Waste

Hospitable

Pollution Control
Teacher: Roberto D Marco

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Members: Destefano Germán; Morán, Juan José; Moscoso, Mariano; Plana,
Ariel; Sedan, Vanina;
Course: 3° C
Higher Technician in Safety, Hygiene and Industrial Environmental Control
(Bahía Blanca)
ENVIRONMENTAL POLICY

We understand the importance of working while respecting the environment,

and we assume it as a reference in our work. The environment is a reality to
defend and restore, which we have the right to enjoy and the duty to conserve.
Reason why we establish an Environmental Policy as a framework in which all
the activities of the organization must be developed, so that patients, users,
suppliers and other interested parties are guaranteed this commitment acquired
through its management system. environmental.

We acquire the following commitments:

1.- Identify and evaluate all environmental impacts derived from our activities
and services, with the aim of implementing measures to reduce them, prevent
pollution, minimize resource consumption and promote energy efficiency and
savings in our facilities.
2.- Ensure compliance with the provisions of the Legislation and Regulations
applicable to our organization and as well as other requirements that the
organization subscribes to.
3.- Involve and motivate our own staff, professionals and companies with
which we collaborate, in continuous respect for the environment, promoting the
development of “environmental culture” throughout the organization.
4.- Prevent and avoid significant environmental impacts produced by the
hospital's activity, especially those produced by the generation and
management process of toxic and dangerous, biosanitary and cytotoxic waste.
5.- Practice sustainable use of natural resources, minimizing, as far as
possible, the consumption of natural resources (water, fuel and energy).
6.- Continuously control the environmental aspects of the facilities, adopting
preventive and/or corrective measures when necessary, to guarantee rational
use of Natural Resources.
7.- Coordinate environmental management with respect to our supply
companies and contractors, to guarantee that they comply with the principles of
this environmental policy.
8.- Practice Comprehensive Management of the Waste generated in the
Center, which is respectful of the Environment, involving correct segregation
and recycling of the same when appropriate, and as well as adequate
intermediate and final storage of the same.
9.-Develop a review and continuous improvement of the Environmental
Management System implemented to keep it active and effective.

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 To demonstrate these commitments, this Environmental Policy will be
circulated among Hospital workers, suppliers and subcontractors, making it
available to any citizen.
INTRODUCTION

The problem created by waste from health centers and its final disposal
constitutes an important topic of study. The safe management of hospital waste
requires the diligence and care of all people involved in order to improve their
working conditions and reduce risks.
Health centers are responsible for reducing and preventing the population's
health problems. During the development of their activities, these
establishments inevitably generate waste. In general, the mass of waste is
made up of 85% non-hazardous waste, 10% infectious waste and 5%
hazardous waste.
Although 85% of waste does not present any more risks than those
associated with common municipal waste, the remaining 15% presents special
risks and difficulties during its management (handling, storage, transportation,
etc.), mainly due to its infectious nature and /or dangerous of its components.
The heterogeneity of the elements, the frequent presence of sharp objects and
the eventual appearance of toxic, flammable and radioactive substances also
contribute to increasing such risks.
The aforementioned risks involve the personnel who must handle this waste,
both inside and outside the establishment. Therefore, in order to reduce such
risks, personnel must have sufficient training, have adequate equipment, tools
and personal protection elements, and appropriate facilities for handling and
treating waste. Personnel must receive training on the ways to carry out each
assigned task, the safety rules to follow, the correct handling and characteristics
of the equipment and materials used during the performance of their specific
functions. To all this must be added information about emergency situations,
such as spills.
Finally, it should be noted that poor management of the infectious and
dangerous fractions of hospital waste can not only create risk situations that
threaten the health of the hospital population (staff and patients), but can also
be the cause of situations of environmental deterioration that transcend the
physical limits of the establishments, or treatment places, generating
inconvenience and loss of well-being of the population surrounding them.

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DEVELOPMENT

DEFINITION
Any material that has been used for its intended purpose is considered waste.
Hospital waste is that generated in the hospital's own activities as a result of all
the procedures carried out or the services provided by health institutions.
The ability of waste to cause pathologies in personnel depends on several
factors:
 Presence of an infectious agent in the waste.
 Sufficient concentration of the infectious agent to have infective capacity.
 Presence of a host susceptible to infection.
 Presence of an entrance door for access of the germ to the host

