Presentation on HWM

8/2/2019 Presentation on HWM

1/25

A Short Over View ofHospital Waste Managementfor Bangladesh


2/25

What is hospital waste (HW)?

Hospital Wastes

Non-hazardous Waste (general) Hazardous Waste (general)

-Domestic type waste

-Packing materials

-Non-infectious materials

-Infectious waste-Pathological waste

-Sharps

-Pharmaceutical

-Chemical waste

-Waste with high content of

heavy metals-Radioactive waste

The wastes that are being generated from any hospitals, clinics, or any

institution that provides healthcare services are commonly know as hospital

waste or health care waste. There two types of waste usually generated from

these places which is shown in the following flow chart:


3/25

Bangladesh 40,150

India 47,000,000

Indonesia 89,400

Maldives 16

Myanmar 21,800

Nepal 2,800

Sri Lanka 22,150

Thailand 30,400

Source:Strengthening of Hazardous Waste Management in the Countries of South East Asia,

WHO SEARO, 2000

Yearly HCW production in our

region, 2000

(Metric tons per year)


4/25

Risks Associated with HWHazardous Health-care waste and health risk

it contains infectious agents

it is genotoxicit contains toxic or hazardous chemicals or

pharmaceuticals

it contains sharps

Occupationalrisk

-Health-care personnel andwaste workers may come in

contact with infectious wastethat hasnt been packagedsafely or treated inadequately.-Many injuries occur becausesyringe needles or other sharpshave not been collected insafety boxes, or because thesehave been overfill.- On landfills or waste dumps,waste recyclers or scavengersmay come in contact withinfectious wastes if the wastehas been disposed of withoutprior treatment.

Risk to the public

-Worldwide, an estimated 10 to 20million infections of Hepatitis B

and C and HIV occur annuallyfrom the reuse of discardedsyringe needles without priorsterilisation.

-If health-care waste is dumped onun-controlled sites or in otherareas, which the public, can access,and in particular children cancome in contact with infectious

wastes.

Indirect risks via the environment

In addition to risks from direct contactwith health-care waste, waste can also

contaminate the environment, such as thewater or the air and so indirectly impacton health.

-When wastes are disposed of in a pit thatis not lined, the groundwater may

become contaminated.

-If waste is burned or incinerated in an

incinerator, which does not have anemission control (which is the case with

the majority of incinerators in developingcountries), the air may becomecontaminated by a large number of

pollutants and cause serious illness in

people who inhale this air.

Source: Decision Making Guide for Managing Healthcare Waste from Primary Healthcare Centre, 2002


5/25

The persons at Risk

Personals at risk

Patients in health-care

establishments

Doctors, nurses,

health-care auxiliaries

Workers in supportservices in health care

establishments such

as laundries, waste

handling and

transportationVisitors to health-care

establishments

Hospital maintenance

personnel

Workers in waste

disposal facilities,

including scavengers


6/25

Definition Hospital WasteManagement

Good management of health care waste in hospitals means theeffective segregation of waste and the separate handling anddisposal of each segregated waste category. This cannot beachieved without the commitment of senior directors and themotivation of medical and support staff.

The Following diagram shows the general practices of HWM

Generation

Collection

TreatmentDisposalSeparating

TransportationHandling

Waste

Identification Storage


7/25

Hospital waste Management in

Bangladesh

Hospital Waste Management is quite unsafe

No system of segregation of waste (both the wastes arethrown together)

Wastes are not identified at the place of generation.

There was no provision of quantifying and record keeping

on waste or any accident occurred.

There are no measures on the health and safety of the staffs


8/25

Different ways for thedisposal of HW in Bangladesh

A: Sold

Container

Syringe

Saline

bag

D/Syring

e

Bucket

Saline set

Needle

X-ray

Water

Plastic

bottle

Ampoules Vials

B: Burned

Cloths

Gauze

Cotton

Mattress

Bandage

AIDS

cloths

Rabies

clothe

Paper

Gloves

Saline Bag

Saline set

X-ray filmNeedle

Syringe

Blood bag

Plaster of

Paris

Apron

D/Syringe

Plastic

Sputum potTB slide

Bed Sheet

C: Buried

Common

Waste

Needle

Syringe

Blood

lancets

Specimen

Collection

pot

Blood

Urine

Stool

Sputum

Saline BagDamaged

body part

Placenta

Slides

Cotton

D: Dumped

D/syringe

Salinebag set

Gloves

Needles

Cotton

GauzeBandage

Pad

Paper

Plastic

TB slide

Sputum

Polythene

Blood sample

Tissue paper

Stool

Urine

Broken tube

Acid bottle

Syringe

Paper packet

placenta

G: Container/Basin

Tips

Reagent

Chemicals

Blood

Urine

Stool

Sputum

D/syringe

Needle

Gloves

Slide

Broken glass

h:Destroyed by

acid/Autoclave

Cotton

Needle

Syringe

TB slides

Sputum potTested samples

vials


9/25

Little awareness on HW health hazards

Lack of unity

Not enough human, technical and financial resources allocatedfor HWM

Employees are less paid

Little or no control/supervision mechanisms to manage wastessafely

IN FACT, THE PROBLEM HAS DEEPER ROOTS:THERE IS

A GENERALISED LACK OF INTEREST IN ADRESSING

WASTE MANAGEMENT AND IN INTRODUCING SAFER

HWM SYSTEMS.

