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INTRODUCTION • With the increasing number of health care agencies, hospital waste has become a major threat to environmental health at global level as well as in our country. Therefore, it is essential to have safe and reliable method for its handling. Inadequate and inappropriate handling of health-care waste may have serious public health consequences and a significant impact on the environment.
DEFINITION Bio-medical waste is the waste that is generated during: • -diagnosis, treatment or prevention of disease • -bio-medical research and • -production and testing of bio-chemicals According to bio-medical waste (Management &Handling) Rules 1988 of India; • “Bio-medical waste” means any waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of biological, including categories mentioned in schedule-I.
SOURCES OF BIO-MEDICAL WASTE • Hospital and health care centres • Clinics/offices • Animal’s institution • Medical research centre and laboratories • Blood banks and collection centres/donation centres • Bio-technological institutes and production units
RISK GROUPS • Direct care giver: nurses, doctors • Hospital care taker staff: caretakers, ward boys, ayahs, sweepers, dhobi etc • Support service staff: technicians, lab assistants, radiographers etc. • Workers of waste disposal management: incinerator operators, transporters, radiographer etc • Patient and visitors
BIO-MEDICAL WASTE MANAGEMENT IN INDIA • Safe disposal of bio-medical waste is now a legal requirement in our country. In this regard, Govt. of India first enacted an environment (protection) act in 1986, then notified the bio-medical waste (Management and handling) Rules 1998. • Environment act and Bio-medical waste rules are applied to all the individuals who generate, collect, receive, store, transport, treat, dispose off or handle bio-medical waste in any form. • Different provision and schedules about safe disposal of bio-medical waste are described in BMW (Management & Handling) Act 1998. 3 Schedules: • Schedule I - Categories of bio-medical waste in India • Schedule II - colour coding 7type of container • Schedule III - Label for bio-medical waste container/bags for disposal of bio-medical waste.
Collection and segregation POINTS TO REMEMBER • Bins and bags should bear the symbol of bio-medical hazards. • Never mix infectious waste with non-infectious waste. • Needles should be destroyed with a needle cutter. Manual mutilation of sharps should never be tried as it may cause injury. All other sharps must be strongly disinfected (chemically) before they are shredded or finally disposed off. • All sharps should be kept in puncture proof box and properly labelled. • Disposable items (syringes, IV bottles, catheters, rubber gloves etc) should be undertaken only when they have been mutilated (cut) and chemically disinfected (by dipping in 1% hypochlorite solution for 30mins) • Waste should not spill outside • Non infectious waste and does not require any special treatment.
SCHEDULE-I CATEGORIES OF BIO-MEDICAL WASTE TREATMENT AND DISPOSAL
SCHEDULE-II COLOUR CODING & TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICAL WASTE
SCHEDULE-III LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS • Bio hazard symbol Cytotoxic hazard symbol • NOTE: Label shall be non-washable and prominently visible.
TRANSPORTATION AND STORAGE POINTS TO REMEMBER: • Before taking the bag away, ensure that it is properly tied and labelled and there is no possibility of spillage. • Persons handling the waste bags should not touch the items of public use. • A covered, bio-hazard symbolised hand cart may be used to transport the waste to the central storage area of the hospital • Do not throw the bags haphazardly as this may tear them apart and the waste may spill out. • A full time person should be posted at the central site of storage for regular receiving and dispatching the waste. • Unauthorised people should not enter in the storage area. • As per rules, bio-medical waste cannot be stored for more than 24-48 hrs. • Always use closed transportation from the site of central storage to find disposal site.
DISPOSAL TECHNIQUES 1. Chemical disinfection 2. Thermal measures (wet &dry) • Autoclave (wet thermal treatment) • Hydroclave (dry thermal treatment) 3. Microwave irradiation 4. Inertization 5. Incineration 6. Landfill
Chemical disinfection • Solid waste as plastic, rubber and metallic item, IV sets, blood bags, gloves, catheters, urobag, syringe, needles etc must be disinfected before they are sent for disposal (landfill). Chemical disinfection is also most appropriate method to treat the liquid waste such as blood, urine, stools or hospital sewage.
Thermal measures (wet &dry) Autoclave (wet thermal treatment): • It is effective method of sterilization for microbiology waste. But it cannot be used for human anatomical waste or animal carcasses. Also it is not effective for pharmaceutical or chemical waste. Hydroclave (dry thermal treatment): • In this method shredded infectious waste is exposed to high temperature, high pressure steam like autoclaving. It dries 80% liquid of waste and waste is reduced to 20-30% in weight. Adequately trained operators or technicians are needed for hydroclaving techniques operation.