According to Law 11,347, pathogenic waste is considered as: “All waste or

material elements in a solid, semi-solid, liquid or gaseous state, which present
characteristics of toxicity and/or biological activity that can directly or indirectly
affect living beings. and cause contamination of the soil, water or atmosphere;
that are generated for the purpose of patient care (diagnosis, treatment,
immunization or provision of services to human beings or animals), as well as in
the research and/or commercial production of biological elements.”
The following are considered pathological waste:
a) Waste from laboratory cultures;
b) Remains of blood and its derivatives;
c) Organic waste from the operating room;
d) Animal remains resulting from medical research;
e) Cotton wool, gauze, used bandages, blisters, syringes, sharp or sharp
objects, disposable materials, items impregnated with blood or other putrescible
substances that are not sterilized;
f) Chemotherapeutic agents.
Likewise, any “natural or legal, public or private person that produces such
waste as a consequence of its activity” is considered a generator . In Annex I,
healthcare establishments, medical, dental, veterinary, clinical and medicinal
analysis laboratories, pharmacies, research centers, nursing offices and any
natural or legal person that generates pathogenic waste as a result of their
activity are considered generators. .

The Generator will be responsible for the supervision and implementation of

programs that include:
a) the training of all personnel who handle pathogenic waste, from operators to
technicians and/or medical professionals, especially those who maintain regular
contact with pathogenic waste.

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b) maintenance, cleaning and disinfection tasks to ensure the hygienic
conditions of equipment, facilities, internal and local means of transport used in
the management of hospital waste.

The amount of waste generated is in the range of 2.6 to 3.8 kg/bed/day.

The amount of waste produced depends on:
 The knowledge that the personnel has to separate or segregate the
different components and carry out their conditioning.
 The number of daily consultations or occupied beds.
 The level of complexity and frequency in the provision.

The most significant waste generated in health care centers is called

infectious waste because it is highly dangerous (capable of producing infectious
diseases) for the health of the people who handle it directly or indirectly, such
as doctors, nurses, assistants, maintenance personnel. maintenance, public
services and health workers in general.

CLASSIFICATION

NON-HAZARDOUS WASTE: These are those produced by the generator

anywhere and in the course of its activity, which do not present a risk to human
health and/or the environment.
It is worth clarifying that any non-hazardous hospital waste that is presumed
to have been in contact with hazardous waste must be treated as such.
Non-hazardous waste is classified into:
 Biodegradable: These are chemical or natural remains that decompose
easily in the environment. These remains include vegetables, uninfected food
waste, toilet paper, papers not suitable for recycling, biodegradable soaps and
detergents, wood and other waste that can be easily transformed into organic
matter.
 Recyclable: These are those that do not decompose easily and can be
used again in production processes as raw materials. Among this waste are:
some papers and plastics, scrap metal, glass, fabrics, x-rays, obsolete or
disused parts and equipment.
 Inert: These are those that do not decompose or are transformed into
raw material and their natural degradation requires long periods of time. These
include: Styrofoam, some types of paper such as carbon paper and some
plastics.
 Ordinary or common: These are those generated in the normal
performance of activities. This waste is generated in offices, hallways, common
areas, cafeterias, waiting rooms, auditoriums and in general in all areas of the
generator's establishment.

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 HAZARDOUS WASTE: These are wastes produced by the generator with
any of the following characteristics: infectious, combustible, flammable,
explosive, reactive, radioactive, volatile, corrosive and/or toxic; which can cause
harm to human health and/or the environment. Likewise, containers, packaging
and packaging that have been in contact with them are considered dangerous.
 Infectious or Biological Risk Waste : These are those that contain
pathogenic microorganisms such as bacteria, parasites, viruses, fungi,
oncogenic and recombinant viruses such as their toxins, with a sufficient degree
of virulence and concentration that can produce an infectious disease in
susceptible hosts.
o Biosanitary: These are all those elements or instruments used during the
execution of care procedures that have contact with organic matter,
blood or body fluids of the human or animal patient such as: gauze,
dressings, applicators, cotton pads, drains, bandages, wicks, gloves. ,
bags for blood transfusions, catheters, probes, laboratory material such
as capillary and test tubes, culture media, object holder sheets and
covers, slides, closed and sealed drainage systems, disposable clothing,
sanitary towels, diapers or any other disposable element that medical
technology introduces for the purposes provided for in this section.
o Anatomopathological: These come from human remains, samples for
analysis, including biopsies, amputated organic tissues, body parts and
fluids, which are removed during necropsies, surgeries or other
procedures, such as placentas, remains from exhumations.
o Sharps are those that, due to their sharp or sharp characteristics, can
give rise to an infectious percutaneous accident. These include: files,
lancets, blades, needles, remains of vials, pipettes, scalpel blades or
glass, and any other element that, due to its sharp characteristics, may
cause injury and cause an infectious risk.
o Animals: These are those coming from experimental animals, inoculated
with pathogenic microorganisms and/or those coming from animals
carrying infectious diseases.
 Chemical waste: These are the remains of chemical substances and
their packaging or any other waste contaminated with them, which, depending
on their concentration and exposure time, have the potential to cause death,
serious injuries or adverse effects on health and the environment. atmosphere.
o Partially consumed, expired and/or deteriorated drugs: These are
expired, deteriorated and/or surplus drugs that have been used in any
type of procedure, which includes waste produced in pharmaceutical
laboratories and medical devices that do not comply. quality standards,
including their packaging.
o Drug waste, whether low, medium or high risk, according to the
classification, can be treated by incineration given its effectiveness and
safety; however, in the aforementioned annex, other alternatives for
treatment and final disposal are considered viable. .