Some Reasons why we fail to cope

with the HW Public Health Risk


10/25

Basic

Conditions

Unmet

Requirements

Practical

Implications

Basic

Conditions

Health

Affects

Lack ofawareness of

health risk

Lack of

political

commitment

Lack of

evidence forcertain

subgroups

Poverty

No sense ofresponsibility

Insufficient

national policyand regulations

Insufficient

allocation ofresources

Insufficientaccess to

information

Lack of safe lowcost options

Inadequate

waste system

Inadequate

training of staffor waste workers

Uncontrolledscavenging

Inadequate

protection of

workers

Reuse ofdisposables

Blood-borneinfections

Effects from

exposure to

toxic

pollutants

Interference of Causes andEffects of Inadequate Waste

Management


11/25

What We can do now?

1. Appoint a HW Supervisor and Allocate

ressources

2. Learn more: assess type and quantity, appraise

current handling methods, evaluate treatmentand disposal facilities

3. Encourage Safe Practices throughout the

different stages of the wastes life cycle4. Recur to regular training sessions, for all staff

5. Tax the polluterImplement the Polluter

Pays principle


12/25

Safe practices for HW

Management

Waste minimisation at source

Biodegradable materials where possible

Use chlorine (PVC-) free plastics

No heavy metals (mercury, cadmium) Recover non contaminated recyclables

Waste segregation

Separate waste by categories

Use rigid containers for sharps

Waste Identification

Wastes needs to be identified and stored into different colourcoded bags or container


13/25

Some safe practices forHW handling

Waste collection and stograge

Bins with proper covers

Follow a routine programme

Seal and label containers, collect daily, replace promptly

STORE NO LONGER THAN 24 HOURS

Waste transfer:

Follow chalked pathway from generation to disposal sites

Container containing clinical wastes should be trasported in a

totally enclosed vehicle.

s


14/25

Treatment option of Hospital

waste

Non-Burn

practice

Landfill: Only for pre-treated waste.

Bury on restricted access andControlled sites. Avoid leaching to

Water bodies, isolate from animal and

Human contact.

Encapsulation: Fill metal or plastic

drums to3/4 with waste, fill up with

Cement or clay or bituminous sand.

When dry seal and landfill. Ok for

Remote areas.

Waste Reduction: hydroclave

Including steam sterilization of

Waste and shredding melting

temperature above 121 degree

Celsius (suitable for plastic, needleCutter)

Burn

practice

Incineration:

Complete combustion

Of waste to totally

Sterile ashes.

Efficient only if at

800 degree Celsius

Or else it canProduce highly toxic

Dixoxins and furans.Biological Method:Collect all the wastes and then

Put the waste in a ditch with a capacity of 0.72

Cubic meters.then every day cover it with thin layer

Of cow dung and soil, this process continues till the

Ditch is filled. Then finally the ditch will be covered

with thick layer of cow dung and soil.and plantMedical plants that will absorb the toxic agents.

After few months open the ditch and remove the

Non-degradable wastes.


15/25

Advantages and disadvantages oftreatment and disposal option

Treatment/Dis

poals

Single

chambered

incineration

Drum or brickincineration

Biological

Method

Microwaveincineration

Encapsulation

Safe burial

Advantages

Good disinfections efficiency, drastic reduction in

waste in weight and volume of waste. No need for

highly qualified operators; relatively low

investment and operational costs.

Drastic reduction in weight and volume of waste.

Very low investment and operational costs.

Wastes are touched less, there is no toxic gas nor

incinerator ash, both aerobic and anaerobic

infectious agents doesnt survive and land is used

Good disinfections under appropriate operational

conditions. Environmentally friendly

Simple and safe, low cost

Low costs, safe if access restricted and natural

infiltration

disadvantages

Generation of amorphous pollutants. Need for

periodic slag and soot removal. Inefficient in

destruction of thermally resistance chemicals

and drugs such as cytotoxic.

Massive emission of smoke, flying ash, toxic

fuel gas. Not distract many chemicals and

pharmaceuticals.

