SAFE MANAGEMENT HEALTH CARE WASTE - SELECTED RESOURCES · Community Health

SAFE MANAGEMENT HEALTH CARE WASTE - SELECTED RESOURCES

Item

Title: SAFE MANAGEMENT HEALTH CARE WASTE - SELECTED RESOURCES
extracted text: CARE WASTE MANAGEMENT CELL
1

INDIANSOCIETYOFHOSPITALWAS

I

MANAGEMENT CELL HEALTH CAP
HEALTH CARE WASTE MANAGEME
HOSPITAL WASTE MAN AG EMEN'
MANAGEMENT CELL INDIAN SO

LL INDIAN SOCIETY OF
HEALTH CARE WASTE
OF HOSPITAL WASTE
TE MANAGEMENT CELL
IAGEMENTCELLHEALTH
SOCIETY OF HOSPITAL
E WASTE MANAGEMENT
5 T E MANAGEMENT CELL
LL INDIAN SOCIETY OF

ISHWMCon

2001

1st Annual conference
THE INDIAN SOCIETY OF HOSPITAL
WASTE MANAGEMENT®

SAFE MANAGEMENT OF HEALTH CARE WASTE ■ SELECTED RESOURCES
HEALTH CARE WASTE MANAGEMENT CELL
DEPARTMENT OF COMMUNITY MEDICINE
M S RAMAIAH MEDICAL COLLEGE
BANGALORE

Hospital Waste Management is an important Subject that needs urgent attention. In most
circumstances it is appropriate to consider an incremental approach realising that an improvement
is of great value even if resources do not allow achievement of the highest standards immediately.
Report of a consultation ofMedical Wastes Management in Developing countries. WHO, Geneva,
1992

WASTE SHARPS MANAGEMENT - the Question and Answers

What?
WASTE SHARPS are Needles, Syringes, Scalpels, Blades, Broken Glass, or any other item which, can cause punctures

or cuts. Thus they are capable of causing injuries or introducing infection by piercing the skin or mucus membrane.

They may be USED or UNUSED.

Why?
• Sharps are commonly used in Patient Care.
•

Nurses, Laboratory Technician or any other category of Health Care Personnel can get injury/lnfection; either before,

during or after handling these WASTE SHARPS.
• When WASTE SHARPS are not collected separately or contained properly, they can cause injury / infection to the people

collecting the Waste.

Where ?
Particular Attention for WASTE SHARPS MANAGEMENT should be given in the following areas:

•

Nursing Stations

•

Blood and other Sample Collection Areas

•

Operation Theatres

•

ICU/CCU/ITU

•

Injection Rooms

• Wards
• Any other place

When ?
Special Precautions should be undertaken for WASTE SHARPS MANAGEMENT during:
•

Drawing of Blood

• Transfer of Blood/Specimen
•

Recapping Needle

• After incision/suturing
• While discarding Needles and other sharps
•

Collecting Waste

• Transporting Waste

How ?
STEP
1

Be Aware Beware

WASTE SHARPS can Injure or Infect

STEP
2

Segregate

Separate Collecting reduces chances of Injury

STEP
3

Decontaminate1

Decontamination / Disinfection reduces
Chances of Infection

STEP
4

Deform/Destroy2

Prevents misuse of the Needles and Syringes

STEP
5

Contain

STEP
6

Label

Use a Blue /White Transluscent Container or
Label the container properly (VISIBLE & READABLE)

STEP
7

Transport

Use Heavy Duty Gloves while handling
WASTE SHARPS especially while Transporting; AVOID Transporting Manually - Use Trolley

STEP
8

Final Disposal

Mutilation / Shredding prevents reuse; Send
to the recycler or bury in a concrete pit

Use a heavy duty (Puncture Proof) Plastic container to collect the WASTE SHARPS.
A narrow mouth contain facilitates collection; minimizes / obstructs unnecessary handling/
removal.
If it is broken Glass: Cordon and Secure the area; Wear Gloves and boots; Collect with spatula;
Discard into the WASTE SHARPS CONTAINER

