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Bio-Medical Waste Management
Bio-Medical Waste Management
WASTE
MANAGEMENT
Contents: Bio-Medical Waste Management
1. Introduction
6. Conlusion
INTRODUCTION
All over the country, unsegregated and untreated biomedical
waste is being indiscriminately discarded into municipal bins, dump sites, on
roadsides, in water bodies or is being incompletely and improperly burnt in
the open. All this is leading to rapid proliferation and spreading of infectious,
dangerous and fatal communicable diseases like hepatitis, AIDS and several
types of cancers. In urban and rural areas alike, incidence and prevalence of
several such human diseases has increased and the per capita medical
expenditure has also gone high several folds. Although, yet to be proven,
morbidity or illness amongst both urban and rural dwellers has increased
albeit for different reasons.
The Ministry of Environment and Forests, Govt. of India has notified the
Biomedical Waste (Management and Handling) rules 1998 with subsequent
amendments (June 2nd 2000 and September 2003). However, only 5-10% of
institutions in the country have implemented the Rules or are following them
at present.
-The problem with medical waste lies in the fact that it is not handled and
treated according to its type, which leads to hazardous working conditions for
hospital personnel and exorbitant investment in technology that creates more
problems.
- Reuse of disposable like syringes, needles, catheters, IV and dialysis sets are
causing spread of infection from healthcare establishments to the general
community.
- Chances of vectors like cats, rats, mosquitoes, files and stray dogs getting
infected or becoming carriers which also spread diseases in the community.
Bio-medical waste: “Bio-Medical Waste” is any waste,
which is generated during the diagnosis, treatment or immunization of
human beings or animals. These wastes are also generated during research
activities or in the production or testing of biological material.
Cytotoxic substances, as the word suggests are toxic to cells and are often
anti-neoplastic which inhibit cell growth and multiplication. These drugs
when come in contact with normal cells can damage them and cause severe
disability or even death of those affected. These drugs could be present in the
waste generated from the treatment of cancer patients or from other work
related to testing and control of cancerous cells.
Infected plastics are those biomedical plastics which have been used for
administering patient care or for performing related activities and may
contain blood or body fluids or are suspected to contain infectious agents in
sufficient number which may lead to infections among other humans or
animals. These generally include IV tubes / bottles, tubings, gloves, aprons,
blood bags / urine bags, disposable drains, disposable plastic containers,
endo-tracheal tubes, microbiology and biotechnology waste and other
laboratory waste.
WASTE:
This is usually taken to include all waste from inpatient and casualty wards
and doctors' practices, e.g. used dressings, disposable linen and packaging
materials.
It only constitutes a risk for patients with weakened defences while it is still
inside the hospital. Once it has been removed from the wards it can be
handled by the local domestic refuse collection service.
Type C: Waste which must be disposed of in a particular way to prevent
infection.
This is waste from isolation wards for patients with infectious diseases; from
dialysis wards and laboratories, in particular those for microbiological
investigations, which contains pathogens of dangerous infectious diseases, e.g.
tuberculosis, hepatitis infectious diarrhoeal diseases and which constitutes a
real risk of infection when disposing of this waste. It includes needles and
sharp objects coated with blood, or disposable items contaminated with stool.
Hospitals provide a service, and hence have infrastructures which can also
generate hazardous waste products, e. 9. chemical residues from laboratories,
as well as inflammable, explosible, toxic or radioactive waste, which must be
disposed of in accordance with statutory provisions.
1. Thermometers
2. Blood pressure cuffs
3. Feeding tubes
4. Dilators and batteries
5. Dental amalgam
6. Used in laboratory chemicals like Zenkers solution and histological
fixatives.
GLUTARALDEHYDE/ CIDEX
Glutaraldehyde is a colourless, oily liquid, which is also commonly available
as a clear, colourless, aqueous solution. It is a powerful, cold disinfectant, used
widely in the health services for high-level disinfection of medical instruments
and supplies and available with trade names such as: Cidex, Totacide, and
Asep.
RADIOACTIVE WASTE
BIO-MEDICAL
WASTE
Acute and chronic exposure to lead can cause metabolic, neurological and
neuro-psychological disorders. It has been associated with decreased
intelligence and impaired neurobehavioral development in children.
Cadmium has been identified as a carcinogen and is linked to toxic effects on
reproduction, development, liver and nervous system.
PLASCTICS IN HELTHCARE
GLUTARALDEHYDE/ CIDEX
Aqueous solution is not flammable. However, after the water
evaporates the remaining material will burn. During a fire, toxic
decomposition products such as carbon monoxide and carbon dioxide can be
generated.
RADIOACTIVE WASTE
Accidents due to improper disposal of nuclear therapeutic material
from unsafe operation of x-ray apparatus, improper handling of radio-
isotopic solutions like spills and left over doses, or inadequate control of
radiotherapy have been reported world over with a large number of persons
suffering from the results of exposure. In Brazil while moving, a radiotherapy
institute a left over sealed radiotherapy source resulted in an exposure to 249
people of whom several either died or suffered severe health problems
International atomic Energy Agency, 1988). In a similar incidence four people
died from acute radiation syndrome and 28 suffered serious radiation burns
(Brazil, 1988)
Collection and
Treatment of Bio-
Medical Waste
Generally, plastic bags are used for Type B and C waste, and plastic buckets
for Type D waste. The material these disposable containers are made of must
be appropriate for the next treatment stage. If the waste is subsequently
incinerated, for example, combustible materials with a low level of toxicity
must be used; if it is heat-disinfected the materials must be steam-permeable.