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 o Cytotoxic Waste: These are surplus drugs from oncological treatments
and elements used in their application such as: syringes, gloves, bottles,
gowns, absorbent paper bags and other materials used in the application
of the drug.
o Heavy Metals: These are objects, elements or remains of these that are
disused, contaminated or contain heavy metals such as: Lead,
Chromium, Cadmium, Antimony, Barium, Nickel, Tin, Vanadium, Zinc,
Mercury. The latter comes from the dentistry service in processes of
removal or preparation of amalgams, due to broken thermometers and
other work accidents in which mercury is present.
o Reagents: These are those that, on their own and under normal
conditions, when mixed or come into contact with other elements,
compounds, substances or waste, generate gases, vapors, toxic fumes,
explosion or react thermally, putting human health or the environment at
risk. environment. They include developing and fixing liquids, laboratory
liquids, contrast media, in vitro diagnostic reagents and blood banks.
o Pressurized Containers: These are pressurized packaging of anesthetic
gases, medications, ethylene oxides and others that have this
presentation, full or empty.
o Used oils: These are those oils with a mineral or synthetic base that have
become or become unsuitable for the initially assigned or intended use,
such as: motor and transformer lubricants, used in vehicles, greases,
equipment oils, residues from waste traps. fats.
 Radioactive waste: These are substances that emit predictable and
continuous energy in the form of alpha, beta or photons, whose interaction with
matter can give rise to x-rays and neutrons.
It must be understood that these wastes contain or are contaminated by
radionuclides in concentrations or activities higher than the exemption levels
established by the competent authority for the control of radioactive material,
and for which no use is foreseen.
These materials originate from the use of radioactive sources assigned to a
practice and are retained with the intention
HOSPITAL of restricting emission rates to the
WASTE
biosphere, regardless of their physical state.

NON-HAZARDOUS WASTE DANGEROUS RESIDUES

Infectious or Chemicals Radioactive

Biological risk

Biodegradable Biosanitary Drugs

Recyclable Anatomopathological Cytotoxic

Inert Sharps Heavy metals

Reagents
Ordinary or Animals
common Containers
Pressurized 7
Used oils
 According to Law 11,347, we can classify pathogenic waste as follows:
TYPE A PATHOGENIC WASTE: This is waste generated in a healthcare
establishment, coming from administration tasks or general cleaning thereof,
warehouses, workshops, food preparation, packaging and ashes.
These wastes may receive treatment similar to those of household origin, with
the exception of what is provided for in this regime due to their low or no level of
toxicity.
TYPE B PATHOGENIC WASTE: These are those wastes or material
elements in a solid, semi-solid, liquid or gaseous state, which present
characteristics of toxicity and/or biological activity, which may directly or
indirectly biologically affect living beings and/or cause contamination. of soil,
water or atmosphere. Waste of this type will be considered in particular,
including, but not limited to, the following: used bandages, organic waste from
childbirth and operating rooms, necropsies, morgues, bodies and remains of
experimental animals and their excrement, food remains from infectious and
contagious patients, anatomical pieces, pharmaceutical waste, disposable
materials with and without blood contamination, pathological anatomy, glass
and disposable material from analysis laboratories, hemotherapy, pharmacy,
etc.
TYPE C PATHOGENIC WASTE: Radioactive waste from diagnostic,
therapeutic or research methods, which may be generated in radiotherapy
services, imaging medicine, biological assays, or others. Waste of this type
requires, depending on current national legislation and due to its physical-
chemical properties, special handling.
Healthcare establishments may dispose of drugs, pharmaceuticals,
medications and their packaging as waste designated in TYPE B. When the
scale of production of this type of waste responds to industrial levels, these will
be considered Special Waste, with the generating establishment falling within
the scope and provisions of the respective regulations.