1

Decontamination procedure:
Chemical Treatment: 1% Hypochlorite Solution or 2% Bleach (Freshly prepared One Full scoop Teaspoonfull Bleachinq
powder (7/10grams) in 1 litre of Water) Minimum Contact Period of 60 minutes
b
Autoclaving: ATemperature of 121c: pressure of 15 psi fora minimum of 60 minutes.
Before removing the needle from the syringe flush it with the disinfectant liquid. Discard Needle into WASTE SHARPS
CONTAINER; remove plunger from the barrel of the syringe before immersing it in the disinfectant Liquid If the Container
is Medium or Large size; Drain the Disinfectant Liquid every day. (Make a hole in the cap I Use a Strainer / Use double
containers)

2

Deforming/Destroying:
Always use Instruments. Do Not Use Bare Hands. Use heavy-duty gloves.
Cutting-pliers are availabe every where, not costly and many know how to use them
Use a Mechanical / Electrical Needle Cutter where ever possible
9

p
L

WHAT YOU SHOULD KNOW AND DO

S

I
C

□

Plastics are a heterogenous family.

□

Plastics are polymers of Hydrocarbons typically derived from petroleum of natural gas.

□

Plastics by not being biodegradable remain in the soil for more then one thousand years, contaminating the soil and
the surrounding water bodies.

□

Plastics constitute a major chunk of Health Care Waste. More so, with the increase in use of disposable items like
syringes, IV bags, blood bags, catheters etc.

□

There is four times more plastic in Health Care Waste than in Municipal Waste.

O> 2 > g

PROBLEMS
□

Collection and reuse or Resale of the single-use (disposable) products without adequate treatment result in possible
spread of infections

□

Infection to the Waste Handlers, especially the rag pickers and pourakarmikaas.

□

Improper Burning or Sub-standard incineration of these plastics release toxic gases like dioxins and furans and also
other harmful gases like sulphur dioxide, oxides of nitrogen, hydrochlorides, etc. The dioxins and furans are said
to be potent carcinogens.

□

Improper landfilling or dumping them results in leaching and contamination of soil and surrounding water bodies.
7^^

t
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J

2 g

Do’s
1. Ensure dis-infection of the plastics
2. Ensure that they are deformed

3. Segregate the plastic Waste

3

PROPER MANAGEMENT

p
L
S

I

c

BIOMEDICAL WASTE RULES, 1998 PROHIBITS INCINERATION OF CHLORINATED PLASTICS
It is possible to EARN FROM PLASTIC WASTE

□

Minimise the use of plastics especially outside patient care, by using bottles, glass, and earthen or metal wares.

□

Properly disinfect waste plastics. Deform it before it can be sold

□

Seperation of the plastics from other types of waste before deforming gets more money

Plastics are better managed by non burn technologies. Microwaves, autoclaves, hydroclaves, chemical disinfection are
the most suited to treat plastic waste.

w
Examples of Plastic Waste in Health Care Institutions are given below

s

Type

T
E

IV Bag, IV Fluid Container, Catheter Set, CVP Manometer,
Suction catheter, Blood Bag and Components, IV fluid container,

PVC

Catheter Set, Metrogel Inj. Bottle, Dextrose Bottle, CVP Manometer, Gloves Cover,
Syringe, Syringe Cover, Blood administration set cover, Drape Cover,
IV set cover

PE

Dextrose Bottle, Dialysis fluid Container, Needle Cap, Syringe, Syringe Cover,
Scalp vein set Cover, Geico, Cover, IV Fluid container, Blister cover, IV set cover

PP

M

N

Material

PVC=Poly Vinyl Chloride;PE=Poly Ethylenen; PP= Poly Propolene; PS= Poly styrene

G
E
M
E
N
T

Insulin Syringe
Innerpiston

PS

Outer part

PP

Red part

PP

Back Part

PP

4

PROPOSED METHOD FOR DISINFECTION OF COMMONLY USED ARTICLES/
MATERIALS/SURFACES IN ORDER OF PREFERENCES
Sriniwas (1992): Hospital Acquired infections: Guidelines for Control, Government of India,
Ministry of Health and Family Welfare, Department of Health, Nirman Bhavan, New Delhi.
AH articles and surfaces to be disinfected must first be cleaned and washed with warm water preferable containing detergent
Material

