccesary Kr the isolaton, soparatin, collection and disposal of the waste In the ‘aso of pationts wire dingnacbe stan fs unclear, wand be ap ropriat to dal wih waste in tho same mano Custodial porsonno, mainonanco staf and porters coud be risk rm sharps these have nol bean kept separate aed safely Dackagod or disposal Personnel inaved in the final deposal oF incineration of waste may be expazod to ek om pathological wast hal has nt boon kept slick cool, especialy the wapping er storage sacks ae punctured orton, Pharmacy personnol may be al_risk fem weEptatny or ‘dere expire fo aos Contaminated with pharmaceutcals oF salvonts, Custodial personne could be exposed to isk on any premise hot leaks oF abssrution in drains real in tho escape of gases cr hazardous sotvorts thal may be infalod, Exposure loH2S escap- ing trom blockod ser is a wel known hazards, ‘Measures to Minimize Health Risk ‘To minimize the occupational haalth seks associated wih hath caro waste, occupational heath prograrenes shexdd Intioduce sale or tess hazardous substtuas for chamical ‘agents vith exposure hazards (substance dtbuon wore ties would be holpfu in nding out what agorts ar actualy so) equi closed storage for volte agents, tacos for il ex ‘posure fo which aro a hoalth hazard equi the uo of proper venting and exhausting in accord ‘ance with ho establshad principles of occupational hygiene (tne special problem involved in the collection and Wapping of ‘mercury ust be taken info account): * Provide appropriate protective clothing (cluding masks) ‘win disinfection and disposal arrangemonts, fr workers involved in various stages of wasto disposal ‘oquie the use of colorand emblem-coded tags and contain: {1 where tho pre-soring and sogregaton of waste ie noces ‘sary the colors and emblome shouldbe constant thoughout {Mo esabshmont using then) * iroduce monitoring mensures 10 carty ou spot surveys in roblam areas o highs stuatlons; search lr occupational "exposure where clinical repidemaogicalelamation stgests ‘8 possible sourco of movbiy, and inoduce epidemiological analysis to determine whether Caran goups or subgroups o personnal may be al excossive "ok of Paticlar types of heath problem, 25° impact of Healt Care Waste on Human Health and the Envi- In addon 0 ealth risks 10 pation sw personne, con ‘sideration must be given to the impact of health eae wasto on es ‘man heath andthe envionment ouside healthcare establishments. 'nparicae, tention shoul be palo posible ellocs on the pub, including aesieic factors, an! tothe rk ol the potion air wai and sl. To minimizo those external heath and envitonmoal tisks, acon shoud be takon to deal wih pollens wat source. To tis ond, waste should be sogregated and cancentratod win heath caro establishments to simply ts management and wher ‘ver fasiie, wast should be recycled o thal does nt ei the waste steam roquiing disposal Te saloguard against water pofton, measures shoud bo {akon at source to reduce the quantly and stength of coxnpalble pollute in te wastowator How. I health cao establchwrent Pol camected to a municipal wastowatorteaiment systom oie lwoalmont should bo carried out whore feasible, Sudgo le a Se plant shoud be managed wih the same precautions as for ‘opal waste Sudge. e-, W should not be spread on food «ops Unless propery treated Chemical used in heath. care establishments ato @ potntioh ‘Source of potation, mainly fo walt va the sower system, An on ito Chemical waste survey is prerequisite to the development of an ‘lective waste management programme. Ary hazardous chemical waste goneratod shout bo dealt wih by a prope: chemical waste ‘managomont system: waste chomicals should be recycled whenever possible. Thore should be scope for substituting ‘homicals with loss onvironmental impact than asa at pres Tho Use of disinfectants should be minimized when thoro ‘10 altornatives. This would reduce the quantity of waste ‘sinloctants produced. Where @ large amount of dition water Isavallabo, however, cisinfoctants may salely be dispoted of In tho sowor “Tho grinding ol solid wasto for disposal in tho sower systems {8 not recommended unloss the sowor and the sewage treatment syitems are designed to cope with them, Exceasive solids can cause problems al sewago toatmont plants. Food waste trom halth establishment kitchens, however, 1s olen desposed of ‘trough garbage