WASTE MANAGEMENT IN A PRIVATE HOSPITAL

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• WASTE MANAGEMENT IN A PRIVATE
  HOSPITAL
• Dr.Shanta Nagarajan
• ROCKLAND HOSPITAL

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INTRODUCTION

• Anything not intended for use is waste
• All waste liquid solid generated by health care
  system are bio medical waste .

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• In Delhi there are about 72 hospitals under Govt.
  sector ,550 registered nursing homes and 936
  dispensaries.In addition to this there are about
  1560 underegistered establishments with different
  names like Nursing homes,Medical Centres,Dental
  Hospitals,MTP centres etc.About 40000 hospital
  beds are available in the public private sector
  in Delhi excluding the Laboratory .

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Historical Background

• Hospital waste meansany solid,fluid or liquid .
• Hospital waste includes garbage,refuse,rubbish
  and Bio Medical waste.

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HOSPITAL WASTE DISPOSAL

• Waste is unwanted trash generated near human or
  animal habitation.
• Its quality quantity are location specific,
  dependant on food habits,culture,tradition
  socio-economic conditions.
• 75 of the above refuge in India consists of bio
  degradable the rest 25 is inert material
• It is of high density,varaiable moisture
  content(i.e. 15 40) and partly
  combustible(i.e.50- 75)
• It has poor calorific value 2500KCAL/KG have
  low carbon- nitrogen ratio.

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HOSPITAL WASTE

• The daily waste collected per patient is 2 5
  kgs.There are statistics which say it could be
  between 5 15 kgs.

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• The hospital waste can spread disease to the
  community through microbial contamination- viz.-
  Dressings,bandages,swabs,plaster
  caste,lancets,scalpels etc
• Human tissues from OT.
• Clinical specimens like blood ,urine,faces,aspirat
  ed fluids etc,
• Blood Bags
• Blood products,placenta etc,
• Laboratory waste.

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HOSPITAL MUST HAVE A FIXED POLICY FOR WASTE

• SEGREGATION OF LIQUID AND SOLID WASTE.
• COLLECTION OF SOLID WASTE IN THICK THIGHTLY
  CLOSED LEAK PROOF BAGS
• SHARPS IN PUNCTURE PROOF CONTAINER.
• TRANSPORTATION FROM HOSPITAL TO SITE IN CLOSED
  WHEEL BARROWS.
• TREATED WASTES ARE DISPOSED OFF TO LANDFILL BY
  MUNICIPALITY IN COVERED TRUCKS.
• CONTINGENCY ARRANGEMENTS MUST BE AVAILABLE IF
  REGULAR SYSTEM FAILS E.G BURNING,BURIAL WITH 1
  BLEACH OR DUMPING IN LINE PIT.

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• Decanting to be done in separate room or safety
  cabinet to avoid aerosols.
• Microbiology culture specimens must be
  decontaminated separately collected in leak
  proof bags before discarding.The bags should be
  tightly closed.
• Sharp items to be collected in puncture proof
  container to avoid pricks.
• Tissue from path section is seggregated sent
  for disposal burning or incenerartion
• Blood sera decontaminated before washing usable
  containers.

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Seggregation

• Hospital waste is seggregated area wise in four
  colour bags
• Yellow Bag( Waste for incineration)Human animal
  tissues/organs,body parts,non plastic
  contaminated or soiled waste ,plaster
  casts,dressing,swabs,bandages,microbiological
  pathological/lab waste etc.

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Seggregation

• 2.Red Bag (Waste for autoclave,microwave,chemical
  disinfectionfollowed by shredding or
  mutilation)All plastic disposables contaminated
  with blood or human secretion,syringes,iv
  sets,plastic culture plates,tubes,cathethers,canul
  aes,urobags,blood bags,surgical gloves etc.

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Seggregation

• Blue bag ( Waste for autoclaving,Microwaving,Chemi
  cal Treatment destruction/shredding) sharps
  like needles,scalpels,\blades,broken
  glass/ampules etc. that may cause punture and
  cuts , all sharp disposal to be in puncture proof
  containers.

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Segregation

• Black bag ( waste for disposal in municipal dust
  bins) office stationeries, General waste like
  papers,wrappers,cardboard,kitchen waste etc.

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• Every ward is provided with the three types of
  bags placed in closed bucket.
• Near the nurses station.
• Puncture proof containers are also provided
• All syringes are burnt before discarding into the
  container
• All plastics are shredded before placing in red
  container.

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• These bags are closed and labelled before
  transportation to the common site
• Transportation is by closed wheel barrow in every
  shift.
• Critical care area waste is transported in
  similar way to the common storage space.

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Soiled linen

• Soiled linen from wards and O.T. ,I.C.U and
  Dialysis unit are transported by H.K. staff to
  wash area ,
• Soaked in a covered labelled drum filled with
  detergent solution.
• Washed and transported to laundry
• A register is maintained.

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Final disposal

• The hospital area has a separate zone where
  collected waste is given to pollution control
  body.
• The waste is weighed, before disposal
• And record maintained.
• The area is kept clean and locked.

