Health Hazards Due to Improper Management of Hospital Waste Dr. P. K. Dash, Nodal Officer, Municipal

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Health Hazards Due to Improper Management of
Hospital Waste Dr. P. K. Dash, Nodal Officer,
Municipal Corporation of Delhi
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Introduction

• Every system in nature progresses towards
  disintegration and it contributes to creating
  waste.
• A modern hospital is a complex multidisciplinary
  system which consumes thousand of items for
  delivery of medical care and is part of physical
  environment. All products consumed in hospitals
  have some unusable left over i.e. Hospital Waste.
  This waste is great threat to ecological balance
  by polluting environment.

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Definition

• Any unwanted residual material which cannot be
  discharged directly, or after suitable treatment
  can be discharged in the atmosphere or to a
  receiving water source, or used for landfill is
  waste. (Wilson, 1981)
• Infectious waste are all those substances which
  cannot be resterilised or reused within or
  brought into patient care (Rearly, 1972)

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Definition

• No standard universally accepted definition for
  the terms
• HOSPITAL WASTE
• MEDICAL WASTE.
• REGULATED MEDICAL WASTE AND
• INFECTIOUS WASTE

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Definition

• Hospital waste refers to all waste, biological
  or non biological, that is discarded and is not
  intended for further use
• Medical waste refers to materials generated as a
  result of patient diagnoses, treatment,
  immunisation of human beings or animals

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Definition

• , Infectious waste are the portion of medical
  waste that could transmit an infectious
  disease.
• Medical waste is a sub set of Hospital Waste and
• Regulated medical waste' which is synonymous with
  '"infectious waste' from a regulatory perspective
  is a sub set of medical waste.

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Evolution of HW Globally

• Hospital Waste was brought into focus in 1983
  when WHO European office convened a working group
  at Bergen. Medical specialists, hospital
  engineers, administrators from 19 countries
  participated concluded that it required a
  system approach involving -
• Awareness
• Segregation
• Source reduction of radio-active waste

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Evolution of BMW (contd)

• WHO SEARO questionnaire survey in 1984 conducted
  largely due to disturbing media reports regarding
  plight of rag pickers- found inadequacies
• Beach washings in 1998 of the Florida coast,
  related to syringes, lead to passing of first
  healthcare legislation by any country- Medical
  Waste Tracking Act (MWTA)

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MAGNITUDE OF THE PROBLEM

• GLOBALLY- Developed countries generate 1 to 5
  kg/bed/day
• Developing countries meager data, but figures
  are lower. 1-2kg/pt./day
• WHO Report 85 non hazardous waste
• 10 infective waste
• 5 non-infectious but
  hazardous. (Chemical, pharmaceutical and
  radioactive)
• INDIA-No national level study
• - local or regional level study shows
  hospitals generate roughly 1-2 kg/bed/day

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Why hospital waste is hazardous?

• Infectious waste is capable of producing
• an infectious disease.
• Chances of this are higher with in hospitals
  than outside.
• This depends on factors like
• Dose,
• Host susceptibility,
• The presence of a pathogen,
• The Virulence of a pathogen and
• The portal of entry (most commonly absent
  factors)

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Infectious waste is also generated

• Dental offices
• Nursing homes
• Laboratories
• Research centers
• The work environments similar to Hospital
  environment.

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WHAT CAUSES HOSPITAL WASTE HAZARDOUS

• Chemical-medications, Solutions, or
• Bacteria's like TB, Hepatitis B and C,
• Gases- ethylene oxide, formaldehyde,
  glutaryldehyde, waste anesthetic gases, nitrous
  oxide,
• Chemotherapeutic agents,
• Laser Smoke and
• Aerosolized medications such as Pentamedine

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WHAT CAUSES HOSPITAL WASTE HAZARDOUS

• Physical
• Ionizing radiation,
• Lasers,
• Noise and
• Electricity

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Health Hazards of Hospital Waste

• The hazards are
• Fire
• Breeding of flies and insects
• Proliferation of rodents
• Air pollution
• Water pollution
• Land pollution
• Transmission of infections viz hepatitis B, HIV,
  other microbes
• Mechanical injury
• Re-circulation of waste
• Loss of aesthetics
• Nuclear waste hazards carcinogenic effects

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• Improper management of hospital waste can cause
  serious environmental problems in terms of air,
  water and land pollution.
• CLASSIFICATION BY NATURE OF POLLUTANTS
• a) Biological
• b) Chemical and
• c) radio active

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Categories of Hospital Waste
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Routes of exposure

• Ingestion (Swallowed materials)
• Inhalation airborne chemicals and pathogens,
• Dermal absorption-or through skin openings.

