MANAGING BIO-MEDICAL WASTE
Item
- Title
- MANAGING BIO-MEDICAL WASTE
- extracted text
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Bl -M E DIC A
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WASTE
Citizen consumer and civic Action Group
MANAGING
BIOHAZARD
BIO-MEDICAL WASTE
CAG
Citizen consumer and civic Action Group
CITIZEN, CONSUMER AND CIVIC ACTION GROUP (CAG)
CAG is a non-profit, non-political, voluntary and professional citizens’ group
that works for the,protection of.the rights of consumers on various issues.
CAG is also involved in the areas of corporate responsibility, transparency,
environment public health and safety;
Though the group started as 'Consumer Action Group’ in 1985, it became
Citizen, consumer and civic Action Group in the early 1990’s, keeping
in mind the larger role that was required in the city of Chennai. Specifically,
issues affecting this common citizen such as severe pollution, lack of urban
planning, poor quality of health and poor civic amenities have emerged as
priorities for CAG. The study on the status of bio-medical waste management
in the city of Chennai is. one of. CAG’s.current focus areas of work.
CAG’s contribution has been recognised by the Government of India who
awarded them the National Award for Consumer Protection in 1989 (Second
Prize) and 1991 (First Prize).
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Citizen consumer and civic Action Group
ACKNOWLEDGEMENTS
CAG wishes to acknowledge the efforts of the following people in making
this booklet possible.
Gary Cohen and Health Care Without Harm (HCWH), USA for providing
financial assistance to CAG’s work on bio-medical waste;
Ravi Agarwal, Megha Rathi and others at Srishti, New Delhi whose work on
bio-medical waste has been the source of inspiration for us to take up this
work in Chennai and Tamil Nadu. Srishti’s manual “Managing Medical Waste”
has been the guiding document for this booklet.
Essential Information, USA for their extensive work on the effects of dioxins;
Rajesh Rangarajan and TOXICS LINK, Chennai for their inputs;
The unstinting efforts of my colleague Divya Mohan in putting this booklet
together;
And the spirited VISTAAS team in Chennai for designing this booklet.
Bharath Jairaj
Legal Coordinator
September 27, 2001
Chennai
Citizen consumer and civic Action Group
CONTENTS
WHAT IS BIO-MEDICAL WASTE ?............... 1
WHAT ARE THE BIO-MEDICAL WASTE RULES?.......... 1
SOURCES OF BIO-MEDICAL WASTE.......... 2
CLASSIFICATION OF BIO-MEDICAL WASTE............. 3
HOW DO WE DEAL WITH THE WASTE?.......... 5
HOW DO WE TREAT WASTE?..........6
EMERGENCY SITUATIONS..........9
CENTRALISED FACILITY FOR BIO-MEDICAL WASTE......... 10
COMMUNITY’S ROLE IN BIO-MEDICAL
WASTE MANAGEMENT........ 11
PATIENTS ROLE IN A HOSPITAL..........12
PROCEDURAL REQUIREMENTS UNDER
THE BIO-MEDICAL WASTE RULES..........12
FORM 1..........13
FORM II..........14
FORM III.......... 15
OVERVIEW OF TECHNOLOGY USED FOR BIO-MEDICAL WASTE
TREATMENT AND DISPOSAL
MIRCOWAVE..........16
AUTOCLAVE..........17
INCINERATION..........17
OCCUPATIONAL HAZARDS..........19
MERCURY IN HOSPITALS..........22
ROLE MODELS OF BIO-MEDICAL WASTE MANAGEMENT.......... 23
FOR ANY FURTHER INFORMATION..........24
Citizen consumer and civic Action Group
WHAT IS
BIO-MEDICAL
WASTE ?
