INTRODUCTION:
Health Care Facilities must be committed to waste management principles. Waste management is implemented by the establishment of a waste management committee and the development and implementation of a Waste
Management Plan. The Generic Waste Management Plan provides supplementary detail and forms a practical tool to implement the Guidelines.
These Guidelines will assist managers and personnel of any facility to implement standards and comply with relevant legislation. Adoption and commitment by each facility through the establishment of a Waste Management Committee and adoption of a Waste Management Plan will assist the facility to manage their waste streams correctly, efficiently and effectively.
These Guidelines continue with the concepts of waste segregation into various waste streams, labeling and containment, handling, storage and transport, treatment / disposal, auditing, Occupational Health and Safety, training and legal requirements.
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HEALTH-CARE WASTE:
Health-care waste includes all the waste generated by health-care establishments, research facilities and laboratories, including health-care waste produced at home (dialyses, insulin injections etc.)
CATAGORIES OF HEALTH-CARE WASTE:
Infectious waste (containing pathogens, excreta, etc.)
Pathological waste (body parts, blood, foetuses, etc.)
Sharps (needles, infusion sets, broken glass, etc.)
Pharmaceutical waste (old medicines, etc.)
Genotoxic waste (cytostatic drugs, etc.)
Chemical waste (laboratory material, film developer, etc.)
Heavy metal waste (batteries, thermometers, etc.)
Pressurised containers (gas cartridges, etc.)
Radioactive waste (waste from radiotherapy, etc.)
IMPROPER DISPOSAL:
Hospitals and public health care units are supposed to safeguard the health of the community. However, the waste produced by the medical care centers if disposed off improperly, can pose an even greater threat than the original disease themselves. In most of the cases there are no systematic approaches to medical waste disposal. Hospital wastes are simply mixed with the municipal waste in collecting bins at roadsides and disposed off similarly. Some waste is simply buried without any appropriate measure. While all the equipment necessary to ensure the proper management of hospital waste probably exists, the main issue lies in the staff who fails to prepare and implement an effective disposable policy.
In general disposable syringes and needles are also not disposed off properly. Some patients, who routinely use syringes at home, do not know how to dispose them off properly. They just throw them in a dustbin or other similar places, because they think that these practices are inexpensive, safe, and easy solution to dispose off a potentially dangerous waste item.
How does hospital waste affect us?
If hospital waste is not managed properly it proves to be harmful to the environment. It not only poses a threat to the employees working in the hospital, but also to the people surrounding that area Infectious waste can cause diseases like Hepatitis A & B, AIDS, Typhoid, Boils, etc.Many drug addicts also reuse the syringes that can cause AIDS and other dangerous and contagious diseases. If a syringe, previously used by an AIDS patient, is reused, it can affect the person using it. So, the hospital staff should dispose off the syringes properly, by cutting the needles of the syringes with the help of a cutter, so that the needle ca not be reused. When waste containing plastics are burnt, Dioxin is produced, which can cause Cancer, birth defects, decreased psychomotor ability, hearing defects, cognitive defects and behavioral alternations in infants. Flies also sit on the uncovered piles of rotting garbage. This promotes mechanical transmissions of fatal diseases like Diarrhea, Dysentery, Typhoid, Hepatitis and Cholera. Under moist conditions, mosquitoes transmit many types of infections, like Malaria and Yellow fever. Similarly, dogs, cats and rats also transmit a variety of diseases, including Plague and Flea born fever, as they mostly live in and around the refuse. A high tendency of contracting intestinal, parasitic and skin diseases is found in workers engaged in collecting refuse.
Purpose of the Guidelines
The purpose of the Guidelines is to provide a framework of waste management strategies to assist in the day to day and long term management of waste by implementing the following essential strategies:
Waste management committees, plans and waste audits;
Waste minimization, avoidance, segregation, recycling and re-use;
Waste labeling and containment; C proper waste handling, storage and transport;
Correct waste treatment / disposal
Uniform application of these Guidelines to all facilities will help to reduce
uncertainty when staff moves between facilities. This assists with providing a safe working environment.
Aims
The aims of these Guidelines are to:
Protect public health and safety;
Provide a safer working environment;
Minimize waste generation and environmental impacts of waste treatment / disposal;
Ensure compliance with legislative requirements.
Infection Risk Associated with Waste
Infection Control measures are adopted to prevent cross infection between patients and staff. Changes in infection control and advances in technology have resulted in the increased use of disposable clinical products, which have in turn increased waste treatment/disposal volumes. When clinical waste is appropriately handled and contained through good work practice and the use of protective apparel, the risk of infection is minimized. It is essential to correctly segregate waste to ensure that safe work systems protect all workers. The most significant risk associated with clinical waste is transmission of a blood borne virus from a needle stick injury. The detrimental impacts on the environment of increased disposable items have included pollution and the depletion of non-renewable natural resources. The adoption of waste minimization practices should reduce environmental degradation, without compromising infection control standards.
Waste Management Plan (WMP)
Each Health Care Facility must implement a Waste Management
Plan. To implement an effective WMP:
Establish a Waste Management Committee at facility;
Coordinate major issues such as avoidance, reduction, reuse and recycling;
Conduct an audit to assist with performance improvement.
