BY ANN AND PRABHA TERNA NURSING COLLEGE

The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. Therefore it is essential to have safe and reliable method for its handling. Inadequate and inappropriate handling of health care waste may have serious public health consequences and a significant impact on the environment. Appropriate management of health care waste is thus a crucial component of environmental health protection and it should become an integral feature of health care services.

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The

biomedical waste management and handling rule came into force on 28th july, 1998 as prescribed by the ministry of environment and forests, under the Environment Protection Act of India.
to this rule, proper management of biomedical waste is a statutory requirement. This rule applies to those who generate, collect, receive, store, dispose, treat or handle biomedical waste in any manner.

According

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medical waste can be defined as any solid, fluid or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals in research pertaining thereto, or in the production or testing of biologicals.

Poor bio-medical waste management exposes hospital and other health care facility workers, waste handlers and community to infection, toxic effects and injuries. Doctors, nurses, paramedical staff, sanitary staff, hospital maintenance personnel,patients receiving treatment, visitors to the hospital, support service personnel,workers in waste disposal facilities, scavengers, general public and more specifically the children playing with the items they can find in the waste outside the hospitalwhen it is directly accessible to them are potentially at risk of being injured orinfected when they are exposed to bio- medical waste.

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Risk to all those who generate, collect, segregate, handle, package, store, transport,treat and dispose waste ( an occupational hazard). Occupational exposure to blood can result from percutaneous injury (needle stick or other sharps injury), mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth) or bloodcontact with nonintact skin. Over 20 blood born diseases can be transmitted butparticular concern is the threat of spread of infectious and communicable diseases likeAIDS, Hepatitis B & C, Cholera, Tuberculosis, Diphtheria etc. Waste chemicals,radioactive waste and heavy metals also finds its way in waste stream which are also hazardous to health.

There is public health hazard due to poor management of bio-medical waste whichcan cause a number of disease. Serious situations are very likely to happen when biomedicalwaste is dumped on uncontrolled sites where it can be easily accessed bypublic. Children and rag pickers are particularly at risk to come in contact withinfectious waste Inappropriate treatment and disposal contributes to environmental pollution (uncontrolled incineration causes air pollution, dumping in drains, tanks andalong the river bed causes water pollution and unscientific land filling causes soilpollution).

The infectious waste which is only 20% 25% of the entire waste from hospitals is not segregated and is mixed with general waste by doing so the whole of waste may turn up to infectious waste. If the same is dumped into themunicipal bin then there are fair chances of the waste in municipal bin to become infectious. The disposal of sharps will lead to needle stick injuries, cuts, and infections among hospital staff, municipal workers, rag pickers and the general public.This will lead to transmission of diseases like Hepatitis B, C, E and HIV etc. The needles and syringes which are not mutilated or destroyed are being circulated back through traders who employ the poor and the destitute to collect such waste for repackaging and selling in the market. One of the reasons for spreading of infection is reuse of disposable items like syringes, needles, catheters, IV and dialysis sets etc. The dumping of untreated bio-medical waste in municipal bins may increase the possibility of survival, proliferation and mutation of pathogenic microbial population in the municipal waste.

The sources of health care waste can be classified as major or minor according to quantities produced Major Sources of health care waste
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Hospitals Other health care establishments Related laboratories and research center Mortuary and autopsy centers Animal research and testing Blood bank and blood collection services

Small health care establisment Specialized health care establishment and institution with low waste generation Non-health activities involving intravenous or subcutaneous interventions Funeral services Ambulance services Home treatment Health care and research involving radionuclides and waste produced Nuclear medicine laboratories

Items and equipments required for bio medical waste management

Bio medical waste may have serious public health consequences and a significant impact on the environment.

General waste Pathological waste Radioactive Chemical Infectious Pharmaceutical wastes Sharps and Pressurised containers.

Infectious waste: Waste suspected to contain pathogens, tissues, materials or equipments that have been in contact with infected patients, excreta.

Human tissues or fluids e.g. body parts, blood and other body fluids,

Sharps are items that could cause cuts or puncture wounds including needles, blades, knives, infusion sets etc

It includes expired, unused, split, and contaminated pharmaceutical products, drugs, vaccinces and sera

It is highly hazardous and may have mutagenic, teratogenic or carcinogenic properties. Eg Drugs used in cancer therapy.