Ground water can be contaminated if spillage

happens

High investment and operational cost

Not recommended for non sharp solid waste

Only safe if accessible is limited


16/25

Sharps Management Solutions

Used syringes

Non-Burn Technology Burn Technology

Collect in safe box Collect in safe box

Sterilization Double Chamber

incinerator

Bury the AshesBury in controlled pit Waste Reduction

Bury in controlled pit


17/25

Treatment of Hospital Waste

Regional Medical Waste Incineration

This is a system where wastes are incinerated withcontrolled of air pollution far away from the city.

Different organizations are responsible of

collecting the HW from all the hospitals, clinics

and healthcare service centers in a city andincinerates the wastes. In this system hospitals are

not responsible for the waste treatment only they

need to pay for the wastes produced each day.

Basic Steps in HWM in Minimal


18/25

Basic Steps in HWM in MinimalProgramme

Assign

Responsibilities

Classify and

assess wastegeneration

Adequately

treat and

dispose ofwastewater

Identifyreuse

options

Train

personnel andwaste

workers

Ensuresafe

storage

Ensure workers

safety

Improve stockmanagement of

chemicals and

pharmaceuticals

Recycling of

selected materialsWaste

segregation

Return outdated

drugs or chemicalsto the supplier

Treatment and disposal of health-care waste

Treatment

Incineration, on-site or off-site

Open air burning

Chemical disinfectionsAutoclaving of highly infectious waste

Encapsulation

Disinfections of stools from cholera patients

and of other infectious body fluids

Final Disposal

Municipal landfillBurying on premises

Discharge into sewer

A general wastejoins the municipal

waste stream

Hospital waste management


19/25

Hospital waste management

StructureHead of Hospital

Hospital Engineer Headof Environmental

Services

Advisers Infectioncontrol Pharmaceutical

Radiation

Department Heads

Medical and DentalEngineeringPharmacy

Radiology

LaboratoryBlood bank

Catering

HousekeepingInternal transportation system

Administration

Finance

Support staff

Hospital attendance and ancillary workers

Matron and HospitalManager

Ward sisters, nurses and

medical assistants

Waste

ManagementOfficer

(WMO)

Hospital Waste management In Australia


20/25

Hospital Waste management In Australia

Loading Dockets

Ward Level

These three types of waste bins are located in every ward and departments in each level of the hospital. The nurses doctors and patients areresponsible to dispose different types of waste in different bins as identified. Then the cleaners duty is to collect the wastes from different bins and

take them to the to the waste disposal rooms that is located in each level. Wastes are collected 3-4 times in a day shift and 3 times in afternoon shift.

Clinical Waste

Bins

General Waste

Bins

Sharp Boxes

Disposal Room

In the disposal rooms there are six types of bins and the bins are larger than the ward level bins. The cleaner after collecting the wastes fromeverywhere puts the waste into these bins according to the waste types. Then the second group of waste collectors comes to with empty bins to

replace full bins in the disposal rooms. This group of waste collectors are only responsible to collect waste from disposal room to loading docket and

wastes are collected 3-4 times a day.

Clinical Waste

Bins

General Waste

bins

Sharp Boxes Cardboard

Bins

Cytotoxic

Waste Bins

Recycling

Waste Bins

Once all the bins are stored in the loading dockets it is the responsibility of different waste contractors to collect the wastes and take it for treatments.

Clinical wastes, and recycle wastes are collected 3 times a day, cardboard is collected once, general waste is collected daily and sharps are collected twice aweek. The clinical wastes and cytotoxic waste goes for incineration, a sharp first goes for pre-treatment where is mashed properly then goes for incineration,general wastes goes to land filling system before it is land filled the waste is put into waste converter to segregate waste cardboard is taken to recycle and

recycling waste also goes for recycling. Clinical waste cytotoxic and sharps are charged by weight per kg is .60 cents and general wastes and recycle wastes

are charged by bin per bin is Aus$2.70. There is no charge for cardboards.

Clinical Waste

Bins

30bins/day

General Waste

bins 40-

50bins/day

Sharp Boxes

60boxs/week

Cardboard

Bins 6bins/day

Cytotoxic

Waste Bins

1bin/day

Recycling

Waste Bins

6bins/day

W


21/25

HWM in Australia Authorities are emphasizing on waste segregation at the

source which helped to reduce waste upto 40-50% and

some areas of clinical wastes has been reduced to 80-90 %. Four organization are there to collect the wastes

- ACE: responsible for collecting the hazardous wastes and also thedialysis that needs to be incinerated.

- VISIE: Responsible for collecting the cardboard and waste papers forrecycling paper.

- Denial: It collects the sharp waste then reduce the volume and sells itto ACE for incineration.

