1.

INSTALLATION OF INCINERATOR
Installation
Installation of incinerators should include site preparation, equipment
installation and commissioning, service and operating instructions provided
by the manufacturer, assured
manufacturer support, metal works (fuel tank, filter and supply lines,
electrical power supply, etc.), and civil works (foundations, pits, water supply
and run off for rinsing reusable recipients). Security and the safety of the
installation need to be given great importance. The following sections
summarize civil engineering requirements applicable to permanent HCWM
disposal sites

Site selection
Certain measures need to be taken to protect the local communities from the
possible hazards of medical waste. Incinerators should never be installed in
areas where crops are grown; particles from the smoke emitted by the
incinerators can settle on crops, making them highly toxic. If for whatever
reason incinerators have been installed near cultivated land, the incinerator
should be operated only when the wind is blowing away from the crops. The
selection of an appropriate location to install an incinerator is of paramount
importance. Key factors to be taken into consideration are:
The location should be at least 30 meters away from the closest occupied
or inhabited
building.
The prevailing winds at the location should blow in a direction away from
occupied
buildings.
There should be no regular public passage within immediate proximity of
the
incinerator.
There should be no horticulture or leaf crops within 300 meters of the
incinerator in the
direction of the prevailing winds.
The bottom of the ash pit should be above the maximum level of the water
table.
The location should be secure and free from risk of vandalism or theft.
The location should permit construction of a facility to house the
incinerator (unless
designed for external use) and store the waste awaiting disposal. The site
should also
include an ash pit and placenta pit (as appropriate). Incineration by itself is
not a solution for medical waste disposal. A complete, self-contained waste
management system needs to be put in place. This includes an incinerator; a
secure waste storage facility; a fuel store; an area for glass and sharps
deposit; a protected ash disposal pit; a lockable secure enclosure for the
incinerator; a facility to store the tools, protective clothing, and operator
records; and a washing area with waste water runoff.
Protective enclosure
Incinerators should be installed in a protective enclosure or suitably
ventilated building to prevent access by unauthorized persons and to protect
the incineration equipment. A protective enclosure or building should ensure
that:
The incinerator and other materials stored inside are protected from rain
and UV
radiation from direct sunlight.
The incinerator is well ventilated and the stack emissions are clear of the
building or
enclosure so that the operator is not exposed to fumes when the incinerator
is in use.
The enclosure is robust and corrosion resistant, and its design-life is at
least equivalent
to the expected life of the incinerator.
The enclosure or building can be securely locked against unauthorized
entry.
There is space within the enclosure to store the operators protective
clothing, tools, and
equipment required to operate the system. There should also be sufficient
space to
conveniently store waste to be destroyed, as well as load and operate the
incinerator.
There is provision for an emergency exit should there be a fire or other
emergency at the
facility.
There is storage space for solid fuels or a storage reservoir for fuel. This is
best located
within the incinerator enclosure to ensure adequate security.
The enclosure has a provision for waste to be deposited without allowing
the waste
handle, to enter the enclosure or building.

Ash pit
All HCWM sites using incineration should be equipped with an ash pit that
has sufficient capacity to store ash for a period of at least 5 years. Essential
features of a pit are:
The pit is positioned above any shallow aquifer.
The pit is positioned to prevent risk of flooding.
The pit is constructed of concrete, concrete blocks, or brick, with a water-
resistant floor
to ensure the pit will not collapse.
The pit has provision to deposit ash or other authorized wastes (i.e., needle
containers),
without a risk to the waste handler.
 There is provisional access to the pit for purposes of leveling or removal of
accumulated
waste and subsequent transfer to a municipal landfill.
The pit is protected from access by unauthorized persons.
The pit is in the immediate proximity of the incinerator to ensure
convenient transfer of
ash.