•
Bio - Medical waste is “Any waste which, is generated during the
diagnosis, treatment or immunisation of human beings or animals or in any
research activities pertaining thereto or in the production or testing of
biologicals. It includes “any waste which is generated during the diagnosis,
treatment or immunisation of human beings or animals or in any research
activities pertaining thereto or in the production or testing of biologicals, and
including categories mentioned in Schedule 1” - as defined by the
Bio-Medical Waste (Management and Handling) Rules, 1998.
•
It includes infectious and non-infectious waste. Infectious waste
includes pathological waste, cotton, dressing, used needles, syringes,
scalpels, blades, glass, etc. and non-infectious waste includes general waste
from the kitchen / canteen, packaging material.
WHAT ARE THE BIO-MEDICAL WASTE RULES?
o
The Government of India formulated the Bio-Medical Waste (Handling
and Management) Rules in 1998 (hereafter referred to as the Bio-Medical
Waste Rules) in order to specify procedures that have to be followed in the
management and disposal of waste.
•
The Rules apply to all hospitals, nursing homes etc. etc. in the country
o
The Rules apply to all persons who generate, collect, receive,
store, transport, treat, dispose or handle Bio Medical Waste in any
form.
Citizen consumer and civic Action Group
SOURCES OF BIO-MEDICAL WASTE:
•
The primary sources of Bio-Medical Waste are - Hospitals,
Diagnostic Centres, Laboratories, Blood Banks, Nursing Homes and
Clinics and Veterinary Hospitals and Clinics.
Non - infectious waste forms nearly 90% of the waste generated by a hospital.
The remaining 10% comprises of infectious waste and is generated in all
the Wards, Operation Theatres, Intensive Care Units, Laboratories and
Blood Banks. The waste generated in each of these areas can be categorised
as follows:
•
General ward (Out Patient Department - OPD), Department wards,
Intensive Care Unit and Emergency Care - Cotton, dressing, bandages,
syringes, needles, IV sets and tubing, blood sets, urine bags - all contaminated
with blood, pus or other body fluids and other waste like packaging, paper
waste and food waste.
•
Operation Theatres - Pathological waste, Cotton, dressing,
instruments, contaminated plastic waste like syringes, tubing, IV sets, Blood
sets, contaminated linen, contaminated gloves, caps, masks, hospital gowns
used by the patients as well as the staff and doctors.
•
Laboratories - Contaminated samples, cultures, pipettes, petridishes,
tips, test tubes (both plastic and glass), slides.
•
Blood Banks - Contaminated samples, cultures, pipettes, petridishes,
tips, test tubes (both plastic and glass), slides, blood bags, unused blood
bags (past the expiry date) and infected blood bags.
•
Nursing Homes and Clinics - These generate the same kind of
waste that hospitals generate but on a smaller scale depending on the
facilities provided and the number of beds.
Citizen consumer and civic Action Group
CLASSIFICATION OF BIO-MEDICAL WASTE
Option
•
•
•
•
•
Category
Treatment &
Disposal
1
Human and Anatomical Waste
Human Tissues, Organs, Body parts
Incineration /
Deep Burial.
2
Animal Waste Animal Tissues, organs, body parts, carcasses,
bleeding parts, fluid, blood and experimental animals used in
research, waste generated by veterinary hospitals colleges,
discharge from hospitals and animal houses.
Incineration /
Deep Burial.
3
Microbiology & Biotechnology Waste Waste from laboratory
cultures, stocks or specimens of micro-organisms live or
attenuated vaccines, human and animal cell cultures used in
research and infectious agents from research and industrial
laboratories, wastes from production of biologicals, toxins,
dishes and devices used for transfer of cultures.
Incineration Autoclaving
/ Microwaving.
4
Waste Sharps Needles, syringes, scalpels, blades, glass, etc.
that may cause punctures and cuts. This includes both used
and unused sharps.
Disinfection (Chemical
disinfection / autoclaving
/ microwaving and
mutilation / shredding.
5
Discarded medicines and Cytotoxic drugs Waste comprising
of outdated, contaminated and discarded medicines.
Incineration / Destruction
and drugs disposal in
secured landfills.