Method

Ampoules

Disinfectant with alcohol/Methylated spirit/P.VJ. before cutting

Skin

Tincture lodine/Alcohol

Thermometer

Keeping Gluteraldehyde/PVI/ Hexachlorophenes/ chlorhexidine + cetrimide (salvon) for at least 10 minutes
before next use.)

Articles/Ware:

Wash with warm detergent, disinfect with chlorine releasing compound/P.V.I./ Formaldehyde/Phenolic
compounds/ Chloro
xylenols/Hexachlorophenes/Chlorhexidine

Stainless Steel/Enamel
plated/Plastics e.g. Bedpan/Urine
bottles/Bowls

Surfaces like Floor/Walls/Trolleys/
Furniture/Sink/Wash basin

Wash with detergents disinfect with chlorine releasing
Compound/Carbolic acid / P.V.I. / Hexachlorophenes

Humidifiers and incubators

Fill daily humidifiers with sterile distilled water containing 0.1 % silver nitrate. Clean and disinfect with chlorine
releasing Compounds/activated gluteraldehyde/alcohol or carbolic acid.

Crockery/Cutlery
disinfectant

Wash with warm detergent solution, keep in boiling water for 10 minutes/expose to steam. No chemical
should be used.

Laboratory Discarding Jar

Phenolic compounds (carbolic acid)/ chlorine releasing Compounds/ chlorxylenols and hexachlorophenes

Syringes and needles

Chemical disinfectant must not be used for needle and syringes

Instruments
Cheatle forceps

Keep in concentrations recommended for grossly contaminated articles of PVI/ Chlorhexidine
+ Cetrimides/ Chloroxylenols, gluteraldehyde. Change the disinfectant daily

5

PROPOSED METHOD FOR DISINFECTION OF COMMONLY USED ARTICLES/
MATERIALS/SURFACES IN ORDER OF PREFERENCES (continued)
Sriniwas (1992): Hospital Acquired infections: Guidelines for Control, Government of India,
Ministry of Health and Family Welfare, Department of Health, Nirman Bhavan, New Delhi.

AH articles and surfaces to be disinfected must first be cleaned and washed with warm water preferable containing detergent.

Method

Material

Sharp instruments
- Skin piercing and invasive
instruments (not sterilisable by heat

Chemical disinfection only as last resort, if sterilisation by heat is
situations, Activated gluteraldehyde/ Carbolic acid for at least 10
hours for sterilisation

Equipment:

Chemical disinfection only at last resort, if sterilisation by heat is
not possible. Immerse in activated solution of gluteraldehyde/
Carbolic acid for 4 to 10 hours or more. Only vegetative bacteria,
fungi and viruses are killed by immersing in surface disinfectants
for 30 minutes.

Catheters, Cystoscope Endoscope,
Laproscope

6

CONCENTRATION/DILUTION OF THE DIFFERENT DISINFECTANTS TO BE USED IN CLEAN CONTAMINATED
AND GROSSLY CONTAMINATED
Sriniwas (1992): Hospital Acquired Infections: Guidelines for Control, Government of India,

Ministry of Health and Family Welfare, Department of Health, Nirman Bhavan, New Delhi.
Disinfectants

I

Recommended Concentrations/Diiution
Clean Contaminated
Grossly contaminated
(Dirty)

Chlorine releasing compounds available Chlorine

0.1%

1.0%

1 gL(1 OOOppm) 20ml/L

1.4g/L

10gL(10.000ppm)
200ml/L
14.0g/L

3. Sodium-dichloroisocyannurate (NaDCC) (usually 60% available chlorine) More
stable, available at tablets of 1.5g)

1.7g/L

17.0g/L

4. Chloramine Slow Chlorine release (More stable than 1 & 2 (25% available chlorine)

20g/L

20g/L

II Iodine Compounds
1. Tincture of Iodine (iodine 0.5% + alcohol 70%)
2. Polyvidone iodine (PVI) (Usually 10% sol.(1% Povidone iodine (Betadine)

2.5%
2.5%

2.5%
2.5%

2.0%
5%(2%formaldehyde)

2.0%
10%(4% formaldehyde)

1. Sodium Hypochlorite Liquid bleach usually 5% availabe chlorine

2.