grinders to tho sewor systom, FFa0ces and urino from ations in isolation wards should be asinfected belore disposal in ho sewer. Prowsion should bo ‘made in case of an epidamic forthe emorgeney disinfection of wast oma large nambor of inloctious patents, bolore dieposal Intne sower system ‘ General wasto and properly treated infectious waste can sally be disposod olin @ landlil, ut special measures may be necessary for aosthetc reasons Incinerator emission are 9 potential source of ait olution. Incinerators for health ‘care waste. should be designed specially for the purpose and must comply wit ait ‘olution contol standards. Fume hoods aro anelor dull fr ai polutants, Protective moasures may require thal thoy ar ited wih fitors. Tho height of chimney stacks fs also an important factor, Climatic conditions. are @ datactabie factor in tho gap bbetwoen normal iloctous dsoaso rates and apidemics. This a> is smaior in hot climates than in moderate ones. Health caro {slablishmonis in hot climates may, therefor, noed to bo more alert to detecting changes in normal conditions. Tho cillorence bbotwoon seasons may also calor allention. ‘3 HOSPITALMEALTH CARE SERVICES WASTE MANAGEMENT COMPO- NENT 34 Handing, Storage and Transport of Waste SA Waste Handling Porsonnel and patos shoud be mai uy aro ol th need tooxarcse extreme caution when handling sutances which are 0 Do discarded ae waste Paton should be mado aware of tho heath hazards assoc! ‘led with contaminated or infoctous materi Prolectve clothing such as gloves, vera. masks. and where ‘necessary visors should be woen whon hendling those tems whore hazarcous waste ate goneated. Provision of adaquate supply of approntistey markoct or coc Container of sutabie’ strength and daily, in sae, yot con ‘orion! location throughout tho area whore wasto fs bowng gor ~ A system of marking, cocing ot iseniticaton shout be un- orstood by al tal ofthe hospital, especialy for personnel {engaged in th collection of wast or cleat osteo that appropriate Nandling and disposal ches are employed, ‘Appropiato codes of practice must be anforced at bh fends ofthe waste cpa system, 3.4.2 Storage ‘The Hospital Management chall maintain adequate sanitary {actos for tomporary storing Posptal waste on is premsos.. A ‘ental storage area forall accunelated” wast shal also bo pro- \ided and mainiainod in sanitary conhtion. Peper separation of ‘vats types of wasle genuratod nthe hospital is necessary to avakd any accents or hazards to personnes, 34.24 Waste Receptacies ana Bulk Storage Recoptacte/contanors fr tho temporary storage ‘of hospital wastes should bo dasignad Speciicaly for the waste 1 be stowed. The folowing ao quidotnes. tor sanitary waste storage requirement for varous kas of hospital waste: General Waste 235 gallon metal binor tie binfbag locate wit the hospital rome cindy is suitable slorage for gonora wi These shoud preferably be equipped witha ‘ype cover and should ba washod i ierval placed in a stratogic placa lor garbage outs tho hospital ule to maintain gone! ‘oss of wo surounclngs. (See Annex 3) Pathological Waste -a sinlar receptacle (genoral wast with chemical dsinloctants a ‘Radioactive Waste - the PN roquites tho fol towing to ensure proper slerage of radioactive wast: 61. Storage sito chouid not be accessible. to ‘authorized personnel, (See Annex 3) 62 Method of storage shouitpravent acct onal tolease io surroundings, 69 Recads of wast sored must bo Kept to one ‘ufo tal tha slorage facies are not ver teadod, 164 Thostorageatea or rom should bo 20 ch Sen fo mninize the. hazards arising fmm oosing and re accident £5 The storage area or roam should be prop- “ely merkoc wih conepiua sign aor appropriate symbas stag Wat rackoactve wastes ao stered ther, (©. Pontodc invents oho comsiners showkd be perlormed anc recorded 6.9. rear - speci of liquid contaminanis to ensio ‘nal leoks havo not occu, ©.7 Tho storago atea or rom should be used ‘only or slorago of radioactive wastes (© Highly contaminated dating, nen and the lke should rot bo rleasod Yo pubic lan ‘ry. Thy shouldbe slrad unt radoact- ‘ay aston to alo lve ‘4. Chemical Waste — hazardous chomica waste should be stored in container glass/pacto) wih {ight covers fo provnt om epling, (See Annex a {6 Infectious Waste - a metalor plate ih bin ‘storage vequrod and ska be separates om ‘goneral