6
Solid Waste Items contaminated with blood, and body fluids
including cotton, dressing, soiled plaster casts, lines, bedding,
other material contaminated with blood.
Incineration Autoclaving
/ Microwaving.
7
Solid Waste. Items generated from disposable items other
than sharps such as tubings, catheters, intravenous sets etc.
Disinfection by chemical
treatment Autoclaving /
Microwaving and
Mutilation / shredding.
8
Liquid Waste Waste generated from laboratory and washing,
cleaning, housekeeping, and disinfecting activities.
Disinfection by
chemical treatment and
discharge into drains.
9
Incineration Ash Ash from incineration of any Bio BIO-MEDICAL
Waste.
Disposal in Municipal
Landfill.
10
Chemical Waste Chemicals used in production of biologicals,
chemicals used in disinfection, as insecticides, etc.
Chemical treatment and
discharge into drains for
liquids and secured
landfill for solids.
Chemical treatment using atleast 1% Hypochlorite solution or any other equipment chemical reagent.
Chemical treatment must ensure disinfection.
Mutilation and shredding must be such to prevent unauthorised reuse.
No chemical pre-treatment before incineration and chlorinated plastics shall not be incinerated.
Deep Burial shall be an option available only in towns with population less than 5 lakhs in rural areas.
Citizen consumer and civic Action Group
HOW DO WE DEAL WITH THE WASTE?
•
There are a few basic steps that hospitals have to follow in order to
deal with Bio-Medical Waste.
•
The first and the most crucial step being that of SEGREGATION.
Segregation of waste refers to the basic separation of the different categories
of waste generated (as given earlier) at the source of their generation.
•
The Bio - Medical Waste (Management and Handling) Rules, 1998
have stipulated the following method of segregation on the basis of a simple
colour-coded system:
Color
Code
Waste Category
Treatment as per
Schedule I of the Rules
Yellow
• Human Anatomical Waste. • Animal Waste Incineration / Deep Burial.
(These containers or bags
• Microbiology and Biotechnology Waste.
shall not be made of
• Soiled Waste.
chlorinated plastic).
Red
• Microbiology and Biotechnology Waste.
• Soiled Waste. • Solid Waste.
Blue White • Waste Sharps. • Solid Waste.
Translucent
Black
• Discarded medicines and Cytotoxic drugs.
• Incinerator ash. • Chemical Waste (Solid).
Autoclaving / Microwaving
/ Chemical treatment.
Autoclaving / Microwaving
/ Chemical treatment and
destruction and shredding.
Disposal in secured landfill.
Categories 8 and 10 (liquid) do not require containers/bags.
Category 3 if locally disinfected need not be put in containers or bags.
4
Citizen consumer and civic Action Group
COLOUR CODED SYSTEM FOR
SEGREGATION OF BIO-MEDICAL WASTE
Citizen consumer and civic Action Group
5
HOW DO WE TREAT WASTE?
Each kind of waste requires a different process of treatment depending on
the material it is made of as well as the kind of micro organisms and waste
it is likely to contain. Given below is a list of the different kinds of waste and
the measures that have to be taken for safe handling and disposal of each
kind of waste:
Infectious waste:
•
Bags should be colour coded and should also be properly labelled
to avoid confusion while handling or disposing.
•
Infectious waste should be segregated at the point of generation itself
and bins lined with inert material or with inner chambers for bleach should
be used.
•
Usage of a lidded bin will discourage inadvertent use by others and
also keep it away from the public.
•
Personnel involved in the handling of infectious waste should be
provided with suitable protective gear. Proper training in managing this waste
as well as in handing emergency situations like spillage of the waste should
be given to them.
•
It is easier to handle and transport waste when bags are not completely
full. This also reduces the risk of spillage around the bin. The bag has to
be sealed at the top before transportation within or outside the hospital.
•
The recommended method of destruction of infectious waste if
autoclaving and microwaving. Incineration is also an option but only for
certain kinds of waste. The former however apart from being more
environmentally friendly is also more cost effective than incineration.