Calcium hypochlorite (usually 70% available chlorine)

III Aldehydes
1. Glutaraldehyde (Activated) Cidex.2% glutarldehyde)
2. Formaldehyde-formaline (40% Solution of formaldehye and 10% methanol in water)
IV Alcohol
1.
Ethyn Alcohol
2.
Isopropyl Alcohol
3.
Methylated Spirit (Denatured alcohol)

-70%
70%
70%

70%
70%
70%

--- . ■

(table continued o verleaf)

7

CONCENTRATION/DILUTION OF THE DIFFERENT DISINFECTANTS TO BE USED IN CLEAN CONTAMINATED AND

GROSSLY CONTAMINATED (continued)
Recommended Concentrations/Dilution
Clean Contaminated
Grossly contaminated
(Dirty)

Disinfectants

6%(freshly Prepared)

Not recommended

1. Phenol(Carbolicacid)

5.0%

10.0%

.2. Creson

2.5%

5.0%

3. Lyson (saponified cresol)

2.5%

2.5%

1. (4.8%V/V is marketed as Dettol)

4.0%

10.0%

2. 1+0.1% (EDTA)

3.0%

6.0%

5.0%

10.0%

V Hydrogen Peroxide (30% stabilized Soln.)
VI Phenolic Compounds

VII Chloroxylenol

VIII Diguanides
Chlorhexidine(1.5%V/V)(Hibitane)

Chlorhexidine + Cetrimide(Savlon)

IX Ethylene Oxide gas

450-800mg/L

---------- - ---------------

8

ROUTINE CLEANING SCHEDULE
Wash Basin

Daily and as needed

Soap solution / Water

Bathrooms

Every two hours and as needed

Soap solution, water, bucket, cloth

Bedside lockers, beds

Daily - damp wipe
Fridays - thoroughly clean

Soap solution, water, bucket, cloth

Buckets, bedpans, urinals, sputum mugs,
and feeding cups

Daily and as needed

Soap solution, phenol, water

Cleaning Clothes

Daily

Soap solution, water, Bucket

Dustbin

Daily and as needed

Vim powder, water, cloth

Fans

Thursdays and as needed

Damp cloth

4-5 times duty

Broom / Dust mop
Soap solution, water, Bucket, Cloth

Floors

Morning duty :
07.0 a.m. - Wet-mopping
11.0 am - Sweeping and wet mopping
Afternoon Duty :
02.00 p.m. - Sweeping and wet-mopping

Night Duty
08.00 p.m. - Sweeping and wet-mopping
06.00 a.m. - Sweeping

Kidney tray

Daily and as needed

Soap solution, Phenol, Water

Wall dusting and removal of cobwebs

Sundays and as needed

Long - handled broom

Mondays and as needed

broom

Wednesdays and as needed

Razor blade, cloth, water bucket

Wall - wet mopping, stands for
intravenous sets, oxygen tanks, and
bedside screens

Window Glass

9

General Tips for Safe Managment of Health Care Waste
1.

Categorise the WASTE into SIX Categories

I

General Waste - Dry (Waste Paper, Paper covers,Packing materials)

Il

General Waste(Food Remains any decomposable Matter)

III

WASTE SHARPS (Blades, Broken Ampoules, Needles, Lancet, etc.)

IV

RECYCLABLES (Container, Items of Plastics, Intact Glass, Metals)

V

INFECTIOUS WASTE Any item/material which has come into contact with blood and or body fluids including Urine, Stools, specimen materials and
Culture plates,etc.