Fuel storage
All incinerators require fuel either to preheat (in the case of auto-combustion
incinerators) or to assist throughout the incineration process (in the case of
fuel-assisted incinerators). Safe and secure storage of incinerator fuel is
imperative. There should be adequate space to safely store dry solid fuel
(wood, coconut husks, charcoal, etc.) sufficient for at least one week of
operation of the incinerator at auto-combustion sites.
A storage reservoir, fuel filter, and shutoff tap or valve should be positioned
within the enclosure or building to ensure the fuel supply is not exposed to
excessive heat from the incinerator. It should be mounted at an appropriate
level to ensure a gravity supply of fuel and deter access by unauthorized
persons. Any storage reservoir should be large enough to store fuel for 3
times the period between normal waste deliveries.

Water supply
All HCWM disposal facilities should be equipped with a water supply (spigot)
mounted above a
concrete pad with either a gutter for runoff and percolation into the ground
or connection to a
drainage channel. All recipients (e.g., plastic containers, bins, etc.) should be
thoroughly rinsed
before being returned for reuse.

Glass disposal
Glass vials deposited in incinerators tend to clog grates and causes
explosions when unopened. As a general rule, glass should not be
incinerated. The increasing use of glass syringes for new prefilled vaccines
represents a new challenge to waste disposal since these syringes are
infectious and should not be incinerated with other waste.
A glass crusher with provision for crushed glass to be heated and sterilized
will be essential at
disposal facilities in the coming one to two years as new vaccines emerge
packaged in glass.
Provision of space within the enclosure or building for equipment to crush
glass syringes and vials is important.
Placenta pit If you are using a fuel-assisted incinerator at a facility where a
maternity unit is located then, subject to local customs, a placenta pit should
be built. Auto-combustion incinerators are not suited to destroying placenta.
The pit should be located at some distance (20 meters or more) from the
incinerator enclosure.
Equipment inspection Each incinerator needs its own checklist. The
manufacturer should help to put this checklist together, as they know best
which parts might break and require replacement. The supervisor needs to
inspect the system quarterly at a minimum. In order to determine the
condition of the system, and predict possible problems or failures across the
network. In this way, spare parts can be ordered in advance so they are
available if and when the need arises.

2. HOSPITAL WASTE MANAGEMENT

HOSPITAL WASTE MANAGEMENT

Hospital waste is Any waste which is generated in the diagnosis, treatment
or immunization of human beings or animals or in research in a hospital.
Hospital Waste Management means the management of waste produced by
hospitals using such techniques that will help to check the spread of diseases
through
 Hospital Waste categories and Disposal

Option Waste Category Treatment & Disposal

Category 1 Human anatomical waste Incineration /deep burial
Category 2 Animal waste Incineration /deep burial
Category 3 Microbiology & biotechnology Incineration /deep burial
waste
Category 4 Sharps Incineration / disinfection /chemical
treatment /mutilation
Category 5 Medicines and cytotoxic drugs Incineration / destruction and disposal in
secured landfill
Category 6 Solid waste (Blood and Body Autoclave/chemical treatment/burial
fluids)
Category 7 Solid waste (disposable items) Autoclave/chemical treatment/burial
Category 8 Liquid waste ( blood & body Disinfection by chemicals/discharge into
fluids) drains
Category 9 Incineration Ash Disposal in municipal landfill
Category Chemical waste Chemical treatment/ secure landfill
10
Infectious
Materials containing pathogens if exposed can cause disease.

Human anatomical waste: waste from surgery and autopsies on

patients with infectious diseases;

Sharps: disposable needles, syringes, saws, blades, broken glasses,

nails or any other item that could cause a cut;

Pathological: tissues, organs, body parts, human flesh, fetuses, blood

and body fluids;

Non Infectious (Hazardous)

Pharmaceuticals: drugs and chemicals that are returned from wards,

spilled, outdated, contaminated, or are no longer required;

Radioactive: solids, liquids and gaseous waste contaminated with

radioactive substances used in diagnosis and treatment of diseases
like toxic goiter.