•
ALL OPERATION THEATRE (OT) WASTE SHOULD BE SENT FOR
AUTOCLAVING.
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Citizen consumer and civic Action Group
Disposable Waste:
••
Such items are often single use, disposable products like syringes,
IV bottles, sharps, catheters and gloves. These items are often recycled
and reused illegally and it is therefore imperative that chemical disinfection
be followed for them.
•
They have to be dipped in a chemical disinfectant solution
(concentration depends on the potency of the waste - atleast 10gms per
litre of water)) for a minimum duration of 1^2 to 1 hour or autoclaved or
microwaved. The bins used for chemical disinfection are a set of bins - one
inside the other. The smaller being perforated and easily extractable. This
will help ensure that the bleach solution in the outer bin permeates the inner
bin containing these waste items and minimises contact with the waste while
the waste is being removed.
o
These items once disinfected have to be cut or mutilated in order to
ensure that they are not reused. For instance, the fingers of the gloves
should be cut and the IV bottles punctured.
•
Sharps should be handled with proper protection.
•
Blood bags should not be handled.
o
Bleach solution should be changed after every shift.
•
The plunger and the barrel of the syringe have to be separated before
disinfecting it.
Citizen consumer and civic Action Group
Sharps:
•
Sharps have been defined by the Central Pollution Control Board
consist of needles, syringes, scalpels, blades, glass and so on. These are
all capable of causing punctures, lacerations and cuts.
•
Sharps need separate attention as the risk of injury and infection in
this area is very high. They therefore have to be separated at the point of
generation.
•
Manual bending, breaking or clipping of needles should be avoided
as this may cause accidental innoculation. They should be destroyed with
a Needle Cutter I Destroyer and then shredded.
•
Sharps should be placed in a puncture proof container and it has to
be marked conspicuously by the Universal Biohazard symbol.
Liquid Waste:
•
Liquid chemical waste has to be neutralised with reagents before
disposal.
•
Liquid pathological waste has to be treated with disinfectant before
disposal.
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Citizen consumer and civic Action Group
EMERGENCY SITUATIONS:
Accidents should be avoided and therefore systems have to deal with
emergency situations should be developed. One of the most common
occurrences while dealing with Bio-Medical Waste is the spillage and leakage
of waste.
o
Spill Protocol is therefore essential for any hospital. This refers to
the measures that have to be taken to contain and decontaminate the
accident site. This should include the following:
1.
The surface containing the spill has to be mopped up with a swab
soaked in disinfectant and then the swab should be put in the infectious
waste bin.
2.
No reagents should be sucked into the pipette with the mouth.
3.
Other precautions to be kept in mind are the same as those followed
in the rest of the hospital.
4.
Laboratories should be well ventilated so as to ensure that personnel
do not breathe in contaminated air. Precautions should also be taken to
ensure that the general public do not breathe in this air.
Citizen consumer and civic Action Group
CENTRALISED FACILITY FOR BIO-MEDICAL WASTE:
Waste from
Blood banks
Waste from
Hospitals
Waste from
Nursing homes
& Clinics
•
Small healthcare units, like nursing homes and clinics, with minimal
investment and space constraints may find it difficult to afford an individual
disposal facility for bio-medical waste.
o
In such cases these units could overcome this shortcomings by
teaming up to establish a centralised facility for disposing off bio-medical
waste.
•
The Bio-Medical Waste Rules also have provisions for such combined
facilities.
•
Many municipalities and corporations across the country are proposing
to establish such common treatment facilities.
•
Bangalore and Hyderabad have already set the trend in the South,
with Chennai soon to follow suit.
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Citizen consumer and civic Action Group
COMMUNITY’S ROLE
IN BIO-MEDICAL
WASTE MANAGEMENT:
*4
While management of bio-medical waste is primarily the responsibility of
medical institutions and those who actually generate this waste, the community
has a very important role to play in ensuring that the hospital practices the
prescribed procedures for treating bio-medical waste.
