ZAMOKUHLE PRIVATE HOSPITAL

ZAMOKUHLE PRIVATE HOSPITALORIENTATION TRAINING FOR ISIKHOVA CONTAINERS HEALTH CARE RISK WASTE HANDLINGIsikhova Kelniksher Trading cc (Zamokuhle)1

ZAMOKUHLE PRIVATE HOSPITAL ORIENTATION TRAINING1.Key Outcome :

The main objective of this session is to inform participants of waste classifications and the different containers to be used for Health Care Risk Waste, with specific reference to the containers as supplied to Zamokuhle Private Hospital by Isikhova Kelniksher Trading ccIsikhova Kelniksher Trading cc (Zamokuhle)2

ZAMOKUHLE PRIVATE HOSPITAL ORIENTATION TRAININGLearning outcomes 1.1At the end of this session participants should be able to : (i)identify and quantify the safe containerization methods for the four main health care waste streams(ii) be aware of the cradle to grave life cycle of wasteIsikhova Kelniksher Trading cc (Zamokuhle)3

GENERAL WASTEBetween 75% to 90% of waste generated in health care facilities is general waste and it is similar to household wasteSegregation of materials that can be reused or recycled will greatly reduce the impact burden of the general waste streamGeneral waste consists of cardboard, damaged containers, discarded flowers, food, bags, tins, paper, non-clinical glass, wrappings, plastic bottles and building rubbleIsikhova Kelniksher Trading cc (Zamokuhle)4

Handling and containerisation General wasteGeneral waste containers must be available at the point where the waste is generated for ease of useThe liners are closed using plastic cable ties, or tied, and stored in an intermediate storage to await collection by the internal transportersIsikhova Kelniksher Trading cc (Zamokuhle)5

Onsite storage General wasteA large skip is provided for the collection of general waste. When full, the skip is removed by the local municipality or contractor using the special truck for the size of skip providedIsikhova Kelniksher Trading cc (Zamokuhle)6

DisposalGeneral wasteThe cost of treating and disposing health care general waste is considerably lower per kilogram than for health care risk wasteIt is not necessary to treat the general waste before disposalIsikhova Kelniksher Trading cc (Zamokuhle)7

HCGWBlack/Clear liners / ContainersIntermediate StorageCentral StorageMunicipal waste collection systemPrivate contractor (recycling)Disposal by landfill

2.5 Summary diagram of cradle to grave management of HCGW

Isikhova Kelniksher Trading cc (Zamokuhle)8

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3Health Care Risk Waste

The four main Health Care Risk Waste streams are :

3.1Infectious waste

3.2Sharps

3.3Anatomical (pathological) waste

3.4Pharmaceutical waste (including expired medication)

Isikhova Kelniksher Trading cc (Zamokuhle)9

3.1INFECTIOUS WASTE

This category forms the largest component of health care risk waste generated in health care facilities. Infectious waste basically consists of discarded materials arising from activities performed on people, which could potentially transmit infectious agents to people.Isikhova Kelniksher Trading cc (Zamokuhle)10

3.1Infectious waste

Discarded materials or equipment used for diagnosis, treatment and prevention of disease that has been in contact with bodily fluidsWaste such as cultures, stocks, tissues, dressing, excreta, swabs or other items soaked in blood from infection and isolation wardsNappies and blood bagsIncontinence materialWaste that has been in contact with infected patients undergoing haemodialysis (eg dialysis equipment such as tubing and filters, disposable towels, gowns, aprons and gloves)Any other utensils and materials that have been in contact with infected persons and animalsThis category also includes liquid waste such as faeces, urine, blood or other body secretions (such as sputum or lung secretions)

Isikhova Kelniksher Trading cc (Zamokuhle)11

3.1.1Safety, Health and Environment HazardsInfectious waste may contain any one of a great variety of pathogenic micro-organisms (bacteria and viruses) from body fluids such as blood, urine, faeces, saliva, sputum, etc. Pathogens in infectious waste may enter the human body by a number of routes :Through a puncture, abrasion or cut in the skinThrough the mucous membrane (eg lining of mouth and nose)By inhalation (through breathing) andThrough ingestion (eating and drinking)

Isikhova Kelniksher Trading cc (Zamokuhle)12

3.1.2Handling and Containerization

The separation of infectious waste must be done at point of generation of the waste. Suitable containers, in accordance with specifications for the containment of infectious waste, must be used with the red colour coded liners of the correct size and thickness for the size of the container. All containers used for infectious waste should be marked with a recognized signIsikhova Kelniksher Trading cc (Zamokuhle)13

The four circled symbol is the international symbol for bio-hazardous waste

Isikhova Kelniksher Trading cc (Zamokuhle)14

The skull and crossbones is sometimes used to indicate that the waste is dangerous (NOT Orlando Pirates)

Isikhova Kelniksher Trading cc (Zamokuhle)15

3.1.2Handling and Containerization To encourage segregation at source, smaller reusable containers such as pedal bins with liners are placed as close to the point of generation as possible When they are full, the liners are closed by tying with plastic cable ties and placed at the intermediate storage areasSuitable latex gloves must always be used when handling infectious wasteIsikhova Kelniksher Trading cc (Zamokuhle)16