VI

Other Hazardous Waste Chemical and Lab reagents. Pressurised containers and canisters

2.

Keep appropriate containers to collect the particular type of waste for further processing CONTAINMENT IS THE FIRST STEP IN WASTE PROCESSING
DO NOT MIX THE DIFFERENT TYPES OF LABORATORY AND CHEMICAL REAGENTS INTO ASINGLE CONTAINER

3.

Reducing the Infectious Nature of the Waste takes immediate priority. Chemical Dis-infection is Simple and easy to perform Cleaning of the Reusable
items is mandatory before chemical disinfection TWO TEASPOONS of Bleaching Powder in ONE LITRE of water (approximately 2% Bleach Solution) is
an effective dis- infectant The infectious nature of the Materials is immediately reduced when once fixed in Formalin TO REDUCE FURTHER POLLUTION
AND TO ADHERE TO THE POLLUTION CONTROL GUIDELINES SEGREGATE CONTAIN AND BAG THE INFECTIOUS WASTE GOING FOR INCINERATION
DO NOT ADD CHLORINE COMPOUNDS TO THE INCINERABLE WASTE

4.

Ensure that all understand the

A)
Categories
of Waste
Methods of Handling Waste
B)
Use
C)

5.

of Barrier Protection while handling Waste

ASK QUESTIONS AND OBTAIN CLARIFICATION ASSUMPTION CAN BE DANGEROUS AND HAZARDOUS

10

PROTECT YOURSELF WHILE HANDLING PATIENTS
Are your taking these UNIVERSAL PRECAUTIONS? All the time?

GLOVES
I

Taking B.P. -

Taking T.P.R.

Giving I.M. Injection
Handling soiled Laundry
Cleaning Contaminated Instrumens

Starting I.V. or Taking Blood

Controlling Minor Bleeding
Controlling Massive Bleeding
Delivery
: Intubation
Suctioning

REPORT ALL ACCIDENTS
- CUTS, NEEDLES PRICK -

TO YOUR SUPERVISOR

II

MASK

GLASSES

The Policy Towards Safe Management of Health Care Waste
of.
Introduction:

(The Mission and vision of the Institution)

Preamble:

Health Care Waste needs to be handled carefully. Mismanagement of this potentially hazardous waste will affect not just the generators or operators of this wastt

but also the general community. All efforts in Safe Management of Health Care Waste must have the common end point of being eco-friendly.
11

Towards this end,

will ensure the following:

will be managed in such a manner so as not to pose special risk to the individual and to the community

a)

The Health Care Waste generated in

b)

The Health Care Waste will be managed in an environmentally friendly manner.

c)

will make all attempts and facilitate for an Integrated Waste Management System both within and outside the institution.

d)

All necessary steps and precautions will be undertaken provide appropriate protective measures including preventive measures to all the Health Care Personnc

e)

who come into contact with the Health Care Waste.
will proactively reach out, interact, co-operate, collaborate, undertake research and network with both governmental, Non-governmental and othe

agencies for Safe Management of Health Care Waste.
!'

•

f)

will undertake any other endeavour required to promote Safe Management of Health Care Waste.

Towards operationalizing these aspirations-------------------------- _will sincerely imlement the following Codes of Practice.

Health Care Waste is a special category of Waste, which needs special precautions while handling. Mis management of Waste affects not just the generator

operators but also the General Public. This has been the most often quoted fact whenever any one talks of Safe Management of Health Care Waste

CODES OF PRACTICE
CODE

1

---------------- —will evolve an appropriate institution policy for Safe Management of Health Care Waste

CODE

2

All efforts will be made to involve the Health Care Personnel in evolving the Institution policy towards Safe Management of Health
Care Waste

CODE

3

A house-keeping policy will be evolved and streamlined for effectiveness and efficiency

CODE

4

The Instituion Committee for Safe Management of Health Care Waste will bear the responsibility of implementing, monitoring and
evaluating practices for Safe Management of Health Care Waste by developing suitable indicators