wastes. (See Annex 5) |. Sharps - storage must bo in. puncture prot ‘conan pio To pre-treanent and dsposal to provent any cu-acoidon. (See Annex 6) 9.” Pharmaceutical Waste - Expired quid mec ‘lnes can bo deposed crety to tho Sirk wiio ‘mogsins mabe form shoukd bo pulverized and ‘can be stored temperaiy in a metal or paste ‘container prot fo final disposal (See Annex 4) Pressurized Container Waste ~ must be han- ‘dled and prop sero in a container mado of ‘lal oF tin canin with calor cocing of “red” ‘and marked 2s “flammable”. Storage ofthis waste should be lcaed in a room outside the ‘ospital buleing ane away ton hoa to prover accidents duo to procarous volatile charac- tonite, Bulk Storage a motal bin, plastic bin, ot dn ‘« conerete bin lovato ina place win the hasta ‘compound is necessary lo koop te accumulated waste ‘material collected rie fn epoca 3.4.22 Color Coding of Various Category ‘Some hospital wasie clo heath hazard. Sopa- ‘ation of those wastes by color ceding sorage Ia Cities used wil provent accident or sicknoss among {he hospia porsomel in chage of waste managernont system, (Cocr cocina for waste storage to sting one ‘ype of hospital waste tram othors are tho follow: ing: Black —~ for collection of nonintactous cry b. Green — tor calloction of nor-inlctoss wet & Yallow - for collection of infoctious and pathological 1. Yellow with black band - for colection of chem ‘al waste © Orange for collection of radioactive waste {Red - fe cotaction o sharp and pressu- rized containers ote: Car 0 plasie bag inner ining must resembio| the color of receplaco to lactate eatacton processes, 3 Storage Areas, ‘Storage aoas sal ba located ata place dos ate away fom paint roms, aboratons o any hoe pal functonloperaton rooms in hospitals whe space 's nol avadablo, day coloction and disposal shou be enforced. Waste shal be stood and cisponed manner thal wl not permit the tanerréssion of ce ‘municablo diseaeo, create a nuisance or provide brooding placa for thes and otter vermin, raga lucaiment vith insecticides, rodantcides andor ci ‘olectant should ba cariod out wit tho area, 3.4.3: Pre-Treatment Requiroments Satisfactory prteaiment process prior o posal of acct ‘mulated wastos in hospitals, cine, laboratories, research ofl {government and private contaod esiabshmenis fe nocessary ‘maximize promation of wath anc enrormantal yoione. 3.4.3.4 Category of Hospital Waste that Requites Pro- ‘Treatment Process: Pathological Waste - Application of chemical Sisitectans's nocessary fo aiminate re ome '0n of ollensive odor Autclaving fs one proc 0 wherein application ol hea in an aati vo 01 of chamber wih superheated stea ude pressure alaning most tempore abom 2126 (eee) Radioactive Waste - The waste can_ be pro- treated by string in a designated storage voor for en hall ves oF unl the acy. decays to ‘background lool a9 survoyod with a dolccion survey mer tha they can bo considered ina: lve a5 porregulaions and deposed a or. ary, roluso (See Annex 3) Users should Koop radioactive content of quid wastes gonerated inthe aboratoics to tho minimum. in some instances, ho wastes nee 10 be classitiod as aquoous and non-aqueous, ‘acidic, akano, or novia Acc and akalino wastes are best stored ‘soparataly tom oach other mixed, pri ion ofthe inactiva ions present may occu and Ccorprecipitate the rachoscve ons Also, appre able heating of tho solution may caus he 0 ease of active arosols which coud contaminate the laboratory almosphovo andl werk aro, Now aqueous guid waste shoud be sored soparataly for aqueous ones because ‘mbang wah aqueous solution wil pose prebians Inthe subsoquent oaiment Ten or twenty te polytyone cavboys wth seating disc an Screw cap a salable fC. lection of aqueous wastes. Each carboye shat be dsinctly marked aise o akan wath propor ‘adiation symbols posted on, Non- aqueous wastes (organic iquids) must be stored glass bollles. Organic liquide are tkely to attack polyetiyeno cherricaly: polyethylene contain- {es cannot bo used Ter the Calacton ot na age ‘a wactos, Hgts bots have obo ved, esa should be provided with secondary containors to ‘protect them tom breaking orto socut tho con- Tenis shot tho oto bros Al containers should be kept closed when notin us fo prevent evaporation. Won ho con- Taner are fl, tho activity level and chomieat

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