In this article we will discuss about the Waste Management in Health Care Setting and Universal Precautions.
(A) Waste Management:
(I) Classification of hospital waste:
(a) Hazardous (20%)
(i) Infectious (15%) — Non-sharps, sharps, plastics and infectious liquids.
(ii) Non-infectious (5%) — Radioactive materials, glass, pressurized chemical, cytotoxic drugs, incineration waste.
(b) Non-hazardous (80%) — Kitchen waste, fruit peels etc.
(II) Infectious wastes:
These include waste contaminated with blood and body fluids, waste from patients, discarded diagnostic samples, laboratory cultures, stock of infectious agents, waste from laboratory animals, animal carcasses, human body parts (imputed limbs, placenta etc.). On an average 15% of total HW belongs to this category.
(III) Need for proper disposal:
Infectious wastes need proper disposal in right manner for the following reasons:
1. Waste is potentially bio-hazardous.
2. Pathogens cause disease to HCW and general public.
3. Spread of antibiotic resistance.
4. May lead to poisoning and pollution.
5. My cause injuries. About 10-20 million blood borne infectious take place from sharp.
6. Prevention of access to scavengers.
7. Radioactive accidents.
8. Contamination of drinking water supply.
9. Improper incineration of waste may release potentially toxic gases.
(IV) Components of hospital waste management:
(b) Disinfection of selected articles, e.g. used syringe and needle, culture plates etc.
(d) Sterilisation, if possible.
(e) Temporary storage
(f) Final disposal.
Commonly step ‘f’ is done by agencies, entrusted for final disposal.
This is done at the site of generation in different colour coaded bags kept in bins with lid (to be lifted with foot). Appropriate containers are to be placed at all points of patient care areas.
Following is the schedule of colour coading for bio-medical wastes:
1. Non-infectious waste — discarded in black bag. Only non-breakable items are discarded here. If the waste is breakable (e.g. glass), it is first placed in card board box, then discarded in black bag.
2. Sharp — is discarded in puncture proof container, painted blue, bearing biohazard symbol.
3. Infectious plastic items — are to be segregated in red/pink bag. This bag should not be mixed with other items and should not be incinerated in conventional incinerator.
4. Non-plastic infectious wastes — are discarded in yellow bag. Cottons, dressings, anatomical waste, placenta, tissue, experimental animals are included in this category.
While transporting the observable rules are as follows:
(1) To be done at regular interval.
(2) Avoid spillage by transporting in proper container.
(3) Transportation is to be done by designated trained persons, wearing protective clothing; through the designated areas.
(4) Custom made covered transportation trolleys/trucks are to be used.
(c) Temporary storage:
Biomedical wastes after removal from generation areas, are to be placed in temporary storage area. Sharps are left in the wards until the containers are 3/4th full.
(d) Final disposal:
1. Black bag (non-infectious) — landfill.
2. Yellow bag (non-plastic infectious waste) — deep buried.
3. Red bag (infected plastic) — treated, shredded and finally go to landfill.
4. Blue bag (sharp) — mutilated and landfilled.
(B) Universal Precaution:
Retrospective data analysis reveals nurses, laboratory workers, physicians, surgical technicians, dialysis technician, respiratory therapist, health aid, embalmer/morgue technician and house keepers are at risk in discharging their professional duties. To avoid contracting the disease in course of their works, ‘Universal Precaution’ measures are suggested.
(a) Sources of infection:
2. Any fluid containing blood
3. Body fluids — e.g. C.S.F., pericardial, amniotic synovial, pleural and peritoneal fluid.
5. Vaginal fluid
6. Aerosols from patients
8. Used sharps
9. Articles used for procedures etc.
(b) Policy for safer discharge of duties:
1. Do not harm the patient
2. Do not expose provider to unnecessary risk.
3. Do not result in waste that is dangerous to others.
4. Personal protection.
5. Sharp policy.
6. Consider all patients are potentially infected and all the areas of hospital contain infectious agents.
(c) Dos and Don’t dos of Universal Precautions:
1. Personal protection using barriers — e.g. gloves, masks (N-95 for H1 N1, SARS, Nipah, MDR-TB), apron, eye wear, foot wear.
2. Sharp management:
i. Reduce use.
ii. Select devices with protective measures against needle stick injuries.
iii. Be careful during use.
iv. Don’t recap needle after use.
v. Destroy needle, disinfect (if possible), discard in puncture proof blue container with biohazard sign.
3. Hand washing, preferably with alcohol based hand sanitizer, before and after examination of patient or handling clinical sample.
4. Get ready a beaker containing disinfectant (1% sodium hypochlorite) to dispose infected small materials and tackle any infective spillage.
5. Get immunized where applicable (e.g. HBV vaccine).
6. Segregate waste properly.
7. Preserve a sample of serum for assessment of base line titre.
8. Do not take food, drink in work place.
9. Do not move about with open needle in hand.
10. Do not mouth pipette.
11. Do not create aerosol.
12. Do not try to express the last drop of liquid from a pipette.
13. Do not keep unnecessary long hair.
14. Do not allow pregnant staff to perform only in potential infective setting.