RISKS

The RISKS of hospital waste management are:

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  Infectious injuries caused by sharp objects of hospital cleaning staff and
personnel who handle solid waste.
 The risks of infection outside hospitals for personnel who manage solid
waste, those who recover materials from garbage and the general public.
 Infections of hospitalized patients due to poor waste management.
 Among the technical problems we can mention the inadequate
separation of hazardous waste at the point of origin due to the poor training of
the personnel in charge. In addition, sharps are not stored properly, which
explains the numerous injuries to personnel handling the waste.

Due to incorrect handling of hospital waste, a series of diseases can arise,

among which we will mention:

ELIMINATION
Potentially pathogenic waste is contained in bags, these must be red in color.
They should be transported in containers that can be closed perfectly, are
opaque and have notable resistance to breakage. The ideal shape is conical,
with a mouth wider than the base to facilitate emptying. They should be light

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and not very large to facilitate handling and transportation, waterproof and with
a smooth surface to facilitate washing.
Sharp items must be placed in waterproof, airtight and sufficiently resistant
containers.

Bags and Containers

The temporary disposal of pathogenic waste within the generating
establishment will be carried out exclusively in polyethylene bags, which must
have the following characteristics:
 Made of plastic material (high-density polyethylene) resistant to tension
and shock.
 Individual bag weight with waste should not exceed 8 Kg. and the
resistance of each bags not less than 20kg
 Color according to your classification
 In opaque red color, which does not allow you to see what is inside
 Resistant to rupture and puncture, they do not tear when full. It must
have a caliber greater than 1.8 mm
 Completely waterproof
 With mark to avoid the maximum filling point. (up to 3/4 of its capacity)
 Wear the infectious waste symbol.

For type B pathogenic residues

- minimum thickness 120 microns
- size that allows entry into incinerator ovens or other pathogenic waste
treatment devices.
- waterproof, opaque and resistant.
- red
- they will be inscribed at 30 cm. of the base in black, the Registration number
of the GENERATOR before the PROVINCIAL DIRECTORATE OF
ENVIRONMENT repeated at least four (4) times around its perimeter, in fonts
whose size will not be less than 3 centimeters.

For pathogenic residues type A

- minimum thickness of 60 microns
- Green color
- they will be inscribed at 30 cm. of the base in white, the Registration number
of the establishment before the PROVINCIAL DIRECTORATE OF
ENVIRONMENT repeated at least four (4) times on its perimeter, in fonts whose
size will not be less than 3 centimeters.

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 The closing of both types of bags will be carried out in the same place where
the waste is generated, through the use of a resistant and combustible seal,
which once adjusted will not allow it to be opened. Likewise, the control card
will be placed in each bag (Generation: date and place; Dispatch: time, date,
amount of waste in kg)

The containers intended to contain the different bags of pathogenic waste of

various types will be removed daily from their places of generation, being
replaced by others of equal characteristics, previously sanitized.
The polyethylene bags containing type B pathogenic waste will be placed in
truncated conical containers (bucket type), lightweight, with smooth surfaces
inside, washable, resistant to abrasion and shock, with a tight-fitting lid and
handles to facilitate transportation. , with capacity appropriate to the needs of
each place. These containers will be identified as follows: black with a 10 cm
red horizontal band. Wide.
The bags of type A pathogenic waste will be placed in white containers, with a
green horizontal band 10 centimeters wide.

Each waste generation site must have sufficient container capacity to receive
waste. The container must be located in a place close to where the waste is
generated. These should spend as little time as possible in the technical areas.
The containers used for the temporary storage of infectious waste are plastic
bins called CONTAINERS, which must always have a plastic bag inside. They
must have the following characteristics:
 Hermetic
 Resistant to breakage or puncture
 Conical in shape, the widest part facing upwards
 Smooth surface for easy washing
 Lightweight for easy transportation
 Completely waterproof, made of plastic material
 Impact and dent resistant
 Automatic and airtight closing lid, with pedal to open
 Maximum capacity of 10 liters
 Red with the infectious waste symbol on the front.

Waste consisting of disposable, sharp or pointed items (needles, scalpel

blades, etc.) will be placed in containers resistant to impacts and punctures,
such as plastic bottles or cardboard boxes, or appropriate containers for this
purpose, before introduction. in the bags. The container must have the following
characteristics:

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 • Rigid, in high-density polypropylene-not PVC
• Break and puncture resistant
• Adjustable or screw cap, narrow mouth, airtight
• Sharp marking “Biological Risk”
• Lightweight and with a capacity of no more than 2L.
• Puncture shear resistance greater than 12.5 Newton
• Disposable and thick-walled

Pathogenic waste B with a high liquid content will be placed in their

respective bags (red) to which absorbent material has previously been added to
prevent spillage.

