HOSPITAL WASTE MANAGEMENT

By- Ashish Sharma 601001006

Health Care Waste

Includes all the wastes that is generated or produced as a result of any of the following activities: 1.Diagnosis, treatment or immunization of human beings or animals 2.Research pertaining to the above activities 3.Production or testing of biologicals. 4.Waste originating from minor or scattered sources

Environmental Concerns
Spread of infection and disease through vectors (fly, mosquito, insects etc.) which affect the in -house as well as surrounding population. Spread of infection through contact/injury among medical/non-medical personnel and sweepers/rag pickers, especially from the sharps (needles, blades etc.). Spread of infection through unauthorized recycling of disposable items such as hypodermic needles, tubes, blades, bottles etc. Reaction due to use of discarded medicines

Waste Generation
Types of waste generated in hospitals 1- Infectious waste 2-Pathological waste 3-Sharps 4-Pharmaceutical waste 5- Genotoxic waste 6- Chemical waste 7-Wastes with high content of heavy metals 8-Radioactive waste

1- Infectious Waste - suspected to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease. Example- Cultures and stocks of infectious agents , Waste from surgery and autopsies on patients with infectious diseases (excreta, dressings from infected or surgical wounds) , dialysis waste , Infected animals from laboratories, 2-Pathological waste Can be considered as a subcategory of infectious waste Includes- Tissues, organs, body parts, human fetuses and animal carcasses, blood, and body fluids. Within this category, recognizable human or animal body parts are also called anatomical waste

3-Sharps Sharps are items that could cause cuts or puncture wounds Includes - needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws, broken glass, and nails. 4-Pharmaceutical waste includes - expired, unused, spilt, and contaminated pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to be disposed of appropriately. also includes discarded items used in the handling of pharmaceuticals, such as bottles or boxes with residues, gloves, masks, connecting tubing, and drug vials. 5- Genotoxic waste Includes -cytostatic drugs, vomit, urine or feces from patients treated with cytostatic drugs, chemicals and radioactive materials Highly hazardous and may have mutagenic, teratogenic or carcinogenic properties .

6- Chemical Waste Consist of solid, liquid and gaseous chemicals from diagnostic, experimental work, cleaning & housekeeping and disinfecting procedures Maybe considered as hazardous if it has one of following properties I. Toxic; II.Corrosive (e.g. acids of pH < 2 and bases of pH > 12); III. Flammable; IV. Reactive (explosive, water-reactive, shock-sensitive); V. Genotoxic (e.g. cytostatic drugs). The types of hazardous chemicals used most commonly a) Formaldehyde - is used to clean and disinfect equipment ,preserve specimens, disinfect liquid infectious waste, and in pathology, autopsy, dialysis, embalming, and nursing units b) Solvents Organic and inorganic solvents

c)Photographic chemicals Photographic fixing and developing solutions are used in X-ray departments . Eg 10% hydroquinine , 10% potassium hydroxide , 45% glutaraldehyde 7-Wastes with high content of heavy metals Wastes with a high metal content & represent a subcategory of hazardous chemical waste & are usually highly toxic Mercury wastes generated from spillage of broken clinical equipment Cadmium waste comes from discarded batteries Reinforced wood panels containing lead

8- Radioactive waste Includes - disused sealed radiation sources, liquid & gaseous materials contaminated with radioactivity, excreta of patients who underwent radionuclide diagnostic and therapeutic applications , paper cups, straws, needles & syringes, test tubes, & tap water washings of such objects The common concern regarding the waste is to ensure that everyone is protected from the potential hazards of radiation.

Categories of Bio-medical Waste

Waste Management
1-Segregation Segregation refers to the basic separation of different categories of waste generated at source and thereby reducing the risks as well as cost of handling and disposal

2) Certification When a bag or container is sealed, appropriate label clearly indicating the information has to be attached They should be labelled with the Biohazard or cytotoxic symbol as the case may be
3-Collection The containers/ bins should be placed in such a way that 100 % collection is achieved. Sharps must always be kept in puncture-proof containers to avoid injuries and infection to the workers The bags/containers should not be filled more than 3/4th capacity

4-Storage Once collection occurs then biomedical waste is stored in a proper place with labeled containers. Segregated wastes of different categories need to be collected in identifiable containers. The duration of storage should not exceed for 8-10 hrs in big hospitals (more than 250 bedded) and 24 hrs in nursing homes. 5-Transportation The waste should be transported for treatment either in trolleys or in covered wheelbarrow. Special vehicles must be used so as to prevent access to, and direct contact with, the waste by the transportation operators, the scavengers and the public