Patients, who form a part of the community, constantly utilise services of
healthcare institutions and hence they also share the responsibility of ensuring
that these institutions do not pollute the community.
A community can therefore do the following to ensure a higher level of health:
•
Communities should strive to ensure that awareness programmes
should be conducted in their areas through residents' associations on the
issue.
•
Communities should ensure medical practitioners having clinics in
their localities do not dispose off their waste in the municipal waste stream,
but arrange to send it to the centralised facility.
•
Communities should remain vigilant and should promptly report breach
in proper bio-medical waste practices by any hospital to the pollution control
board.
PATSENTS ROLE
!N A HOSPITAL:
o
Patients can ensure that they dispose off of waste only in the bins
provided in the hospital and help keep the premises clean and litter-free.
o
Patients should understand the system of Bio -Medical Waste
Management followed in the hospital.
o
Patients should make sure that they report any irregularities in the
hospital to the management.
o
Patients with infectious diseases should ensure that they strictly
adhere to the procedure suggested by the doctors especially for disposal
of body fluids like sputum.
PROCEDURAL REQUIREMENTS UNDER THE BIO-MEDICAL
WASTE RULES:
»
o
,
,
,
12
Hospitals are required to file Form 1 to the prescribed authority for
grant of Authorisation accompanied with the payment of the fee as
prescribed by the State or Central Government.
They are also required to submit a copy of their Annual Reports to
the prescribed authority under Form II by January 31st every year.
These reports shall be sent to the Central Pollution Control Board by
the state pollution control board.
Hospitals are mandatorily required to maintain records regarding
generation treatment, disposal etc. of bio-medical waste, and these
should be kept open for scrutiny. They are also required to report
accidents under Form III.
For non-compliance or violation a hospital or clinic could be closed
or individuals could be punished with imprisonment upto five years
(under the Environment Protection Act) or fined upto Rs. one lakh
or both. For repeated violation a fine of Rs.5000/- every day could
be levied.
Citizen consumer and civic Action Group
FORM I
(see rule 8)
APPLICATION FOR AUTHORISATION
(To be submitted in duplicate.)
To
The Prescribed Authority
(Name of the State Govf/UT Administration)
Address.
1.
Particulars of Applicant
(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Address:
Tele No., Fax No. Telex No.
2.
Activity for which authorisation is sought:
i) Generation
ii) Collection
iii) Reception
iv) Storage
v) Transportation
vi) Treatment
vii) Disposal
viii) Any other form of handling
I
3. Please state whether applyingfor resh authorisation or for renewal:
(In case of renewal previous authorisation-number and date)
4.
(i) Address of the institution handling bio-medical wastes:
(ii) Address of the place of the treatment facility:
(iii)
5.
Address of the place of disposal of the waste:
(i) Mode of transportation (in any) of bio-medical waste:
(ii) Mode(s) of treatment:
6.
7.
Brief description of method of treatment and disposal (attach details):
(i) Category (see Schedule 1) of waste to be handled
(ii) Quantity of waste (category-wise) to be handled per month
8.
Declaration
I do hereby declare that the statements made and information given above are true
to the best of my knowledge and belief and that I have not concealed any information.
I do also hereby undertake to provide any further information sought by the
rescribed authority in relation to these rulesand to fulfill any conditions stipulated
y the prescribed authority.
§
Date :
Signature of the
Applicant
Place :
Designation of the
Applicant
Citizen consumer and civic Action Group
13
FORM n
(see rule 10)
ANNUALREPORT
(To be submitted to the prescribed authority by 31 January every year).
1. Particulars of the applicant:
(i) Name of the authorised person (occupier/operator):
(ii) Name of the institution:
Address
Tel. No
Telex No.
Fax No.
