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Waste Handling in Health Care facilities Poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment. It is essential that all medical waste ma...

Waste Handling in Health Care facilities Poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment. It is essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely (WHO). Definition of Health Care Waste: Health Care Waste generated by health care activities includes a broad range of materials, from used needles and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices and radioactive materials. Definition of Health care waste management (HCWM): Is a process that ensures proper handling and disposal of the HCW in a safe way from generation and collection to final disposal. Classification of Waste according to WHO: A. Noninfectious waste (Non-medical waste or non-hazardous waste) - General or non-medical waste poses no risk of injury or infection to staff, patients, visitors, or to the community at large. Examples include: Kitchen waste, paper, boxes, packaging materials, bottles, plastic containers, hand towels, tissues, and similar materials that are not contaminated with body fluids. 1  B. Infectious waste (Medical waste or hazardous waste) - Medical waste consists of several different subcategories that should all be dealt with in the same way. - Like infectious waste, pathological waste, sharps, pharmaceutical waste, cytotoxic waste, chemical waste, and radioactive waste: 1. Infectious waste: - It means waste contaminated with blood and other bodily fluids or suspected by any type of pathogens such as bacteria, viruses, parasite or fungi such as: - Contaminated catheters and gloves. - Contaminated Waste from dialysis and dentistry units. - Contaminated wound dressings. 2. Pathologic waste: It Includes a) Human tissues (e.g., diabetic foot and grafts). b) Organs (e.g. placenta, appendix and tonsils). 3. Sharps: It Includes: a) Contaminated needles, syringes, scalpels ‫مشارط‬, and infusion sets. b) Broken glass (e.g. Suction jars). 4. Pharmaceutical waste: - It includes expired, unused and contaminated drugs and vaccines. 5. Chemical waste: - For example solvents and reagents used for laboratory preparations, disinfectants, sterility and heavy metals contained in medical devices (e.g. mercury in broken thermometers) and batteries. 2 7. Radioactive waste: Such as glassware contaminated with radioactive diagnostic material or radio therapeutic materials; radioactive waste includes liquids, gas and solids contaminated with radionuclides. Major sources of health-care waste: ▪ Hospitals and other health facilities. ▪ Laboratories and research centers. ▪ Blood banks and collection services. ▪ Nursing homes for the elderly. Health Care Waste Management Process: 1. Segregation (sorting) ‫ فصل‬of medical waste: Medical waste should be segregated as infectious or noninfectious. The waste should be placed into appropriate designated containers. Most errors in the medical waste management system occur at the segregation point and involve all associated occupational subgroups. 2. Packaging/containment of medical waste: *Proper packing: For protection and proper handling, storage, and treatment or disposal of the waste. - Medical waste should be handled as little as possible before disposal. - Medical waste should not be collected from patients-care areas by emptying it into open carts. 3  - May lead to contamination of the surrounding and to increase in the risk of injury to staff, clients and visitors. *Selection of packaging materials: *A three-bin system for waste sorting should be established as follows: I. Red bags are used for infectious and pathologic waste that needs to be incinerated. Examples of items to be disposed of in red bags include used gloves, disposable gowns, and any other materials contaminated with bodily fluids or infectious agents. Hospitals should provide clear guidelines to staff regarding what constitutes infectious waste and the proper procedures for disposal. Red bags should be clearly marked with labels indicating their purpose to prevent accidental mixing with other waste streams. II. Yellow bags are used for radioactive waste as protective clothing. III. Black bags are for general waste that is to be disposed with the normal general waste such as food wrappers, paper towels and is to be transferred by the municipals. *For Sharps containers must be: - Rigid, puncture resistant, leak proof on the sides and bottom, and closable. - Should be located as close to the point of origin. 3. Storage of Waste: Central storage areas: - It generally situated separately with hospital buildings. 4  - Waste is transported in close air-tight color –coded container trolleys at scheduled time interval through predefined route. - Route of transportation should be no crossing over with food trolleys or sterile area and public route. - Adequately lit and ventilated room. - Secured from animal entry. - Scheduling washing and disinfection. - Limited access to authorized personnel only. - Should be insect and vermin resistant. 4. Transportation to final disposal site: - Waste bags may be placed directly into the transportation vehicle. - Transportation vehicle must not be used for transportation of any other materials. - The international hazard sign should be displayed on the vehicle or container. 5. Treatment and disposal: Final Disposal of Solid Medical and General Waste: Non-Burn techniques - Disposal of general or non-hazardous waste. - Burying ‫ دفن‬solid medical waste. Burn techniques ▪ In this process, the organic waste is burnt in the high temperature producing mainly gaseous emissions, including steam, carbon dioxide, nitrogen oxides, and certain toxic substances. ▪ The gaseous emissions can be toxic as well. 5  ▪ Incinerator when operated at optimum temperature kills the pathogen but if it is run at lower temperature, it causes more harm than benefit Chemical disinfection: ▪ Chemical disinfection is used to kill microorganisms on medical equipment, floors and walls. ▪ Chemicals are added to waste to kill or inactivate the pathogens. ▪ This method is appropriate for treating liquid waste such as blood, urine, stools. Autoclaving: ▪ An autoclave is used to sterilize reusable medical equipment like surgical equipment, laboratory instruments, and other materials. Role of Infection Control Nurse in Waste Management: 1. For waste collection: - Ensure internal collection of waste bags and waste containers. - Waste bins /containers must be regularly washed and disinfected - Ensure that sanitary staff and sweepers immediately replace used bags. 2. For waste storage: - Ensure correct use of the central storage facility and that it is kept secured from unauthorized access. 3. For waste disposal: - Ensure that the correct methods of transportation of waste are used on-site to the central storage facility of incinerator if installed. 6 4. Ensure that the waste is not stored on the hospital premises for longer time. 5. Staff training and information: - Ensure that all staff are fully aware of their duties and responsibilities under the waste management plan. - Handlers must wear PPE and take all precautions to prevent sharp injury or body fluid exposure. 6. For incident management and control: - Investigate record and review all incidents reported regarding hospital waste management. - Record the quantities of waste generated by each department on a weekly basis. 7