Microwave irradiation This technique is also effective (like autoclave/hydroclave) in sterilising the infected, disposal waste. Most microorganisms are destroyed by the action of microwaves.
Incineration Incineration is a high temperature, dry oxidation process that reduces. Organic and combustible waste to an inorganic, incombustible matter. It also reduces the volume and weight of the waste.
Inertization In this process, cement and other substances are mixed with the waste before disposal. Mixing of cement etc. reduces the risk of migrating toxic substances into surface water or ground water. After making homogeneous mixture cubes are prepared at site, then transported to final disposal site.
Landfill Besides incineration, landfill is the second important choice for final disposal of bio-medical waste. It is quite effective, provided practiced appropriately. Open dumping of health care waste is not recommended due to reasons of acute pollution problems, fires, higher risk of disease transmission and open access to scavengers and animals. So sanitary landfill observing certain rules can be accepted choice for disposal of bio-medical waste, particularly in developing countries like India.
SAFETY MEASURES FOR NURSES • Each of us needs to observe certain safety measures while handling hospital waste. Among all health care workers, nurses spend more and longer time in the hospitals. So safety measures are necessary to protect the nurse’s own health.
AIMS OF SAFETY MEASURES • To prevent the transmission of disease from patient to patient, from patient to nurses, health care workers and vice versa. • To prevent injury to nurses while handling the waste and • To prevent general exposure to the harmful toxic effects of the cytotoxic, genotoxic, chemical bio-medical waste as much as possible.
Measures of protection: 1. Personal protective device • Cap/ scarf • Shield (for working in a radiation prone zone) • Goggles/ plain glass • Mask • Apron/ gowns (or full sleeve shirt) • Gloves • Gumboots
2. General protective measures • All nurses including other hospital employers must be vaccinated against hepatitis b • Extreme care is needed while handling needles and other sharps. • Sharps should not be left casually on counter tops, food trays, beds etc. • Clipping, bending or breaking the glass and needles with hands must not be practiced as this can cause accidental injuries. • Sharps should be segregated at the site of generation and there after placed in a puncture proof container. • All disposal items must be dipped in 1% hypochlorite solution for atleast half an hour to ensure that they are disinfected. • Personal exposure to radiation should be avoided as much as possible. • Care during dealing with HIV or hepatitis B positive cases: keep this patient in isolation wards. Always wear 2 pairs of gloves, use other protective devices. • In operation theatre goggles/ glasses must be worn. Transfer of instruments should not be from hand to hand between a nurse and surgeon or vice-versa. Instead a bowl should used to keep them.
3. In case of injury caused by infected sharps A) Special precaution is needed if the sharps are infected with the HIV or hepatitis B cases • Clean the wound immediately. First with saline and then with spirit or betadine • An injection of TT is advisable • Dressing of wound may be required • Consult physician as early as possible B) In case infectious solution is spilled on the body • Remove the soiled clothes and wash the part thoroughly with plenty of water. • Apply non-irritant cream on that part. • In case of spillage in eyes, wash it with water. Avoid rubbing. • Consult physician
Contd... C). Other measures of safety • Nurses need to be well equipped with latest information, skills and practice in managing and handling the bio-medical waste. • There should be a course on bio-medical waste management in all nursing curriculums. • There should be continuous system of evaluation about the hospital waste management by the nursing supervisors for the nurses. Experts should also be invited. • It is better to use such techniques which can prevent and minimize waste production.
CONCLUSION The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. Therefore it is essential to have safe and reliable method for its handling. Inadequate and in appropriate handling of health- care waste may have serious public consequences and a significant impact on the environment. Appropriate management of health care waste is thus a crucial component of environmental health protection, and it should become an integral feature of health care services.
BIBLIOGRAPHY • SwarnkarKeshav, community Health Nursing, 3rd Edition (2011), N>R Brothers Publishers, Indore, M>P, PP. 875-884. • Park.K, Preventive and Social Medicine, 20th edition, 2009, M/s Banarsidasbhanot publishers, Jabalpur, PP.694-699. • Module on Hospital Waste Management by Sulabh International Institute of Health and Hygience, New Delhi. • Problems in community waste management, Public Health Paper; No. 38 W.H.O. Geneva 1969. • www.google.com
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