2. Categories of waste generated and quantity on a monthly average basis:
. Brief details of the treatment facility:
In case of off-site facility:
(i) Name of the operator
(ii) Name and address of the facility:
Tel. No., Telex No., Fax No.
4. Category-wise quantity of waste treated:
. Mode of treatment with details:
. Any other information:
. Certified that the above report is for the period from
14
Date
Signature ....
Place
Designation.
Citizen consumer and civic Action Group
FORM in
(see Rule 12)
ACCIDENT REPORTING
1. Date and time of accident:
. Sequence of events leading to accident
. The waste involved in accident:
. Assessment of the effects of the accidents on human health and the environment,.
. Emergency measures taken
. Steps taken to alleviate the effects of accidents
. Steps taken to prevent the recurrence of such an accident
Date
Signature
Place,
Designation
Citizen consumer and civic Action Group
15
OVERVIEW OF TECHNOLOGY USED FOR BIO-MEDICAL
WASTE TREATMENT AND DISPOSAL
As bio-medical is a specialised class of waste, that is highly infectious and
hazardous, there are specific technologies are required to treat and dispose
the waste. The standard technologies being utilised in the country for
treatment and disposal of bio-medical waste are
•
•
•
Microwave
Autoclave
Incineration
Microwave
•
The microwave is based on the principle of generation of high
frequency waves.
•
These waves causes the particles within the waste material to vibrate,
generating heat.
This heat generated from within, kills all pathogens.
Autoclave
The autoclave operates on the principle of the standard pressure
cooker.
The process involves using steam at high temperatures.
•
The steam generated at high temperature penetrates waste material
and kills all micro organisms.
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Citizen consumer and civic Action Group
INCINERATION
A process that works on the simple principle of burning or combustion is
technically called incineration. The incinerator, as the machine is referred
to, uses either oil or electricity to power itself. Waste material is fed into the
incinerator and is burnt in it. Normally incinerators are operated at
temperatures between 300 °C to 1100 °C based on the volume of waste,
the type of incinerator and the type of fuel used. Incinerators used in India
are either single chambered or double chambered.
Incineration not only attempts to both kill the pathogens but also destroy the
materials in which these reside - most of which are plastic disposables or
cellulose rich materials etc. The burning of plastics, especially in unregulated
incinerators is extremely hazardous as it creates a new set of chemical
toxins, some of which according to current research, are highly toxic even
in trace quantities. Some of the chemical toxins produced by waste
incinerators are:
(a)
Heavy metals, such as lead, cadmium, arsenic, chromium, nickel and
so on, which are compounds that are present in plastics.
(b)
Acid gases such as sulphur gases, hydrogen chloride and nitrogenous
gases, particulate matter
(c)
Dioxins and furans.
(d)
Poly-Chlorinated Bi phenyls (PCBs) which, if not trapped in pollution
control devices, have grave health effects on humans like endrocrinal
problems thus causing disruptions in the human nervous system. If trapped,
they become a part of the fly ash which is also very toxic and has to be
disposed off carefully.
Of these, dioxins and furans are extremely toxic. These belong to a
family of polycyclic aromatic hydrocarbons compounds which are formed
when waste containing PVC plastic is burnt.
Citizen consumer and civic Action Group
17
WHAT IS
DIOXIN?
Dioxin is the common name for a class of 75 chemicals. Dioxin has no commercial use.
It is a toxic waste product formed when waste containing chlorine is burned or when products
containing chlorine are manufactured. PVC (polyvinyl chloride) plastic is a major source
of the chlorine in medical waste. Commonly used PVC items in health care include medical
equipment such as IV bags, gloves, tubing, oxygen tents, mattress covers, packaging and
office supplies such as medical binders.
Exposure
When medical facilities burn their waste containing chlorinated plastics like PVC, dioxin
will be emitted from the smokestacks of the incinerator. Dioxin particles travel long distances
(transboundary). They are highly stable and do not break down and hence travel up the
food chain. Ninety percent of human exposure to dioxin occurs through our diets of meat,
dairy products, eggs and fish. Dioxin builds up in fatty tissue.