This requirement also applies, incidentalIy, to all disposable items purchased
by hospitals.
The waste must be transported to a central incineration plant outside the
hospital in specially designed vehicles which do not compress it. The interior
of the vehicle body must be easy to clean and it must be adequately ventilated.
• glass, plastics and metals contained in the waste should not impair the
function of the plant in any way.
Plants which satisfy these requirements are now available in all sizes.
There are also devices on the market which shred waste and then disinfect it
with liquid chemicals. These devices are only suitable for small quantities,
mostly prone to breakdowns, and there is no guarantee that the disinfectant
fluid will reach all the waste. They are not suitable for handling all the waste
generated by a hospital.
Ensure
1. That the used product is mutilated.
2. That the used product is treated prior to disposal.
3. Segregation
Do not
1. Reuse plastic equipment.
2. Mix plastic equipment with other waste.
3. Burn plastic waste.
GLUTARALDEHYDE/ CIDEX
Identify All Usage Locations: All departments that use glutaraldehyde must
be identified and included in the safety program. Eliminate as many usage
locations as possible and centralize usage to minimize the number of
employees involved with the handling of glutaraldehyde
Monitor Exposure Levels: Measurement of glutaraldehyde exposure levels
must be conducted in all usage locations.
SAFETY MEASURES:
A chain is as strong as the weakest link in it, thus, not even one person in the
hospital should be missed while training is given. The entire staff is involved
in waste management at some point or the other, including administrators,
stores personnel and other, seemingly uninvolved, departments. To ensure
that the waste is carried responsibly from cradle to grave, and to see that all
the material required for waste management is available to the staff, it is
important to involve everyone, including:
• Doctors
• Administrators
• Nurses
• Technicians
• Ward Boys and safai karamcharis
INFECTION CONTROL
1. Universal Precautions: All the healthcare workers being exposed directly
or indirectly to infectious diseases must take Universal Precautions to reduce
the chance of spread of infection.
2. Sterilization and cleaning: Ensure that the hospital has adequate
procedures for the routine, cleaning, and disinfection of environmental
surfaces, beds, bed rails, bedside equipment, and other frequently touched
surfaces, and ensure that these procedures are being followed. Routine
microbiology tests for air and water contamination should be carried out in
all parts of the hospital. Sterilize and disinfect instruments that enter tissue,
or through which blood flows, before and after use. Sterilize devices or items
that touch
intact mucus membranes. In all the autoclave cycles, spore strips need to be
placed to check the efficacy of the machine. Recommended chemical
disinfectants should be used for the storage of instruments and fumigation of
rooms. All the rooms must have proper ventilation.
3. Managing Body Fluid Spillages: Urine, Vomit & Faeces : All spillages of
body fluids (urine, vomit or faeces) should be dealt with immediately. Gloves
(ideally disposable) should be worn, spillage should be
mopped up with absorbent toilet tissue or paper towels: this should be
disposed of into the waste bin meant for soiled waste. Pour 10 percent
hypochlorite solution and leave it for 15 min. Clean the area with a swab. For
spillages outside (e.g. in the playground) sluice the area with water. Do not
forget to wash the gloves and then wash your hands after you have taken the
gloves off.
RADIOACTIVE WASTE
Facilities and procedures described in the rules:
(d) Disposal: Identify the disposal methods for solid, liquid and gaseous
wastes briefly such as for:
i). Solids: Burial pits, municipal dumping site or waste management agency
e.g. BRIT etc.
ii). Liquids: Sanitary sewerage system, soak-pit, waste management agency
etc.
iii). Gaseous wastes: Incineration facility, fume hood etc.
Safety Clothing: A set of safety clothing and equipment for waste handlers
was identified and provided. It included cap, eye protection goggles, mask,
apron, gloves and boots. Disposable caps and masks were used. Gloves and
aprons selected were of nonpermeable material to prevent contact with blood
& body fluids. However gloves selected were malleable enough to permit
finger movement.
I.N.H.S. KALYANI
HOSPITAL
Strategy:
1. Already existing bins were used.
4. The plastic bags purchased by the hospital are cheaper alternatives to the
expensive bags available.
5. The hospital purchased extra stock in addition to its present needs, as done
for other items, to prevent any slack in the system.
6. To minimize the use of chemical disinfectant in the wards, two bins have
been provided, one for disinfection of plastics and one for disinfected plastics.
After each shift, or when the bin with disinfectant is full, the contents are
transferred to the other bin (min. residence period of any item in disinfectant
is 2hrs)
Strategy adopted:
1. To reduce the load of plastics, the hospital is planning to go in for cloth
lining. This would cost them 1-2 Rs. / bag.
Health workers shouldn’t have to be afraid that saving another’s life will
endanger their own. Nor should communities pay for better health care with
medical waste they aren’t yet able to manage.