- CTA: Collects the general and recycle wastes

Training: Every four months training is provided to all thestaff members and those who came new to update if thereis any change in the system.

Auditing: Twice a year auditing is carried out to find if anychanges are required or not weather the system is working

or not.

W


22/25

Future HWM Plan in Australia

Waste Tracking System as follows:

How much waste is being produced in eachdepartments

Encourage each departments, wards, and clinics to

reduce the waste generation as they are being charged

for their own wastes

If any departments or wards are not segregating their

waste properly could be traced back.

The bins will be bar-coded to different wards, clinicsor departments.

The managing term will be to each wards, clinics, and

departments.

Some Suggestions of HWM for Bangladesh


23/25

Some Suggestions of HWM for Bangladesh

The hospital/clinical authority should upgrade and make changes inthe outdated HWM system and the main aim of the programme

should be to manage, minimise and eliminate, and use pollutionprevention initiatives to reduce negative environmental impacts

Immediately the hospital authority should provide proper disposalsite for the time being before any system is developed.

The municipal city corporation should take initiative for regional

waste treatment plant in all the major districts by promoting privateorganisation to install incinerator.

The hospital should try to minimise the generation of waste throughsource reduction, re-use and recycling programs and the hospitalsshould emphasis on waste segregation at the source of waste

production. More private companies should be encouraged to come forward and

take initiative to manage the hospital wastes environmentally sound.

Build strong communication between the Ministry of Health andFamily Welfare, Ministry of Environment, City Corporations and

other local authorities that are responsible for the job. They shouldcommunicate to stop this hospital waste menace.

Hospital/clinical waste management in


24/25

Hospital/clinical waste management inBangladesh

Hospital/Clinical Waste Management in Bangladesh

Secondary Storage place for waste must have

bins for all different types of wastes with

different colour coding and labelling. In every

level there should be a waste storage area.

Clinical

Waste Bins

Cytotoxic Waste Bins General

Waste Bins

Cardboard

Waste Bins (Big

green Bins)

Waste for Recycling

(green bin with white lid

Sharps

Waste

Boxes

Each ward or room (primary

storage) must have three types of

waste bins for general sharp boxes

and clinical with different colour

coding and labelling

Clinical

Waste Bins

Sharps

Waste Boxes

General Waste Bins

Waste Handling

Personnel and patients should be made

fully aware of the need to exercise extreme

caution when handling substances, which

are to be discarded as waste.

-Proper clothing should be provided to thewaste handlers like cloves and think plastic

aprons.

-There should be adequate supply of bin

and appropriately marked.

-Waste handlers should segregate the

general wastes into recycle, cardboard and

general waste after removing the waste

from the primary storage.

SchedulingThe hospital waste management should

motivate, guide and assists the hospital

housekeeping services to the following:

-Determination of the number of

hospital room or medical sections to be

grouped for waste collection

-Waste collectors and cleaners should

be grouped and given the responsibility

to each grouped area

-Selection of suitable site for waste

segregation after collecting from rooms

and wards.

-Site for secondary and tertiary wastecollection point.

Collection- Preparation of a collection

schedule by area.

-Assignment of responsible

personnel of every area for

monitoring

-The collection of waste from

room to room must be four times

in every shift

-Collection from the secondary

waste storages should be thrice a

day

-The waste should be collected for

off-site treatment within 24 hours-The collection of all sorts of

wastes at the beginning of every

shift

Transportation-The hospital waste

management should select

the appropriate

transportation system.

-Using rolling containers,

trolley or carts for waste

to be transferred from the

secondary point to tertiary

point from where waste

will be going for off site

treatment.

-Closed waterproof

vehicles should be usedfor healthcare waste

transportation

TrainingHospital management

should arrange training

programmes in every six

months to upgrade

information and aware every

one about the proper waste

management. Training

programme will be

addressed to all the staff

members in the hospital

from doctors, nurses to

cleaners.

AuditingThe hospital waste

management should

have auditing in

every three months

after a new

programme is

implemented for at

least first twelve

months. When the

programme is

running smoothly

the auditing should

be carried out whenit is necessary or

every year.

Emergence ResponsesThere should be

emergency kit box for

mercury or citotoxic

waste spillage.


25/25

Recapitulation

Management of HW is an integral part of

our work and a mandatory service to be provided

to the public

Specific resources have to be allocated to handle

waste correctly from generation to disposal

Implement HWM plan

Pay special attention to sharps mangement

There is no ONE SIZE, FIT - ALL

TECHNICAL SOLUTION FOR HCW

Date post:	05-Apr-2018
Category:	Documents
Upload:	tarannum-dana
View:	224 times
Download:	0 times

Presentation on HWM

Documents