Different waste containers used for infectious waste

Isikhova Kelniksher Trading cc (Zamokuhle)17Plastic pedal bin used with a red liner

Different waste containers used for infectious waste

Isikhova Kelniksher Trading cc (Zamokuhle)18Reusable red wheelie bin for infectious waste

3.1.3 On-site / Internal transport and storage

Contact with the infectious waste must be kept to a minimumOnce the bags or containers are sealed, they should be removed from the intermediate storage area by the facilitys internal transport personnel using dedicated wheelie bins or trolleys that are easy to use and do not damage the bags or containersThe principle of not touching the waste again must be upheldIsikhova Kelniksher Trading cc (Zamokuhle)19

3.1.3 On-site / Internal transport and storage

Contact with the infectious waste must be kept to a minimumOnce the bags or containers are sealed, they should be removed from the intermediate storage area by the facilitys internal transport personnelDedicated wheelie bins or trolleys must be easy to use and not damage the bags or containers. The principle of not touching the waste again must be upheldIsikhova Kelniksher Trading cc (Zamokuhle)20

3.1.4 Treatment and/or disposal

Incineration was the commonly used method in Gauteng until recently for the total destruction of these wastes. New non-burn technologies such as autoclaving, microwaving and electro thermal deactivation are now also being usedIsikhova Kelniksher Trading cc (Zamokuhle)21

HCRW - Infectious WasteRed liners / Containers/Pedal binsIntermediate StorageCentral StorageLicensed / Permitted service providerNon-burn technology (eg Autoclaving, Electro thermal deactivation)Burn technology (eg incineration)Residue : Hazardous Waste Landfill

Isikhova Kelniksher Trading cc (Zamokuhle)22

3.2SHARPS

Sharps are items that could cause cuts or puncture wounds, including:needleshypodermic needlesscalpel and other bladesknivesinfusion setssawsbroken glassnailsWhether or not they are infected, such items are usually considered as highly hazardous health care wasteIsikhova Kelniksher Trading cc (Zamokuhle)23

3.2.1Safety, Health and Environment HazardsAs hypodermic needles carry traces of contaminated blood, the hazards, as indicated for exposure to infectious waste, also apply to sharpsSharps, however, may not only cause cuts and punctures but may also infect these wounds if they are contaminated with the pathogens.Sharps are considered as a very hazardous waste class because of this double risk of injuryIsikhova Kelniksher Trading cc (Zamokuhle)24

Safety, Health and Environment HazardsThe principle concerns relate to infections such as HIV and Hepatitis B and CMedical staff, nurses and doctors are at the greatest risk of infection from needle prick injuries during administration of the medicationshandling of the sharps prior to disposal into the containers and from needles not correctly disposed ofIsikhova Kelniksher Trading cc (Zamokuhle)25

Safety, Health and Environment HazardsOthers at risk are :Other hospital workerswaste management operators outside health-care establishments waste reclaimers on waste disposal sites when the sharps are not properly segregated and containedIsikhova Kelniksher Trading cc (Zamokuhle)26

3.2.2 Handling and Containerization at point of Generation

Hazards from sharps such as pricks, cuts and scratches require this category of health care waste to be placed into rigid, puncture-proof disposable containers for either burn or non-burn treatmentAll sharps, whether contaminated or not, should be placed into the sharps containerNo other health-care waste should be deposited in sharps containers, as these containers are more expensive than the plastic liners, containers and boxes used for other categories of risk wasteIsikhova Kelniksher Trading cc (Zamokuhle)27

Handling and Containerization at point of GenerationWhen disposing of a syringe, for example, the packaging should be placed in the general waste bin and the used syringe in the sharps containerIn most circumstances the needle should not be removed from the syringe because of the risk of injuryIf removal of the needle is required, such as for vacutainers, special care must be takenIsikhova Kelniksher Trading cc (Zamokuhle)28

Handling and Containerization at point of GenerationThe sharps containers must be securely placed as close as possible to the point of generation such as in wall mounted brackets at the bed sites (ICU and Casualty) or on the dressing trolleyWhen full, the container must be securely closed and placed in the intermediate storage area for collectionThe containers must be tamper-proof when closed and sealedIsikhova Kelniksher Trading cc (Zamokuhle)29

Examples of Sharps Containers

Isikhova Kelniksher Trading cc (Zamokuhle)30A horizontal loading sharps container helps needles to lie flat inside the container

Examples of Sharps Containers

Isikhova Kelniksher Trading cc (Zamokuhle)31A 20 litre round sharps container

Sharps3.2.3On-site/Internal collection, transport and storage

Sharps should not be allowed to accumulate at the point of generation.