CODE

5

A designated Waste Management Co-ordinator will liaison for effective management of Health Care Waste

CODE

6

The Instituion specific Action Plan will be prepared in a participatory manner for a definite duration; periodicaly reviewed, evaluated
and modified accordingly

CODE

7

All the Health Care Personnel will be made aware of the different points of generation of waste, types of wastes generated, precau
tions to be taken while collection, handling, transportation and disposal. Towards this end a formal orientation for the new incum
bents and a periodic (annual) orientation for all the stafff will be conducted

CODE

8

All Waste generated will be segregated at the pint of generation according to statutory guidelines and options available for waste
managment

CODE

9

An efficient mechanism consonant with the philosophy of waste management (Reduce, Reuse, Recycle) will be developed to collect,
transport and dispose off the Waste after ensuring that it is non-infectious and non-hazardous

CODE

10

All potentially infectious waste will be decontaminated disinfected before it is transported outside the point of generation; where
required a separate discard autoclave will be maintained or any other appropriate method will be utilized for this purpose

CODE

11

All soilded linen will be disinfected before being transported to the laundry

CODE

12

The instituion specific disinfection policy will be reviewd, defined, delineated and monitored

CODE

13

All attempts will be made to provide adequate number of toilets, a system for its maintenance including providing for adequate water
and patient education for effective use

CODE

14

The segregated Health Care Waste will be transported in appropriate containers with minimal handling by the Waste Handlers to the
intermediate storage area (or the disposal site) with in the institution

CODE

15

A Separate area will be designated for storage and (if required for) sorting of the Health Care Waste

13

CODES OF PRACTICE

CODE

16

A daily register indicating and recording the type and quantity of Waste handled will be maintained. The document will be scrutinised
periodically

CODE

17

__________ will periodically submit the prescribed reports to the statutory authority

CODE

18

The Organisation Chart of the personnel/mechanism of Waste Collection-transportation-disposal will be prominently displayed

CODE

19

All attempts will be made to ensure an adequate supply and usuage of protective devices like masks, gowns, boots, aprons, goggles,
etc., to all Health Care Personnel especially Waste Handlers

CODE

20

Appropriate Immunisations and Periodic Medical Examinations will be undertaken for all the Waste Handlers

CODE

21

Practice of Universal Precautions will be made mandatory for all categories of the Health Care Personnel

CODE

22

System of recoring reporting and notifying illness, injuries and accidents consequent to Waste handling will be evolved and main
tained

CODE

23

For generating and managing Health Care Waste,__________ will register with the statutory authority after paying the requisite fee
and completing the due procedures

CODE

24

The Health Care Personnel will be periodically updated with the legal provisions regarding Safe Management of Health Care Waste

CODE

25

All attempts will be made to incorporate aspects of Safe Management of Health Care Wate especially Principles of Universal
Precautions into the Training curriculum of both Medical and para-medical courses

CODE

26

The patients, patients attendant(s), Visitors to the institution and the general community will be involved in endeavours for maintenace
of the system for Safe Management of Health Care Waste

CODE

27

All efforts will be made to provide appropriate support technical, educational materials and such other things for undertaking endevours
towards Safe Management of Health Care Waste including Training, Orientation and Education

CODE

28

All efforts will be made to participate in an develop a co-operative waste management facility fulfilling the norms/quidelines set hv the
statutory authorities
uy tne

CODE

29

All efforts will be made to recycle the cecyclable waste like paper, plastic, metals and glass

CODE

30

All efforts will be made to proactively reach out, interact, co-operate, collaborate, undertake research and network with h th
mental, Non-governmental and other agencies for Safe Management of Helath Care Waste
tn 9°vern'

14

Safe Management of Health Care Waste
Health Care Waste is a special category of Waste, which needs to be handled appropriately with precautions. It affects not just the generators and the operators

but also the general public. Currently it is being managed casually.

