Transcript Segregation
Injection Waste Management
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Waste Management is a process
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Not a technology issue alone
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It requires a change in way of thinking
Introduction
• Waste management for Pediatricians – At Hospital – At PHC.
– Immunization clinic.
• Waste management at community level
Problem
• Hazardous needle waste generated at clinics & hospitals needs to be secured and prevented from being accessed.
• This is possible by: 1. Bringing awareness among health workers, community about potential hazards of sharp waste.
2. Minimizing, segregating, decontaminating (disinfecting) the hazardous waste
at site
3. Destroy (mutilate) used items to prevent their reuse.
Current Scenario
• Segregation of hazardous needle waste in many health facilities, is not well established • In some cities, small towns & villages common facility for disposal or proper open land for digging deep pits does not exist.
• Needle waste is frequently dumped along with the municipal garbage.
• Few large hospitals are have incinerators • Some hospitals are segregating, disinfecting and mutilating and disposing to authorized private vendors or in pits.
WHAT IS NEEDED?
All Biomedical waste has to be – Minimized.
– Segregated.
– Disinfected.
– Transported and – Disposed off in a environmental friendly manner.
Biomedical waste should not be mixed with other wastes.
Pharmaceutical Pathological Pressurized containers Waste with heavy Metal content Hospital waste 75-90% Non Clinical Waste 10-25% Clinical Waste Genotoxic Infectious Needles Chemical Radioactive waste
Challenges for Sharps Waste
Fear of HIV transmission through Dirty needles Mass immunization campaign Environmental concerns Over sharp waste disposal Funding for Curative injection equipment & it’s Disposal Funding for Health Care Waste Disposal
Immunization sharps waste
Waste from hospital and clinical 1% 1% 3% 15% 80%
• Needles represents 1% of Health Care Waste • Immunization injections represents approximately 5 % of injections • Immunization sharps waste has to be integrated into the overall Health care Waste management
Pathological and infectious waste Sharps waste chemical pharmaceutical waste Special waste (radioactive, cytostatic) non-infectious
Source: Safe Management of wastes from Health Care activities (geneva, WHO, 1999)
General principles
Major Considerations
• • • • • • • Minimization Segregation Transport Collection Storage Treatment Disposal
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Segregation
Needles should be segregated at source. Clinical staff is responsible for segregating the waste at source. Appropriate container and different type of waste containers have to be placed at different points as per the act. e.g.: in the ward, OT, ICU’s, clinics. Awareness program is essential and posters for segregating should placed at the site.
Color Coding of Waste Collection Bags / Container
Yellow Blue/ White Infectious Waste for Incineration, Non Plastic, contaminated with body fluids Needles/Sharps/glass/blades Red Black Infectious waste for autoclave/ Microwave, Rubber & Plastic catheters,tubes.
General/Domestic waste Sanitary Landfill / for composting
Segregation – where?
• Containers should be placed at strategic and easily accessible locations • Blue /white translucent puncture proof containers should be used.
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Segregation – where?
Needles: – Should not be re capped, mutilated by hand – Should be disinfected first – Needle should not be disconnected from the syringe by hand Needle and syringe destroyer/Hubcutter should be used at the site of generation – To disinfect – To reduce the bulk – To prevent reusing
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HANDLING
Containers with needle waste should be picked up and carried by the handle provided. They should not be supported at the bottom with hands or carried on the back.
They should not be dropped/thrown Containers should be labeled with Biohazard Symbol Vehicles used should be authorized.
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CONTAINERS
Sharp decontaminating units (SDU’s) for syringes and needles are plastic ,puncture proof containers with handles – To be filled 1/3 with hypochlorite solution – Needles after chemical disinfection should be transferred to puncture proof containers for shredding –
Should be labeled as sharps only
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Sharp Containers
•Do not transfer contents to other container •Do not overfill
Unsafe Safe
Sharp Containers
various innovations • Leak-proof • Closable with narrow neck • Puncture- Resistance • Clearly labeled with warning (easy for the community to understand)
Selection of Puncture Proof Container (PPC)
The principle – Diameter of the puncture proof container should be less than half the length of the smallest syringe ’ – This is crucial for preventing needle stick injuries.
– The syringes getting collected (needle pointing down) in the PPC should not fall horizontally.
– The lid should close tightly and the container should be leak proof.
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MUTILATION / DESTRUCTION / SHREDDING
This will reduce the bulk of the waste.
• • What types of waste required to be mutilated?
– Needles/syringes – Plastic disposable Hub cutters and Needle/syringe destroyers mechanical or electrical
Hub Cutter & Needle Puller Advantages
Reduce needle waste tremendously by separating needles from syringes
Allow more flexibility of downstream disposal of sharps
Improve environmental safety
Reduce needle-stick injuries during handling and transport of used syringes
Reduce numbers of safety boxes for syringe disposal
Further prevent syringe reuse
MUTILATION / DESTRUCTION / SHREDDING
Specification of electrical destroyers: 1. Should be low voltage electrical equipment 2. Temperature range of 1600 – 1700 c so that needle is turned to ash in 1-2 sec 3. Should have a receptacle to collect use 4. Should have a cutter to cut the needle of syringe
TREATMENT & DISPOSAL
• • • To prevent hazardous to human health & environment, it is necessary to treat certain wastes before disposal. Onsite treatment is preferred than Offsite Chemical disinfectants like 1% Hypochlorite solution can be used to treat the needle wastes.
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TREATMENT & DISPOSAL
How to disinfect?
– Syringe with needle should be dropped in to Sharps Disposal Unit, so that both parts are completely immersed in disinfectant.
– Give a contact time of 30 mins – When Sharps Disposal Unit is 1/3 full the syringes and needles are shifted to puncture proof containers for shredding.
Disposal at Small Health Units* (SC/PHC/Private Clinics) Disposable Syringes/Needle/ADS Hubcutter/ Needle puller Needle with Hub Mutilated Syringe Disinfection with 1% Hypochlorite Disinfection with 1% Hypochlorite Sharps pit / Waste collection agency Waste collectors *GOI&CPCB guidelines
Terminal Disposal
• Metal equipment – recycle.
• Shredded plastic – recycle • Plastic Syringes – Mutilate and recycle
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GUIDELINES FOR CLINICS AND CONSULTANTS
– – – – Health waste management at Individual Clinics : Minimize the use of injections Segregate at source Treat with disinfectant Dispose off to Authorized Waste Management agency All health clinics in cities should have proper health waste management. The doctors, nurses and attender’s should have awareness and motivated to follow the guidelines to prevent health hazard.
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DO’S
Do minimize use of Injections Do segregate infectious sharps waste Do collect in a blue /white transparent colour coded container Do decontaminate all sharp & plastic waste Do train & educate all categories of staff in proper segregation & handling of waste.
Do use Hub cutters & needle destroyers Do use authorized persons/agencies to handle/dispose the needles.
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Dont’s
Don’t mix the infectious & non infectious waste.
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Don’t throw sharps in the trash/ non puncture proof containers 3.
Don’t recap the needle 4.
Don’t disconnect the needle from syringe by hand 5.
Don’t use open buckets for infectious waste /sharps