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• THE REFUGE SHOULD NOT BE STORED ,IF IT HAS TO BE
  STORED THEN THE AREA SHOULD BE SEGGREGATED
  CLEANED AND VENTILATED EVEN THEN IT SHOULD NOT BE
  KEPT FOR MORE THAN 72 Hrs.
• NEEDLES AND SYRINGES SHOULD BE BROKEN AND
  COLLECTED IN ANTISEPTIC SOL. BEFORE DISPOSAL.
• THE AREA MUST BE INACCESSABLE TO OUTSIDERS.IN OUR
  LAB WASTE IS NOT STORED IT IS SEGGREGATED IN
  WASTE ROOM SENT FOR DISPOSAL(6 8 Hrs.)

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Laboratory waste

• Laboratory is a potential source of infection
  measures are taken for self protection and
  community protection by following
• Educating Staff.
• Cleanliness
• Proper use of antiseptics
• Prevention of dry sweeping.
• Proper treatment of all specimens.
• Standard precautions
• Proper disposal of needles syringes
• Processing in laminar flow
• Sterilization techniques.

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AIMS

• Self Protection From Infection
• Other
  Hazards
• Control of spread on infection to community.
• Environmental protection, Laboratory being a
  potential source, proper scientific management of
  waste is essential. This includes.
• Decontamination,seggregation , collection and
  transporation,co-ordination with the hospital
  disposal as per policy of the hospital.

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STANDARD PRECAUTIONS (Blood Body Fluid
Precautions)

• All health care workers should use appropriate
  barriers.
• Precautions to prevent skin and mucous membrane
  exposure.
• Hands and skin surface should be washed
  immediately.
• Precautions against pricks by sharps.
• Health care workers having lesions on skin, hands
  should refrain from handling pathological
  materials.
• Pregnant workers should take special precautions
• Proper education in handling of waste on site.
• Environmental Monitoring.

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• Laboratory a critical area,
• Observation of aseptic antisepsis procedures.
• No dry sweeping
• Antiseptic sol. in req
• Disinfection before discarding waste.
• Spillage management

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Laboratory Has The Following types of Waste

• Cultures and stocks of infectious agents.
• Blood and body fluids.
• Pathological waste.
• Excreta
• Urine
• Pus etc
• Organs Tissues
• Highly infectious waste e.g Cholerae
  stool,culture of other communicable diseases.

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Treatment of Infectious waste before disposal

• All infectious waste need to be treated before
  sending it to land filling. All pathological
  waste is treated with chemical, then autoclaved
  before final disposal.
• The various methods of disposals are
• Autoclaving
• Chemical treatment1 sodium hyppochloride.
• Grinding decontamination with chlorine bleach
• Microwave irradiation
• Needle/syringe disposal
• Incineration- To burn to reduce to ashes.

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CLEANLINESS IN THE LABORATORY

• Avoid dry sweeping.
• Desk tops to be cleaned before starting work and
  after work.
• Prompt attention of spillage.
• 2 4 Phenolic Agents
• 1 Hypochloride Sol. 20 To 30 mins.
  
• Care of mops Separate mops masks section
  wise.
• Usage of gloves and masks.
• Cleaning of incubators,ovens Autoclave and
  Refrigerators.
• Immunisation
• Care of sharps and Disposables.

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RECEIVING AREA

• Reception of samples before transportation to the
  different sections.
• Biochemistry
• Haematology Blood,Serum,p
  lasma
• Serology
  Immunology

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RECEIVING AREA conti..

• Bacteriology
• Tuberculosis Special care
• Stool Specimen
• Spillage if any to be treated immediately.
• (Chemical
  Disinfection)

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PROPHYLAXIS AND CONTROL OF SPREAD OF INFECTION

• Health education to all Staff members.
• Regular courses of discussion with Nursing
  Staff,Nursing Aids,Sanitary attendants, House
  keeping.
• Immunisation of staff as per policy of the
  hospital.

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WASH ROOM

• Blood related products
• Reusable
• Disposable
• Separate containers with 1 hypochloride solution
  is provided to these sections .
• Reusable glass tubes after decontamination for 2-
  4 hrs are decanted into sink with flowing hot
  water where they are washed.
• All pathological waste is collected in yellow
  bags for inceneration.

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WASH ROOM

• Bacteriology
• Mycology Special Care
• Tuberculosis
• Stool Specimen
• Spillage if any to be treated immediately
  (Chemical Disinfection) .
  

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SPILLAGE MANAGEMENT

• SMALL SPILLAGE Place double the amount of 1
  Hypochloride Sol.for 20 Mins. .
• Blot dry
• Mop This mop should be washed and dried before
  reuse.
• BIG SPILLAGE- Cover with antiseptic sol. And
  clean as per protocol.

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CONCLUSION

• ALL HOSPITAL WASTE TO BE TREATEDAS HAZARDOUS
• POLICY OF WASTE MANAGEMENT MUST BE FOLLOWED
  RIGIDLY
• BIG HOSPITALS SHOULD HAVE ITS OWN SYSTEM OF WASTE
  TREATMENT AND DISPOSAL./zonalarrangement to be
  enforced
• COLLECTION BAGS TO BE GOOD QUALITY
• UNAUTHORISED PERSON SHOULD NOT HAVE ACCESS TO THE
  COLLECTION SITE.
• EMPLOYEES HEALTH HAZARDS TO BE TAKEN CARE OF BY
  PROPER EDUCATION,IMMUNISATION ETC.

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• The decontaminated segregated waste filled in
  yellow,blue,red black respectively transported in
  a covered wheel barrow to the common hospital
  waste disposal site.
• Thus Lab helps in prevention spread of
  infection.