Health Effects
Dioxin is proved to be a human carcinogen by the International Agency for Research on
Cancer (IARC). Immune system disruption, reproductive and development Effects and
hormone disruption are amongst the major health problems reported from dioxin exposure.
(Adapted from the Dioxin Factsheet of Essential Information)
Incinerators are difficult to run: In hospital environments, technologies
like incineration fail because untrained hospital staff operate incinerators.
Surveys show that most Incinerators (over 85%) are operated at incorrect
temperatures, do not destroy the waste completely, are fuel inefficient, and
are out of order most of the time. There is a lot of difference between
the theory and practices employed in the operation of Incinerators,
making them a high risk method of disposal of waste - especially
medical waste.
18
Citizen consumer and civic Action Group
OCCUPATIONAL
HAZARDS:
Hospital staff and waste handlers in the hospital run the highest sk
of contracting disease from following improper Bio Medical Waste
Management practices as they are exposed to a multitude of diseases
and infection. Therefore, in the interests of the hospital, recognising
the importance of Bio Medical Waste Management at the earliest is
crucial as, apart from contracting disease, hospital staff can also be
carriers of disease and infection.
The current situation prevalent among healthcare waste handlers in
hospitals is tantamount to violation of the basic human right of just
and favourable conditions of work, in particular the Right to Safe and
Healthy working conditions (Art 23) but also that of basic Right to Life
and Security of person (Art 3).
The hazardous nature of health care waste may be due to one or
more of the following characteristics:
1.
It contains infectious agents.
2.
It is genotoxic (waste with mutagenic, teratoxic or carcinogenic
properties). This kind of waste includes - certain cytotoxic drugs
(those drugs with the ability to kill or stop the growth of certain living
cells), vomit, urine or faeces from patients treated with cytotoxic drugs,
chemicals and radioactive materials.
3.
It contains toxic or hazardous chemicals or pharmaceuticals.
4.
It is radioactive.
5.
It contains Sharps.
Citizen consumer and civic Action Group
,19
Infectious waste may contain a wide variety of pathogenic micro-organisms.
Pathogens in infectious waste may enter the body through a number of
routes:
. Through a puncture, abrasion or a cut in the skin.
. Through the mucous membrane.
. By inhalation.
. By ingestion.
•
There is a particular concern about infection with the Human Immuno
deficiency Virus (HIV) and Hepatitis viruses B and C for which there is strong
evidence of transmission via health care waste. These viruses are generally
transmitted through injuries from syringe needles contaminated with human
blood.
France: In 1992, 8 cases of HIV infection were recognised as occupational
infections. Two of these cases, involving transmission through wounds,
occurred in waste handlers
•
Sharps not only cause cuts and punctures but also infect these
wounds if they are contaminated with pathogens. Owing to this double risk
of injury and disease transmission, sharps are considered as a very hazardous
waste class.
USA: In June 1994, 39 cases of HIV infection were recognised by the
Centers for Disease Control and Prevention as occupational infections,
with the following pathways of transmission:
* 32 from hypodermic needle injuries.
* 1 from blade injury.
* 1 from glass injury (broken glass from a tube containing infected
blood).
* 1 from contact with non-sharp infectious item.
* 4 from exposure of skin or mucous membranes to infected blood.
20
Citizen consumer and civic Action Group
•
Different pathogenic micro-organisms have varying abilities to survive
in the environment. For example it has been found that the Hepatitis B virus
is very persistent in dry air and can survive for several weeks on a surface;
it is also resistant to brief exposure to boiling water. It can survive exposure
to some antiseptic chemicals and remains potentially infectious for up to 10
hours at a temperature of 60 ° C.
•
Equipment that is essential for a worker handling waste: Rubber
gloves, shoes or boots, thick trousers and thick long-sleeved shirts. They
should also be provided with convenient washing facilities (with warm water
and soap) - particularly at the storage and incineration facilities.