6- Treatment
There are mainly five technology options available for the treatment of Bio-Medical Waste 1. Chemical processes 2. Thermal processes 3. Mechanical processes 4. Irradiation processes 5- Biological Treatment a)Chemical Disinfection Aldehydes, Chlorine compounds, phenolic compounds, etc. are added to waste to kill or inactivate pathogens Most suitable in treating blood, urine, stools and sewage or in treating infectious wastes containing pathogens Eg- Sodium hypochloride, dissolved chlorine dioxide, peracetic acid, hydrogen peroxide

b)Thermal processes Rely on high heat to destroy pathogens It is been grouped into two categories i. Low-heat systems Autoclave , microwave ii. High-heat systems- Incinerators
Autoclave -Autoclave uses high temperature & high pressure steam sterilization to inactivate most microorganisms Used for sterilization of reusable medical equipment and also to make the equipment contamination free Microwave - Uses micro waves for disinfection of the material. The input material is first put through a shredder then to a treatment chamber and then to second shredder Finally it is automatically discharged into a conventional / general waste container.

-Incineration
Incineration has been recommended for human anatomical waste, animal waste, cytotoxic drugs, discarded medicines and soiled waste. Broadly, three types of incinerators are used for hospital waste : multiple hearth type, rotary kiln and controlled air types

c) Mechanical processes
used to change the physical form or characteristics of the waste either to facilitate waste handling. The two primary mechanical processes are Compaction - used to reduce the volume of the waste Shredding - used to destroy plastic and paper waste to prevent their reuse.

d) Irradiation processes Wastes containing potentially infectious microorganisms ( sewage sludge, biomedical wastes, wastewater) are treated using irradiation systems Exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber
e)Biological Processes Uses an enzyme mixture to decontaminate health care wastes Requires regulation of ph, enzyme level, temperature & other variables Design application is mainly for regional health care waste treatment centers Composting & vermiculture for treating and disposing of placental waste, food waste, yard trimmings & other organic wastes

Deep Burial
To dispose sharps, anatomical waste ,incinerated ash , autoclaved waste. 2 meters deep. It should be half filled with waste, then covered with lime within 50 cm of the surface & then filled with soil. On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be added to cover the wastes. The pits should be distant from habitation, and sited so as to ensure that no contamination occurs of any surface water or ground water

Treatment of specific type of waste generated o Sharps

Generally chemically disinfected , autoclaved or subjected to micro waves. After disinfection they should be disposed in landfill if secured landfills are not available everywhere alternate systems recommended include: sharp pit & encapsulation

o Radioactive Waste
Effective management can be achieved by minimization The radioactive waste should be stored for decay purposes until the activity decays to the background level and can be considered inactive for final disposal as normal waste

o C) Mercury control Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given Proper attention should be given to the collection of the spilled mercury, its storage and sending of the same back to the manufacturers. Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes

Wastewater Treatment
Hospital wastewater contains pathogenic microorganisms, pharmaceuticals, hazardous chemicals, etc., which may have an impact on the environment and public health. The health-care establishment should ideally be connected to a sewerage system ,if not present on-site sanitation should be provided An on-site treatment or pre-treatment of hospital wastewater comprises i. primary treatment (screening, grit chamber, sedimentation tank), ii. secondary treatment (biological treatment processes, such as activated sludge, trickling filters, lagoons) iii. Tertiary treatment (physical, biological, or chemical processes to remove nutrients such as nitrogen and phosphorus, and carbon adsorption to remove chemicals) iv. chlorine disinfection v. sludge treatment

 Small facilities that cannot afford to implement the above mentioned treatment system& thus consider the installation of a proper septic tank and soakaway system a) Septic Tank - The purpose of a septic tank is to reduce the bacterial and nutrient load Waste material is allowed to settle in the tank and is digested by natural bacteria After leaving the septic tank, wastewater has two options, the water is passed into the subsoil to a soakaway system or send to offline treatment plant. b) Soakway pit- Has a perforated lining through which effluent from the septic tank can soak into the surrounding soil This natural purification includes the breakdown of the polluting material by bacteria occurring naturally in the soil, and the eventual die off of the pathogens.

 Adequate purification can only be achieved after the effluent has traveled a fairly long distance through the ground length of perforated pipe (around 20+ meters) a trench backfilled with a similar size stone chippings The size of the soakaway drain must be sufficient to absorb the tank effluent Drain should not be short.. Soil characteristics and water table level must be known before construction

Waste minimization
Use less hazardous isotopes whenever possible. Investigate reuse of solvents like formaldehyde in pathology, autopsy laboratories. Use pre-mixed kits for tests involving solvent fixation. Recover/reuse solvents through distillation Substitute electronic sensing devices for mercury-containing devices. Provide mercury spill cleanup kits and train personnel. Return outdated drugs to manufacturer.