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Routes of exposure depends on

• Durations of exposure
• Dermal absorption-enhanced by Scratches,
  broken, roughened or abraded skin on surface of
  hands, ankles, neck or facial areas
• Dose of toxic components that enter the workers
  body from the waste
• Retention capacity for airborne particulates
  that carry toxic chemicals and pathogens is
  highly dependent on particle size.

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Other Routes of exposure

• Water soluble toxic chemicals can be absorbed
  throughout the body
• Drinking and eating in hospital should be done
  in well controlled areas

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Environmental problems arise from

• a) Generation of medical waste
• b) Process of handling,
• c) Treatment and
• d) Disposal

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Effects of 'improper hospital waste management

• Mismanagement of Hospital Waste implies
• IMPROPER HANDLING, during
• generation
• Collection
• transportation and
• treatment

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• IMPROPER HOSPITAL WASTE MANAGEMENT ARE DUE TO
• a) Improper handling Unsafe actions handling
  without personal protective equipment (PPE),
• b) Poor storage (e.g. high temperature conditions
  combined with prolonged storage time before
  treatment),
• c) Manual Transportation for longer distances.
• d) Use of uncovered containers instead of closed
  plastic bags
• e) Exposure times beyond acceptable limits and
• f) Lack of adequate worker and equipment
  decontamination process/procedures

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EFFECTS OF 'IMPROPER HOSPITAL WASTE MANAGEMENT

• Hospital infections are a major health problem
  all over the world
• Can effect the people working or visiting the
  hospital
• The community is invariably effected

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Transmission of Infectious Agents in Healthcare
Settings

• Individuals are exposed to human sources of
  microorganisms by three primary routes
• Contact transmission
• Direct organism is transferred directly from
  one person to another, e.g. scabies or herpetic
  whitlow
• Indirect- organism is transferred through
  contaminated intermediate object or person, e.g.
  hands or contaminated patient care equipment
• Droplet Transmission- relatively large ( gt5
  microns) droplet heavy with moisture that are
  propelled relatively short distances from the
  source (3-6 feet) onto the mucous membranes of
  the nose, mouth or eyes, of the host and
  environmental surfaces
• Airborne Transmission- droplet nuclei (lt5
  microns) that remain suspended in the air for
  long periods, that may be inhaled by the host
  into the alveoli of lungs

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Transmission Of Infectious Agents In All Settings
Requires 3 Interrelated Elements

• THE TRIAD

Source
Susceptible Host
Mode of Transmission
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Fundamental Elements to Prevent Transmission of
Infectious Agents in Healthcare Settings

• Administrative measures
• Education of HC workers, patients and families
• Hand Hygiene
• Personal Protective Equipment
• Safe Work Practices
• Patient Placement

• Transport of Patients
• Environmental measures
• Patient Care Equipment
• Textiles and Laundry
• Dishware and eating utensils
• Adjunctive measures

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Personal Protective Equipment

• When selecting PPE consider the highest level
  hazard present, the source of the hazard, and the
  potential for simultaneous exposures.
• Face protection
• Goggles or safety glasses with side shields
• Clothing
• Lab coats, scrub suits, gowns (long pants only,
  no open toed shoes)
• Clothing should be replaced immediately when
  contaminated
• Gloves
• Verify that gloves are compatible with your
  specific application, process and materials
  before using
• Gloves should be replaced immediately if torn
• Gloves should not be worn outside the lab area
• Always wear heat resistant gloves and keep your
  face away from the door when loading and
  unloading the autoclave

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RECOMMENDATIONS

• To reduce the burden of disease, healthcare waste
  needs sound management, including alternatives to
  incineration.
• Management of Healthcare waste requires
  'increased attention and Diligence.
• Incinerators provide an interim solution for
  developing countries where options of waste
  disposal such as Autoclaving, shredder, microwave
  or newer technologies like plasma incinerators
  are limited.
• Whatever the technology used, best practice must
  be promoted to ensure optimal operation of the
  system

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Best practices include-

• Construction following detailed dimensional Plans
  to avoid flaws that can lead to incomplete
  destruction of waste, higher emissions and
  premature failure of incinerators.
• Follow proper operational procedures utilize
  appropriate start up and cool down procedures.
• Periodic maintenance to replace or repair faulty
  components, regular inspection, maintaining spare
  parts inventory, record keeping etc.

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Best practices include-

• Training and Management Regular training and
  upgrading skills
• Making available an Operating and Maintenance
  manual and maintenance program for incorporation
  of certification and inspection programmes for
  operation and
• an excellent management oversight are an
  essential components

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Thank you