Non-pathogenic waste is discarded in green bags, transported in the same

way as pathogenic waste, and discarded as common type waste that can be
collected by the municipal service.

STORAGE

The final waste storage site, within the establishments, will consist of a
location located in areas outside the building and with easy access. When the
building characteristics of the establishments already built prevent their external
location, it must be ensured that said premises do not affect, from a hygienic
point of view, other rooms such as kitchen, laundry, hospitalization areas, etc. It
will have:
a) floor, baseboard, toilet and smooth walls, waterproof, resistant to
corrosion, easy to wash and disinfect.
b) ventilation openings, protected to prevent the entry of insects or rodents.
c) sufficient number of containers where the pathogenic waste bags will be
placed. Containers for pathogenic waste B will have the following
characteristics:
- conical trunk (bucket type), lightweight, with a smooth surface to facilitate
washing and disinfection, resistant to abrasion and impacts, tight-fitting lid,
handles for transport, with a maximum capacity of 150 liters and a minimum of
20 liters.
d) Sufficient width to allow the operation of the internal transport carts.
e) Scales to weigh the pathogenic waste generated and whose registration
will be carried out in forms checked by the person responsible for its
management and by the company contracted for its treatment.
f) External identification with the legend “HOSPITAL WASTE DEPOSIT AREA
- RESTRICTED ACCESS”. Only authorized personnel will access this location
and the accumulation of waste will not be allowed for periods of more than 24

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hours, unless there is a cold storage room with adequate characteristics.
Outside the premises and annexed to it but within the exclusivity area, there
must be sanitary facilities for washing and disinfecting personnel and internal
transport containers and carts.

COLLECTION AND TRANSPORTATION

Internal transportation (Destined for the health center's cleaning staff)

As a general rule, the internal transportation of waste will be carried out by
the hospital's cleaning staff.
The waste collected in different areas of the healthcare center will be
transported a minimum of twice a day to an area set up as a healthcare waste
warehouse.
No bag should be removed without having a label that specifies the place of
protection and the contents. The bags will be sealed when they are covered to
three-quarters of their capacity.
Cleaning procedures should not allow breakage of containers. In the event of
a spill, cleanup must be immediate.
In accordance with the architectural structure of the center, a series of
appropriate circuits must be created so as not to affect general hygiene.
Loading and unloading schedules are established and transport systems
(transporter cars, elevators) must be adequately cleaned using pressurized
water and detergent substances.
When due to the method of internal collection, due to the weight or volume of
the bags, it is necessary to use a cart for transportation, it must have the
following characteristics: rubber or similar wheels, plastic or stainless metal box,
smooth surfaces that facilitate cleaning and disinfection.
When planning the collection and internal transportation of waste generated
in a health care center, the following should be considered:
 The time and frequency of collection, which must be known by all staff.
 Avoid high-risk routes and select the shortest possible route between
the generation location and the storage location. The entire institution
must be covered.
 Guarantee the integrity of waste until external collection.
 Identify collection and internal transportation vehicles according to the
type of waste and disinfect it.

External transport

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 The collection and external transportation of waste considered non-
hazardous, that is, those that are comparable to domestic waste, will be the
responsibility of the municipal cleaning service.
For its part, the collection and transportation of waste considered hazardous
is carried out by special transportation for this type of operation, whose
characteristics and specifications are defined and limited in national and
provincial laws.
The National Hazardous Waste Law No. 24,051 , in chapter V, provides
that:
 Persons responsible for transporting hazardous waste must prove, for
registration in the National Registry of Hazardous Waste Generators and
Operators: identifying data of the owner of the company providing the
service and its legal address; types of waste to be transported; list of all
vehicles and containers to be used; insurance policy that covers damages
caused.
 The transporter must: carry in the unit, during the transport of hazardous
waste, a procedures manual as well as adequate materials and equipment
in order to neutralize or initially confine an eventual release of waste;
include the transport unit in a radio frequency communication system;
clearly and visibly identify the vehicle and the load, in accordance with
national standards.
 The transporter is strictly prohibited from: mixing hazardous waste with
non-hazardous waste or substances, or hazardous waste incompatible
with each other; store hazardous waste for a period greater than ten days;
accept waste whose reception is not ensured by a treatment and/or final
disposal plant.