•
Periodic immunisation of hospital workers and staff against Hepatitis
B is an absolute necessity.
•
As far as cleaning up of spillages of body fluids or other potentially
infectious waste is concerned, workers have to be provided with protection
for eyes, respirators and hand tools like a shovel (to avoid direct contact
with the waste) in addition to the standard gear mentioned above, in order
to avoid any risk of eye injury and inhalation of any toxic fumes or dust.
Citizen consumer and civic Action Group
F
Ooi
0 7095
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21
MERCURY IN HOSPITALS:
•
Mercury is used in hospitals in thermometers, blood pressure
instruments, feeding tubes, dilators and batteries, dental applications,
fluorescent tubes and in specific laboratory chemicals.
•
Mercury is a highly toxic metal that has the ability to pass all the four
main human physiological barriers - skin, blood, brain and placenta.
•
Mercury can cause a variety of diseases on exposure like - bronchitis,
muscle tremors, irritability and personality changes. It can also affect the
central nervous system in a variety of ways - impaired vision and hearing,
paralysis, sleeplessness, emotional instability, developmental defects during
foetal development and during childhood. It is particularly dangerous to
foetuses, women of child-bearing age, pregnant women and young children.
•
It is important to note that toxic heavy metals like mercury produce
health effects and symptoms that are not specific and are common to other
disorders. Hence, health effects of Mercury maybe wrongly diagnosed or
may even escape diagnosis i.e they may not be attributed to heavy metal
poisoning.
•
Hospitals and healthcare service providers in western countries are
switching to non-mercury alternatives and gradually phasing out mercury
in medical applications. Non -mercury substitutes are not only safe but also
more accurate than their mercury counterparts.
22
Citizen consumer and civic Action Group
ROLE MODELS OF BIO-MEDICAL WASTE MANAGEMENT
MADRAS MEDICAL MISSION, Chennai
1.
Segregation of waste at source or at the point of generation.
2.
Sharps Management.
3.
Training of staff including doctors.
4.
No incineration of waste.
5.
A dedicated waste autoclave as well as a shredder FOR PLASTICS
AND SHARPS.
SUNDARAM MEDICAL FOUNDATION, Chennai
1.
A system for management of Bio-Medical Waste is being practised.
2.
Dedicate autoclave for waste.
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3.
Sharps management initiated.
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4.
All plastics autoclaved.
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5.
Training was imparted to all hospital staff
SRI RAMACHANDRA MEDICAL COLLEGE AND HOSPITAL, Chennai
1.
Segregation of waste.
2.
Treatment of liquid waste and plastic waste.
3.
Segregation, Hydroclaving and Shredding of plastic waste.
ORTHO NOVA MEDICAL CENTRE, New Delhi
1.
A process to segregate the waste at all points till final point of disposal.
2.
Proper containment and disinfection.
3.
Trained personnel who are responsible.
4.
Method of waste reduction.
5.
Information distribution system.
6.
A format to ensure the system runs smoothly.
HOLY FAMILY HOSPITAL, New Delhi
1.
Good segregation system in place.
2.
Proper waste sharps management and disinfection systems.
3.
Well-trained staff.
4.
Good monitoring of overall system.
Citizen consumer and civic Action Group
23
For any further information please contact:
Citizen Consumer and Civic Action Group (CAG)
8, Fourth Street
Venkateshwara Nagar
Adyar
Chennai 600 020. INDIA.
Phone: +91-044-4914358 14460387
Fax:+91-044- 4914358
Email: cag@xlweb.com
Srishti
H-2, Jungpura Extn.
New Delhi-110014, INDIA.
Phone: +91-011-4328006/4320711
Fax: +91-011-4321747
Email: srishtidel@vsnl.net
Healthcare Without Harm, USA
www.noharm.org
Essential Information, USA
www.essential.org
Citizen consumer and civic Action Group
- Media
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