Audit procedures in the WMP.
Establish benchmarks to facilitate monitoring.
The following key issues are considered essential components of a WMP.
Organizational Issues
Employers legal responsibilities
Employees responsibilities
Licensing requirement
Waste management committees
Purchasing policies
Education and training.
Waste Management Strategies
Hospital waste audits
Numerical profile
Segregation audit
Waste minimization
Waste Handling, Containment and Transport
Waste handling by staff
Spill management
Containment and sharps containers
Tracking
MGBs and trolleys
Holding areas
Transport
Waste Disposal
Contracts with waste transporters and waste treatment / disposal subcontractors
must be documented and should be consistent with relevant Regulations.
Occupational health and Safety
Provision of information, education and training and safe systems of work
Employee’s responsibilities
OH&S committee
Monitoring performance
Personal protective equipment
Standard Operating Procedures
Legislative Compliance
All health facilities have a statutory obligation to comply with applicable legislation. The development of these Guidelines has considered relevant legislation. It is the responsibility of each facility to consult with other authorities and to be aware of their specific legislative requirements.
Licensing
Who Needs a License?
The following is a summary of the license requirements under the Waste Regulation.
The Waste Regulation provides for the licensing of:
Those who generate or store hazardous (clinical) waste (controlled waste
activities)
Waste facilities that treat, store or dispose of hazardous (clinical) waste –
(Controlled waste activities)
Transporters of hazardous waste – (Waste transporters)
Waste Segregation
Waste segregation should follow immediately after waste is generated. Effective segregation will reduce costs, promote recycling and protect the health and safety of all.
What is Segregation?
Waste segregation is the practice of classifying waste and placing it into the appropriate waste container immediately after the waste is generated.
Importance of Waste Segregation
Facilities should accurately segregate waste to protect personnel from injury and infection by preventing hazardous waste entering inappropriate waste streams and divert problematic waste from incorrect waste streams. Correct segregation is necessary to ensure that materials which are reusable or recyclable are not discarded. Correct segregation and containment of all wastes are required in order to comply with the provisions of the Waste Regulation. The mixing of wastes is not permitted. If mixing occurs, wastes containing more than 200g of hazardous waste are to be classified as hazardous.
Segregation Practice Achievement
Effective segregation can be best achieved through:
Providing education and training programs to all personnel who generate waste)
Identification of material composition (Material Safety Data Sheet);
Establishing identifiable color coding, and labeling;
Provide suitable containers in appropriate and suitable locations;
Incorporating quick and efficient waste disposal methods into patient care
Procedures. This may require the redesign or reorganization of procedure trolleys and working environments; and ensuring all waste can be easily, safely and properly segregated at the point of generation.
Training
Importance of training in the processes of achieving continuous
improvement in waste management.
Training and Promotion
Area Health Services and HCF must train managers, supervisors and employees in waste management and reinforce knowledge with promotional activities and special emphasis programs. Training programs must be revised as new equipment is introduced or as technological change occurs. All casual staff needs to be trained in waste management before starting employment. Continuous improvement may be achieved by regularly reinforcing awareness of waste management issues.
The following topics should be covered (effective training stuff)
Operating manuals outlining safe and approved work practices;
Material Safety Data Sheets;
Staff awareness of policies at orientation to the HCF;
Legislative compliance;
Provision of and compliance with the use of personal protective equipment;
Hygiene procedures;
Waste stream definitions and waste segregation practices;
Costs and benefits of waste management;
Explanation of recycling programs;
Details of employee vaccination program;
Management of needle stick and blood body substance exposure; and
WMP.
Community languages should be used where appropriate.
Information, Education, Training and Safe Systems of Work
Facilities management should be responsible providing appropriate information, education, training and ensuring that safe systems of work are developed and maintained.
This should include the provision of OH&S and public health information relating to the equipment and chemicals/drugs used in the facility , e.g. Material Safety Data Sheets for chemicals, Operating manuals for clinical devices using / decontaminating hazardous substances, etc.
Information
Facilities employees who handle waste should be provided with the following information:
Occupational hazards and management of exposure to blood and body fluids;
Policies and procedures for specific waste handling and prevention of injury and disease.
Details on available immunization programs (for Hepatitis B in particular);
Access to medical care and counseling services with rights to privacy; and
Management of needle stick and blood body substance exposure.
The information should emanate from one source only to avoid the distribution of conflicting information.
Education and Training
Management should provide education and training to waste generators, handlers, collectors, transporters, and key managers instrumental in the implementation of the WMP, and waste treatment facility operators. Handlers must be trained and equipped to undertake the handling, internal transport, spill management and storage requirements for the different types of wastes arising at the facility. The purpose of education and training is to minimize the risk of injury associated with waste handling and facilitate efficient waste management.
Education and training programs should include:
Approved work practices;
Regulatory requirements and methods of compliance;
The use of required personal protective equipment;
Waste minimization, segregation, labeling, containment and disposal strategies;
First aid and medical treatment for needle stick and other waste handling related injuries;
Hand washing strategies.
Education and training should be provided at the induction of new employees, on an ongoing basis, with the introduction of new equipment, and at times of technological change. Approved work practices should be documented and promoted. Multilingual translations are to be provided to personnel who may not be proficient in English.