The Provincial Law on Pathogenic Waste No. 11,347 , in its chapter III,
establishes the conditions of collection and transportation for this type of waste.
To consider:
 Companies transporting pathogenic waste must register with the
Secretariat of Environmental Policy.
 Waste transportation must be carried out with a minimum of two vehicles,
in order to ensure non-interruption of service.
 Vehicles must be specifically used for the transport of pathogenic waste.
In addition, they must be white and have a completely closed cargo box,
with hermetically closing doors and must be isolated from the driving
cabin; They must have a minimum height that facilitates loading and
unloading operations and the movement of a standing person. The
interior of the box must be easily washable, with retaining edges that
prevent losses due to possible liquid spills.

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 Characteristics of transport vehicles

 Vehicle drivers and their companions must receive, at the expense of their
employers, training on the risks and precautions to be taken into account
when handling and transporting pathogenic waste. Likewise, they must
have personal protection elements consisting of: work clothes, aprons,
gloves, face masks, boots or waterproof footwear, which will be provided
daily in hygienic conditions.

FINAL DISPOSITION

The treatment of Biopathogenic Solid Waste is currently carried out by any of

the methods indicated below:
a) Incineration
b) Microwave sterilization
c) Sterilization by autoclave.

Incineration treatment
The treatment may be carried out in the Generating Unit that produced them,
in another Generating Unit with idle collection and treatment capacity or in a
Treatment Unit enabled to provide this service.
When the generating units carry out the incineration treatment themselves,
the type and characteristics of the incinerator oven used will be such that they
are appropriate to the quantity and type of waste to be treated so that the
gases, vapors and smoke products of combustion do not produce atmospheric
pollution that affects the environment in the opinion of the Control Agency.
The capacity of the incinerator oven must be sufficient to adequately
incinerate the volume of waste collected in one day.

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 Burial by Security Fill will be carried out in compliance with the following
conditions:
a) Sufficient land for the disposal of waste.
b) Useful life of not less than 5 years.
c) The land selected for the Fill must be located in a non-flood zone and at a
distance greater than 200 meters from any watercourse and/or master drinking
water supply system.
d) Land level 1 meter above the historical flood level.
e) Minimum distance between cell bottom and water table of 5 meters.
f) They must be covered daily with a 20 cm earth cover. of thickness.
g) Final land cover 50 cm thick.
h) 60 cm thick compacted clay cell bottom or 200 micron plastic membrane
across the entire bottom of the cell.
I) Delimited area with perimeter fencing of the burial area.
k) It must have a Surveillance System that guarantees the total absence of
surgical activities or other unauthorized activities.

Microwave sterilization
Microwaves are non-ionizing electromagnetic radiation that have certain
similarities with visible light. Thus they can be concentrated into rays and
transmitted through hollow tubes.
Some packaging materials such as glass, ceramics, and most thermoplastic
materials allow microwaves to pass through with little or no absorption.
Unlike traditional heating systems, microwaves penetrate the tissues,
extending the heating to the entire mass. The heat flow is also very fast.
The absorption of microwaves by a dielectric material has the effect of energy
transfer, therefore increasing its temperature.
Organic materials contain bipolar molecules, such as water. In general these
molecules are oriented randomly. However, when an electric field is applied to
them, they orient themselves according to the polarity of the field.
In a microwave field the polarity changes rapidly (for example at the
frequency of 2,450 MHz the polarity changes 2,450 million times per second).
This constant rotation of the molecules is what causes, through friction, the
increase in temperature.
This disinfection system is based on the crushing of waste and subsequent
internal heating of the crushed mass by adding microwaves.
During the crushing process, water is added which, thanks to the action of
microwaves, is heated and converted into steam that moistens the mass of
waste, contributing to its disinfection. For 25 minutes a temperature of 100 ºC
must be reached inside the treatment chamber.

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 To avoid accidents, the waste load is introduced using an automatic
mechanism. The pre-crushing holding chamber is hermetically closed and
purged with steam before feeding, to prevent unwanted emissions of
pathogens.

Once crushed, the resulting material is transferred to the treatment chamber

using a conveyor belt, whose speed is regulated so that the time the waste
stays there is 25 minutes.
Finally, the treated material is deposited in a holding chamber at
95 ºC for a certain time.
There is a continuous control system for disinfection parameters (basically
time and temperature). A periodically standardized biological test must be
performed in which the mortality of certain very heat-resistant spores (Bacillus
subtilus) is determined.
It is a relatively compact system that requires little space.

Autoclave system.

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 An autoclave consists of a steel container with an airtight seal, designed to
withstand working pressures that usually range between 1 and 4 ATM. And
suitable for the introduction of water vapor at a certain pressure and
temperature, as well as for the drainage of condensed steam.