Preamble:
In the exploratory study undertaken in 1997 by Bangalore Mahanagara palike, Centre for Environment Education. Department of Community Medicine, MSRMC,
the problem areas for Safe Management of Health Care Waste were identified to be:

a)
b)

Lack of Awarness
Lack of Information support

c)
d)

Lack of Practices
Lack of Effective co-ordination

The lack of awareness was not confind to the Group D or class IV workers who usually handle the Waste but was also evident amongst all the categories
of Health Care Personnel. This included Doctors. Nurses and Administrators too. In essence the Health Care Waste Management was not an issue. Those
who had concern did not know how or whom to approach. There was no recognisable information/document/ resource centre which could offer a comprehensive
solutions to their problems. The minority group of Health care Personnel who were aware about the issues and concerns regarding Health Care Waste did
not practice what can be considered essential, i.e., wearing of aprons, use of gloves, masks, gown, or even simple hand washing. There was a small group
who attempted to practice segregation but were immediately de-motivated when what was segregated went into the same container when it was being transported.
There existed no co-ordnation between Waste generation, collection and transportation between within the Health Care Settings and outside the Health Care

settings.
Realising that the issues and concerns regarding Safe Management of Health Care Waste was fundamentally one that of behaviour, attitude and perception,
the study group formulated PROBABLE SOLUTIONS and NOT THE SOLUTIONS. The FIVE PROBABLE SOLUTIONS were

delineated as:
1.

Awarness programmes

2.
3.

Capacity Building
Strengthening of Facilities for systems development

4.

Recording and Reporting

5.

Research Endeavours

SCOPE OF THE PRESENTATION

The current presentation attempts to identify a framework for the efforts undertaken as a follow up of the exploratory study. Thus the objectives include:

15

Safe Managment of Health Care Waste The check list for Health Care Settings
Guidelines for filling up the checklist:
1. Supervision is a difficult task.lt is not fault finding. It is providing for a vision hitherto not available for the personnel i.e., it is providing

2.
3.

super-vision
It is desirable that the activities according to the proforma.
Open mind, Frankness and informal atmosphere need to be set in before the endeavour is undertaken

4.

It is mandatory to provide a feed back to the institution regarding their Health Care Waste Management practices.

5.

Use separate sheet of paper for comments by the investigator

Name of the Health Care Setting:
Address:

Telephone/Fax/Email:
Name of the respondent with designation :
Services provided (encircle):

Only OPD/OPD+IP/Others (Specify)

Facility (encircle one or Many):

General /Speciality /Super-speciality

Staff Position (number):
Duty Doctors

Consultants Doctors

Nursing Staff

Ward Boys/Ayah

X-Ray technicians

Lab Technicians

Others

Others

Total Number of Staff
Number of Beds:

Average Bed Occupany:

Average In patient admission/Day

Average out patients/Day

Average Deliveries/Month

Average Surgeries/Month

Number of Dental Chairs:

Outpatient Strength in the Last One year
Inpatient Strength in the Last one year

16

Tick if the following is present:
• Infection Control Committee
• HIV Infection Control Policy
• Waste Sharps Management Policy

•
•

Waste Management Committee
Waste Management Policy

©
•

Disinfection Policy
Occupational Safety Policy

Encircle the facilities available for Waste Management:
Segregation & Containment

Deep Burial

Incineration

Microwaving

REMARKS
1 Authorisation /Renewal obtained:
2

System of recording illness /injuries / accidents : Yes/No

3

System of recording and reporting illness/injuries/accidents: Yes/No

4

Periodic monitoring of the waste management facility undertaken : Yes/No

5. Training provided to the staff: Yes/No ; Retraining provided to the staff: Yes/No

Record if the following is happening regarding handling of Health Care waste
Waste Materials

Segregation

Disinfection

Disfigurement

Containment

Transportation

Colour
coding

Surgery remains
Waste sharps
Incinerable Waste
Placenta

Plastics

Paper
Food Waste
Laboratory Waste

Others (specify)

