SEMINAR ON

HOSPITAL WASTE MANAGEMENT

GUIDED BY DR. N .C RAO DR. MOHIT DR. SHAILJA DR. ABHISHEK DR. SHIKHA

SUBMITTED BY: SAKSHI SINDWANI BDS INTERN

Hospital Waste An Environmental Hazard and Its Management

Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals are known for the treatment of sick persons but we are unaware about the adverse effects of the garbage and filth generated by them on human body and environment. Now it is a well established fact that there are many adverse and harmful effects to the environment including human beings which are caused by the "Hospital waste" generated during the patient care. Hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases. Air pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin, Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and the diseases transmitted through improper disposal of hospital waste. This problem has now become a serious threat for the public health and, ultimately, the Central Government had to intervene for enforcing proper handling and disposal of hospital waste and an act was passed in July 1996 and a bio-medical waste (handling and management) rule was introduced in 1998. A modern hospital is a complex, multidisciplinary system which consumes thousands of items for delivery of medical care and is a part of physical environment. All these products consumed in the hospital leave some unusable leftovers i.e. hospital waste. The last century witnessed the rapid mushrooming of hospital in the public and private sector, dictated by the needs of expanding population. The advent and acceptance of "disposable" has made the generation of hospital waste a significant factor in current scenario. What is hospital waste Hospital waste refers to all waste generated, discarded and not intended for further use in the hospital. Classification of hospital waste (1) General waste: Largely composed of domestic or house hold type waste. It is non-hazardous to human beings, e.g. kitchen waste, packaging material, paper, wrappers, plastics. Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It is hazardous waste. Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients.

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Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g. needles, broken glass, saws, nail, blades, scalpels. Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have been returned from wards, have been spilled, are outdated, or contaminated. Chemical waste: This comprises discarded solid, liquid and gaseous chemicals e.g. cleaning, house keeping, and disinfecting product. Radioactive waste: It includes solid, liquid, and gaseous waste that is contaminated with radionucleides generated from in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization and therapeutic procedures.

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Amount and composition of hospital waste generated (a) Amount Country U. K. U.S.A. France Spain India Quantity (kg/bed/day) 2.5 4.5 2.5 3.0 1.5

(b) Hazardous/non-hazardous Hazardous a) Hazardous but non-infective b) Hazardous and infective Non-hazardous (c) Composition By weight Combustible Noncombustible Plastic Dry cellublostic solid Wet cellublostic solid 14% 45% 18% 20% 15% 5% 10% 85%

Biomedical waste Any solid, fluid and liquid or liquid waste, including it's container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human being or animals, in research pertaining thereto, or in the production or testing of biological and the animal waste from slaughter houses or any other similar establishment. All biomedical waste are hazardous. In hospital it comprises of 15% of total hospital waste. Rationale of hospital waste management Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of hospital waste i.e. "Biomedical waste" is hazardous, not the complete. But when hazardous waste is not segregated at the source of generation and mixed with non hazardous waste, then 100% waste becomes hazardous. The question then arises that what is the need or rationale for spending so much resources in terms of money, man power, material and machine for management of hospital waste ? The reasons are: injuries from sharps leading to infection to a.ll categories of hospital personnel and waste handler. nosocomial infections in patients from poor infection control practices and poor waste management. risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals. risk associated with hazardous chemicals, drugs to persons handling wastes at all levels. "disposable" being repacked and sold by unscrupulous elements without even being washed. drugs which have been disposed of, being repacked and sold off to unsuspecting buyers. risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.

Approach for hospital waste management Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India). 1. Segregation of waste

Segregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services areas, operation theatres, labour rooms, treatment rooms etc. The responsibility of segregation should be with the generator of biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical personnel). The biomedical waste should be segregated as per categories mentioned in the rules. 2. Collection of bio-medical waste Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At ordinary room temperature the collected waste should not be stored for more than 24 hours. Type of container and colour code for collection of bio-medical waste. Category Waste class 1. 2. 3. 4. 5. 6. 7. 8. 9. Human anatomical waste Animal waste Microbiology and Biotechnology waste Waste sharp Type of container Plastic -do-doColour Yellow -doYellow/Red

Plastic bag punctureBlue/White proof containers Translucent Black Yellow

Discarded medicinesPlastic bags and Cytotoxic waste Solid (biomedical waste)-doSolid (plastic) Incineration waste

Plastic bag punctureBlue/White proof containers Translucent Plastic bag Black -do-

Chemical waste (solid) -do-

3. Transportation Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it's mixing with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment.

Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage. The wheeled containers should be so designed that the waste can be easily loaded, remains secured during transportation, does not have any sharp

edges and is easy to clean and disinfect. Hazardous biomedical waste needing transport to a long distance should be kept in containers and should have proper labels. The transport is done through desiccated vehicles specially constructed for the purpose having fully enclosed body, lined internally with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned. The drivers compartment should be separated from the load compartment with a bulkhead. The load compartment should be provided with roof vents for ventilation. 4. Treatment of hospital waste Treatment of waste is required: to disinfect the waste so that it is no longer the source of infection. to reduce the volume of the waste. make waste unrecognizable for aesthetic reasons. make recycled items unusable.

4.1 General waste The 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the responsibility of the local authority. 4.2 bio-medical waste: 15% of hospital waste Deep burial: The waste under category 1 and 2 only can be accorded deep burial and only in cities having less than 5 lakh population. Autoclave and microwave treatment Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998. All equipment installed/shared should meet these specifications. The waste under category 3,4,6,7 can be treated by these techniques. Standards for the autoclaving are also laid down.

Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps (needles, blades, glass etc) should be shredded but only after chemical treatment/microwaving/autoclaving. Needle destroyers can be used for disposal of needles directly without chemical treatment. Secured landfill:: The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste should be treated by this option. Incineration: it is a high temperature dry oxidation process which converts organic and combustible matters into inorganic and

incombustible matters. Temptature being used in this process is 1100 1300 degree centigrade The incinerator should be installed and made operational as per specification under the BMW rules 1998 and a certificate may be taken from CPCB/State Pollution Control Board and emission levels etc should be defined. In case of small hospitals, facilities can be shared. The waste under category 1,2,3,5,6 can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of chlorinated plastics should not be incinerated. It may be noted that there are options available for disposal of certain category

of waste. The individual hospital can choose the best option depending upon the facilities available and its financial resources. However, it may be noted that depending upon the option chosen, correct colour of the bag needs to be used. Incineration is a waste treatment process that involves the combustion of organic substances contained in waste materials.[1] Incineration and other high temperature waste treatment systems are described as "thermal treatment". Incineration of waste materials converts the waste into ash, flue gas, and heat. The ash is mostly formed by the inorganic constituents of the waste, and may take the form of solid lumps or particulates carried by the flue gas. The flue gases must be cleaned of gaseous and particulate pollutants before they are dispersed into theatmosphere. In some cases, the heat generated by incineration can be used to generate electric power. Incineration with energy recovery is one of several waste-to-energy (WtE) technologies such as gasification, Plasma arc gasification, pyrolysisand anaerobic digestion. Incineration may also be implemented without energy and materials recovery. In several countries, there are still concerns from experts and local communities about the environmental impact of incinerators (see arguments against incineration). In some countries, incinerators built just a few decades ago often did not include a materials separation to remove hazardous, bulky orrecyclable materials before combustion. These facilities tended to risk the health of the plant workers and the local

environment due to inadequate levels of gas cleaning and combustion process control. Most of these facilities did not generate electricity. Incinerators reduce the solid mass of the original waste by 8085% and the volume (already compressed somewhat in garbage trucks) by 95-96 %, depending on

composition and degree of recovery of materials such as metals from the ash for recycling. This means that while incineration does not completely replace landfilling, it significantly reduces the necessary volume for disposal. Garbage trucks often reduce the volume of waste in a built-in compressor before delivery to the incinerator. Alternatively, at landfills, the volume of the uncompressed garbage can be reduced by approximately 70%[citation needed] by using a stationary steel compressor, albeit with a significant energy cost. In many countries, simpler waste compaction is a common practice for compaction at landfills. Incineration has particularly strong benefits for the treatment of certain waste types in niche areas such as clinical wastes and certainhazardous wastes where pathogens and toxins can be destroyed by high temperatures. Examples include chemical multi-product plants with diverse toxic or very toxic wastewater streams, which cannot be routed to a conventional wastewater treatment plant. Waste combustion is particularly popular in countries such as Japan where land is a scarce resource. Denmark and Sweden have been leaders in using the energy generated from incineration for more than a century, in localised combined heat and power facilities supportingdistrict heating schemes. In 2005, waste incineration produced 4.8 % of the electricity consumption and 13.7 % of the total domestic heat consumption in Denmark. A number of other European countries rely heavily on incineration for handling municipal waste, in particular Luxembourg, the Netherlands, Germany and France. 5. Safety measures 5.1 All the generators of bio--medical waste should adopt universal precautions and appropriate safety measures while doing therapeutic and diagnostic activities and also while handling the bio-medical waste. It should be ensured that: drivers, collectors and other handlers are aware of the nature and risk of the waste. written instructions, provided regarding the procedures to be adopted in the event of spillage/ accidents. protective gears provided and instructions regarding their use are given. workers are protected by vaccination against tetanus and hepatitis B.

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Conclusion I hereby conclude my seminar that as we know there are many adverse affects to the environment and human being caused by hospital waste generated during patient care so it is our soul duty to correctly and adequately dissipate all the biomedical waste products generated during or after patient care.