Autoclave treatment
Normally, an external steam source is used, but sometimes it has its own
steam generation source that can be used in case of lack of external
contribution.
Factors such as the quality of the steam, the presence of air inside the
chamber, the type of packaging used, the type and density of the waste and the
configuration of the load, among others, will decisively influence the
effectiveness of the disinfection processes. , being decisively related to the
ability to humidify waste.

Vapor quality:
It can exist in three states:
· Wet steam. When the heat content is not enough for all the vapor to be in
the gas phase, producing the presence of liquid water. In relation to sterilization
processes, the heat content is lower than that of dry saturated steam, and as
there is more water, the drying phase is more difficult.
· Superheated steam. The temperature is higher than that necessary to
produce dry saturated steam. Superheated steam is not advisable, as the
spores are much more susceptible to moist heat than dry heat.
· Dry saturated steam. Since all the vapor is in the gas phase, the heat
content is such that it could be in perfect equilibrium with liquid water at the
same pressure and temperature. It is the most advisable state to address
sterilization and disinfection processes.
The replacement of the air contained in the autoclave chamber with
pressurized steam results in an increase in the temperature of the chamber,
essential to eliminate infectious agents.
The presence of residual air in the autoclave chamber dilutes the steam and
makes its penetration difficult, so that the time necessary to reach working
temperatures increases significantly.
Among the factors that can influence unsuccessful air displacement are: the
use of resistant plastic bags that can retain air inside, the use of very large
containers that make it difficult for air to escape from the deeper areas, and
inadequate loading of the bags that hinders air circulation.
The physical barrier constituted by the type of bags in which the waste has
been deposited will be a determining factor when it comes to ensuring the
effectiveness of steam and heat penetration. The most recommended bags are
those that, allowing steam to pass through their pores, do not break down due
to the temperatures reached inside the autoclave.

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 Low-density waste is easier to treat than high-density waste (liquid waste)
which requires longer exposure time.

Types of autoclave
· Gravity autoclaves; in which the air contained inside the chamber is
displaced to the outside, through the drain valve, by the steam itself.
· Vacuum autoclaves, prior to introducing steam, one or more vacuum cycles
are carried out to extract the air contained in the chamber.
The most used are vacuum autoclaves, although they are 20% more
expensive. The air purging phase is carried out in less time and with greater
guarantees of having displaced the air in all points of the chamber, avoiding the
formation of air in points that are difficult to access. The effectiveness of the
purging phase lies in:
· Reduction in the time necessary to achieve the required temperatures and
pressures, which allows more extreme working conditions to be achieved in an
acceptable time from an operational point of view.
· The reduction of the time in which these working conditions must be
maintained to eliminate the infectious agents present. A disinfection cycle in a
vacuum autoclave that works at a temperature of 121 ºC and 1 ATM of pressure
can be prolonged for
35 minutes, while in a gravity autoclave it is closer to an hour.

PERSONAL PROTECTION AND BIOSECURITY RULES

Personnel in charge of handling hospital waste must wear personal protective

clothing and implements for hygienic reasons and to avoid skin injuries.
Personal protection consists of:
 Long sleeve jumpsuit
 Eye protection with panoramic vision
 Industrial type plastic apron
 Industrial type rubber gloves, 25 gauge
 Rubber boots, mid-calf and non-slip sole
 High efficiency mask category N95% in filtration
 Goggles (if there is a risk of splashes)
The following steps must be performed:
 Decontamination
 Cleaning
 Disinfection
 Drying

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 These steps must be carried out on reusable containers, collection carts,
elevators and freight elevators, toiletries and personal protection elements.
The entity must provide a place for the storage, washing and disinfection of all
cleaning items.