-

Others (specify)
NOTE : NA = Not Applicable; C = Complete; IC = Incomplete, S = Satisfactory, NS = Not Satisfactory,
A = Appropriate; IA = Inappropriate

17

Final
Disposal

Autoclave

Others (Specify)

OCCUPATIONAL SAFETY OF THE HEALTH CARE PERSONNEL :
Indicate Yes //being provided and used. No if otherwise

Uniform

Apron

Goggles

Mask

Boots

Gloves

Vaccination
given

Duty Doctors
Nurses

Technicians
Laboratory

Radiology

Others
Waste handlers

Ward boy

Ayah

4

Helper

Others

WASTE CONTAINERS (sample in a representative fashion)
1

2

3

4

5

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Location of Container

Waste contained
Size (in Lts)

Shape

Lid Present
Material of the container
Collection Frequency/day

In a separate sheet of paper list the suggestions by the staff for the improvement of the solid waste management mechanism
regarding the Containers, Frequency
of Collection, Frequency of Disposal, Use of protective devices, Transportation of the Waste.

18

TECHNOLOGY EVALUATION OF BIO-MEDICAL WASTE TREATMENT SYSTEMS
AJ TECHNOLOGY
a)

Name of the Technology:

b)

Places where being implemented in India:

BJ TECHNICAL CRITERIA:

a)

Waste processing capacity:

Minimum:Maximum:

b)

Change after processing: (%): Weight:

Volume

c)

Categories of waste handled:

d)

Categories of Waste excluded:

e)

Pre-processing requirement:

f)

Post-processing requirement:

g)

Type/Nature of end product after the process:

h)

Any other waste generated during the process:
Liquids

Solids

k) Uses(s) of the end products generated:

19

Gases

i) Space requirement:

equipment per se

including all equipment

including service area (Utility)

Water

Others

Training

Number

Solids

Gaseous

n) Construction requirement:

o) Any other: (Specify)

Power

p) Human resources requirement for managing the facility:

Qualifications

q) Options for enhancing capacity: Specify, if Yes
r) Availability of spares: If Yes, place where sourcing from

s) Nature of Collaboration (include within India and outside India)

g POLLUTION CRITERIA
a)

Types and Nature of Pollutant generated: Describe
Liquids

.----------------.---------------------------------------------------------- .——

20

Method(s) of

Available

Offered

monitoring inside the work spot
monitoring outside the work spot
Control of the pollutants

Treatment of the pollutants

DJ SAFETY CRITERIA

a)

Maintenance requirements:

Nature

b)

General frequency of repairs

c)

Life span of 1 Unit

Periodicity

d Nature of Occupational hazards

E] ECONOMICS / FINANCES:

a) Cost of the equipment
b)

Cost of additional equipment

c)

Running costs per month (Average)

d)

Average Maintenance/repair/replacements costs per month

M'i>O
07031 °6'
21

—■-/

g AGENCY:

a) Name of the agency/dealer

b) Specialisation (in years) in the technology in reference:
c)

Other services offered:

Maintenance
Repairs

Spares
Finances

Technical
Contingency

e) Period since working
f) Other similar agencies in India

22

Story About 4 People
This is story about 4 people.
Everybody, Somebody, Anybody, Nobody.
There was an important job to be done;
Everybody was sure that Somebody would do it.
Anybody could hove done it;
I
But nobody did it.

Somebody got angry about it;
Because it was everybody's job.
Everybody thought anybody could do it.

But nobody realised that,
Everybody would not do it.
It ended that Everybody blamed Somebody
When Nobody did What Anybody could have done.

-Anon

This document was released during ISHWMCon 2001 the inaugural conference of Indian
Society of Hospital Waste Management®

FOR COPIES CONTACT :
The Resource and Documentation Unit,
Health Care Waste Management Cell,
Dept., of Community Medicine,
M S Ramaiah Medical College, Bangalore - 560 054.
Ph : (+9180) 3560084; Fax : (+9180) 3460213
Email: hcwmcell@hotmail.com

Media: 7031.pdf

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