Chemical wastes consists of discarded solid, liquid, and gaseous chemicals for example from cleaning , housekeeping and disinfecting procedures.

Wastes with a high heavy metal content represent a subcategory of hazardous chemical waste and are highly toxic

Many types of gas are used in health care, and are often stored in pressurised cylinders, cartridges and aerosol cans.

Waste containing radioactive substances e.g. unused liquids from radiotherapy or laboratory research etc

Cat-1
Cat-2 Cat-3 Cat-4 Cat-5

Human Anatomical wastes

Animal anatomical wastes Microbiology and Biotechnology wastes Waste sharps Discarded medicine and cytotoxic drugs

Cat-6

Soiled wastes include items contaminated with blood, body fluids such as cotton, dressings, linen etc
Solid wasted generated from disposable items other than sharps such as tubings catheters, IV sets etc

Cat-7

Cat-8
Cat-9 Cat-10

Liquid wastes (washing cleaning)

Incineration ash Chemical wastes (Disinfectants)

Each institution should develop its own bio waste management policy and ensure that the health care workers are adequately trained to handle biological waste. Measures such as universal safety precautions, hand washing and proper segregation of waste material should be encouraged. Rationale patient management policy should be followed and admission restricted to those for whom it is felt absolutely necessary. Proper house keeping is essential and the hospital premises should be kept clean and well ventilated Use of disinfectants should be rationalized

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2) 3) 4) 5) 6)

Survey of waste generated Segregation of hospital waste Collection and Categorization of waste Storage of waste Transportation of waste Treatment of waste

CHEMICAL DISINFECTION TECHNOLOGY It uses chemicals to destroy pathogenic organism from any inanimate object. - Sharps contaminated with blood and body fluids - Instruments, equipments that are used to cut pierce or enter the natural orifices like needle syringes and endoscopes - Contaminated floors, surfaces, clothes beds, beddings, enamel crockery and bed pans - Wet mopping of intensive care units, operation theatres, wards and patient waiting areas.

It uses heat to decontaminate instruments and equipment and the temperature in this process may rise to extremely high level. Most of the microbes are destroyed at temperature below 100 degree celcius 1. Autoclave 2. Hydroclave 3. Incinerator 4. Microwave

Gravity displacement type

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Where air is pushed out of the autoclave steam under pressure. This system operates at temeperatures of 121 degree celsius.

Pre vaccum type -Here vacuum pumps are utilized to evacuate the air in the chamber of autoclave and steam under pressure is pushed in which is enable to penetrate the waste material more thoroughly

This is a steam sterilzation technology in which the stream is used as an indirect heating source thus allowing total dehydration of waste material. The holding time for waste is 15 minutes at 132 deg Celsius or 30mins at 121 degree Celsius The organic components of the waste are hydrolyzed and the waste matter is reduced by weight and volume

Incineration is a high heat system process of burning combustible solids at very high temperatures in a furnace. It employs combustion of wastes material in stages, followed by cleaning of the gas through a number of pollution control devices. The end product is devoid of infectious organisms and organic compounds of waste

This low heat system uses microwaves to heat up the waste material from inside, unlike the external heat given in autoclave and hydroclave. They are able to penetrate materials and create vibrations in all the dipole molecules such as water in the waste materials. The vibration creates friction, which in turn produces heat to disinfect the waste material

-This involves exposing the waste matter to ultraviolet or ionizing radiation in an enclosed chamber. - Decontamination occur when nucleic acids in the living cells are irradiated - The advantage with this technology is that energy input is minimal and it is used to treat items, which cannot be treated. - Source of radiation needs to be properly disposed off after its decay

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are two types of land disposal Open dumps Sanitary landfills

Health care waste should never be disposed in open dumps it should be always dumped in sanitary landfills.

The process of inertization involves mixing waste with cement and other substances before disposal in order to minimize the risk of toxic substance contained in the waste migrating into surface water or ground water

Let the wastes of the sick not contaminate the lives of the healthy