Some rules
 Use gloves and mittens, and after completing the entire handling
procedure, wash your hands.
 Maintain the waste storage site in good hygiene and cleanliness
conditions.
 When handling infectious waste, always wear a rubberized or waterproof
fabric apron over work clothes.
 Avoid smoking, drinking or eating food at the waste storage site.
 Do not store food in the lockers where work clothes are kept.
 Waste should remain in technical areas for as little time as possible.
 If there is a risk of splashing blood or any liquid, use a mask and eye
protection.
 Use rubber boots for washing and general cleaning in waste storage
rooms, emergency rooms, laboratories, blood banks, among other facilities.
 Liquid waste (blood, feces, vomit, urine, secretions and other body fluids)
can be disposed of down the toilet, trash can or similar sanitary equipment. This
is possible when the effluents are discharged into the sanitary network. If the
establishment does not have a sanitary connection to the sanitary network, they
must be treated previously. Special care must be taken when disposing of
liquids to avoid stains on walls, toilets, furniture, and floors. Gloves must be
used for handling, the use of gloves does not invalidate hand washing.
Handling clean and dirty clothes
The objective is to establish proper management of bedding, clean and dirty,
in order to avoid the spread of germs through it. Although the handling of
potentially contaminated clothing can cause infection in the staff or patients who
use it, this fact is infrequent and of little relevance. However, in order to
minimize risks, the clothing cleaning process should be systematized.
Clothing classification
Hospital clothing comprises three categories:
 Clean clothing: is that which, having been subjected to the appropriate
washing process, is epidemiologically safe and is available for use by the
patient.
 Dirty clothing: is clothing that, whatever its type (sheets, pillowcases,
bedclothes, towels, nightgowns, blankets, etc.) has been in contact with the
patient.

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  Contaminated clothing: is clothing that has been in contact with infected
patients or those who are in isolation or when they are stained with blood, fecal
matter or secretions.

Clothing handling
CLEAN CLOTHES
Upon completion of all the processes that make the clothing suitable for use
with patients, it will be placed in a separate area of the laundry room awaiting
transport with blood, fecal matter or secretions.
The transfer will be done in carts exclusively for this function, adequately
covered, taking care that the transfer, especially by the elevator, is not done
simultaneously with dirty clothes, waste or cleaning carts.
Clean clothes will be located in different areas of the hospital in special places
reserved for that purpose. The shelves of these warehouses will be subjected to
periodic cleaning, it is recommended to do so once a week.

DIRTY AND CONTAMINATED CLOTHING

 Place dirty clothes in red bags immediately after removing them from the
patient's bed. The red bag must be on a wheeled bag holder (cart). Do not rest
on the floor or other surfaces.
 Store them in spaces away from the patient interaction area and that
have good ventilation.
 Send bed covers and blankets to be washed upon discharge of the
patient, whether or not they have been in isolation.
 Do not count dirty clothes or air them inside the hospitalization area.
 Avoid storing dirty clothes in the same place as waste.
 Use gloves or mittens when handling dirty clothes and wash your hands
after each procedure.

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 CONCLUSION

As we could see, the potential risk presented by hospital waste constitutes a

problem in terms of public health, environmental sanitation, nosocomial and
epidemiological diseases, etc. It is the responsibility of the institutions providing
health services to prevent and contribute to minimizing this environmental risk.
Therefore, health institutions must order the proper management of waste
material to prevent, reduce and control the risk of accidents, both for patients,
staff and the rest of the community.
We consider that the training and qualification of hospital staff in techniques
and management of highly dangerous waste, as well as the pertinent
explanations about the risks inherent in handling this waste, constitute a very
important factor in reducing accidents and protecting health. . Thus, the training
and awareness of health personnel must be a priority for the authorities. We
must remember that education and training programs must be developed with
appropriate language depending on who they are directed to, so that they
address the particular needs, and can be understood to change the behavior of
that population.
We highlight the need for correct classification of hospital waste, regardless of
the final strategy adopted for its treatment and final disposal. Imposing sorting
practices in hospitals to separate hazardous biological and chemical waste
(generally less than 15% of the total) will result in 85% clean waste, which can
be easily, safely and economically managed, recycling, composting and
sanitary burying. the remains. If adequate classification is achieved through
training, clear standards and strong implementation, resources can be allocated
to managing the small portion of waste that needs special treatment.
Greater emphasis also needs to be placed on reducing hazardous materials
waste. For example, hospital waste management would benefit from a policy to
eliminate the use of products and technologies that contain mercury. Digital and
electronic technology is available to replace diagnostic tools that contain
mercury. This is a purchase and investment decision.

“The land was not inherited by our elders, but was lent to
us by future generations to preserve it”
Rigoberta Menchu. Nobel Peace Prize.

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BIBLIOGRAPHY

 Law No. 24,051 of 1993 on “Hazardous Waste”

 Law No. 11,347 on “Pathogenic Waste”
 Internet pages:
o http://www.cepis.ops-oms.org (Virtual Library of Sustainable
Development and Environmental Health)
o http://new.paho.org (Pan American Health Organization)
o http://micromedicina.com (Faculty of Medical Sciences – National
University of Rosario)
o http://www.cruzroja-jalisco.org
 J Hospital Magazine. M. Ramos Mejía. Volume IX – No. 3 – 2004 –
Electronic edition ( www.ramosmejía.org.ar )

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