3.2.4Treatment and/or disposal

Sharps should be treated by either a burn or non-burn technology Sharps can be treated together with other infectious wasteIsikhova Kelniksher Trading cc (Zamokuhle)32

HCRW SharpsSharps Container ONLYIntermediate StorageCentral StorageLicensed / Permitted service providerNon-burn technology (eg Autoclaving, Electrothermal deactivation)Burn technology (eg incineration)Residue : Hazardous Waste Landfill

3.2.5Summary diagram of cradle to grave management of sharpsIsikhova Kelniksher Trading cc (Zamokuhle)33

3.3ANATOMICAL / PATHOLOGICAL WASTE

Anatomical waste consists of TissueOrgansbody partsplacentasnon-viable human foetusesanimal carcassesblood and body fluidsIt is also known as pathological wasteIsikhova Kelniksher Trading cc (Zamokuhle)34

3.3.1 Safety, Health and Environment Hazards

Aside from general psychological and/or ethical effects of recognizable body parts to sensitive groups, the health hazards from anatomical waste are considered greater than general infectious wasteThis is because of the volume and size of body tissueThe hazards discussed under infectious waste also apply to this waste streamIsikhova Kelniksher Trading cc (Zamokuhle)35

3.3.2 Handling and Containerization at Point of Generation

Anatomical waste must be placed in disposable leak-proof red containers as soon as possible at the site where it is generatedA tamper-proof container with a tightly-fitting two-stage lid/closing device is the preferred option for anatomical wasteThe first stage device is to prevent odours escaping while it is in useThe second stage is to prevent the container from being opened againIsikhova Kelniksher Trading cc (Zamokuhle)36

A 10 Litre Pathalogical/Anatomical waste container (Specican)

Isikhova Kelniksher Trading cc (Zamokuhle)37

3.3.3 On-site/Internal transport and storage

Anatomical waste should be removed from the point of generation (maternity or theatre for example) in the specially marked containers and taken to the cold storage area as soon as possibleIn a health-care facility, the intermediate storage should have a dedicated freezer in a secure place that is only accessible to trained personnelThe mortuary of a hospital can be used to store anatomical waste in the absence of a dedicated freezerA separate waste manifest is normally used to control movement of anatomical waste when collected by an external transporterIsikhova Kelniksher Trading cc (Zamokuhle)38

3.3.4Treatment and/or disposal

As required by the Human Tissue Act no 65 of 1983, pathological waste must always be incinerated completely, in an appropriate and licensed facilityIsikhova Kelniksher Trading cc (Zamokuhle)39

HCRW - Pathological WasteSpecially marked red disposable leak proof containers Cold storage area eg mortuaryLicensed / Permitted service providerIncineration Only(Human Tissue Act 65 of 1983)Residue : Hazardous Waste Landfill

3.3.5Summary diagram of cradle to grave management of Pathological WasteIsikhova Kelniksher Trading cc (Zamokuhle)40

3.4PHARMACEUTICAL WASTE

Pharmaceutical waste includes expired, unused, spilled and contaminated pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to be disposed of appropriatelydiscarded items used in the handling of pharmaceuticals, such as bottles or boxes with residues, gloves, masks, connecting tubing and drug vialsIsikhova Kelniksher Trading cc (Zamokuhle)41

3.4.1Handling and Containerization at point of Generation

Large quantities of unused, obsolete or expired pharmaceuticals stored in hospital wards or departments should be returned to the pharmacy for disposalSpilled or contaminated drugs or packaging containing drug residues should not be returned because of the risk of contaminating the pharmacyThis waste should be deposited in a rigid, leak-proof container or directly into the sharps container at the point of generationIsikhova Kelniksher Trading cc (Zamokuhle)42

4.SPECIFICATIONS FOR CONTAINERS AND LINERS

The service provider is contracted to supply all the equipment requirements for the containment and removal of the waste from the facilityStrict regulations govern the types of equipment to be used by specifying minimum requirements for the manufacture of the equipmentthe type of materials used in its manufactureThicknessesSizesmaximum weighthow it is transportedthe final treatment and disposal methodsIsikhova Kelniksher Trading cc (Zamokuhle)43

SPECIFICATIONS FOR CONTAINERS AND LINERSIn general terms containers must be leak-proof or leak-resistant, tamperproof, puncture-resistant and manufactured without heavy metals or PVC componentsThe thickness of a liner is measured in microns

Isikhova Kelniksher Trading cc (Zamokuhle)44

5.CONTROL OF DISPOSABLE STOCK

The whole waste management system will collapse if disposable items such as reusable containers, sharps containers or liners run out It is crucial that strict control is kept over all items for both health care risk waste and health care general wasteSufficient quantities of receptacles must be available for the quantities of waste anticipated to be generated between ordering routinesIsikhova Kelniksher Trading cc (Zamokuhle)45

CONTROL OF DISPOSABLE STOCKIf containers are ordered monthly, for example, there should be sufficient stock for approx a six week period to cover for peaks and valleys in the generation of waste and to ensure that there are no shortages should there be a spike in demandIsikhova Kelniksher Trading cc (Zamokuhle)46

THANK YOUQUESTIONS ?Isikhova Kelniksher Trading cc (Zamokuhle)47