Non Infectious (Non Hazardous)

Domestic waste: from the offices, kitchens, rooms, including bed linen,
utensils, paper, etc.
 Hospital waste management programme

1. Identification of waste types

2. Segregation of waste

3. Transport & storage of waste

4. Proper disposal of waste

5. Implementation of contingency plans

6. Identify the need for use of personal protective equipment

Segregation by color coding system

Three categories

Infectious waste - Red bags

Domestic waste - Green Bags

Sharps - Needle cutters / Puncture proof containers

Segregation at Source ( ward, operation theater, laboratory, labour

room, other places)

Transportation

Containers: puncture proof, leak proof,

Bags: sturdy, properly tied

Transport trolleys: designated & timely

Staff protection: provided with protective clothing and other items

Never put hands in a bag

Waste storage

Closed covered area

Away from the normal passages

Easily accessible for transportation

 Radioactive waste special containers/ special treatment and disposal

Proper disposal of waste

All infectious waste and sharps containers :Incineration

All Domestic waste : Landfill

All hazardous waste : Chemical treatment before disposal

3. SMOKE DETECTOR AND FIRE ALARM

Alarms are the first line of defence in the event of a fire. They act as an early
warning sign giving you the chance to evacuate premises and escape any
fire-related danger. Everyone wants to protect their homes and by law, any
facility used for a commercial purpose must protect those that work inside it,
but there is often some confusion as to the difference between a fire alarm
and a smoke alarm.
Well, the clue really is in the title. One detects smoke, and the other detects
fire. But as the saying goes, there is no smoke without fire, so both are
equally important. In fact, more people will suffer from inhalation of smoke
than they will from fire burns. Heres why the two are so different and where
they are best suited:

Smoke alarms
Smoke alarms are devices that are able to detect smoke or fire, giving an
audible alarm as a result. They are fantastic at detecting a fire in its early
stages, allowing you adequate warning to evacuate before inhaling any
harmful gases. Smoke inhalation is the primary cause of fatality when it
comes to fire-related deaths. In fact, in the majority of cases, the victims are
asleep when the smoke enters their lungs, cementing the absolute
requirement for smoke alarms.

Because they are simple yet effective, they are ideal for domestic use.
Ideally, one should be placed on each level of the home, and in particular
where you can hear it from the bedroom. It is advisable not to place them in
areas that may cause frequent activation such as the kitchen or bathroom.
Many of these can be combined with carbon monoxide detectors. Carbon
Monoxide is an odourless, tasteless and invisible gas, meaning you can be
killed by it before you even know it existed. Combined smoke alarms can
protect from this as well as smoke particles.
 Smoke detectors are the most basic device available on the market and are
cheap additions to a building considering their vital role. They are best suited
for homes, where people can exit the property quickly and easily.

Fire alarms
A fire alarm detects the presence of fire by monitoring the changes in
environment associated with combustion. This can include the detection of
smoke which is why they are commonly confused with smoke alarms.
In commercial environments, where fire alarms are best suited, if you employ
more than five people, you need to have a written record of your fire
assessment by law. This will affect how many fire alarms are required and
what fire precautions should be made in order to protect the facility and its
staff.

Fire alarms can be linked with other systems making for an efficient and
safer system. For example, when a fire alarm is triggered, sprinkler systems
can be activated, or the local fire station can be alerted. For this reason, and
for their ability to be more complex, fire alarms are generally not used in
domestic environments. When you consider how much damage could be
prevented, and how many lives are saved a year from their simple
installation, their cost is minimal in comparison.

Installing smoke alarms

Choose smoke alarms that have the label of a recognized testing

laboratory.
Install smoke alarms inside each bedroom, outside each sleeping area
and on every level of the home, including the basement.
On levels without bedrooms, install alarms in the living room (or den or
family room) or near the stairway to the upper level, or in both locations.
Smoke alarms installed in the basement should be installed on the
ceiling at the bottom of the stairs leading to the next level.
Smoke alarms should be installed at least 10 feet (3 meters) from a
cooking appliance to minimize false alarms when cooking.
Mount smoke alarms high on walls or ceilings (remember, smoke rises).
Wall-mounted alarms should be installed not more than 12 inches away from
the ceiling (to the top of the alarm).
If you have ceilings that are pitched, install the alarm within 3 feet of
the peak but not within the apex of the peak (four inches down from the
peak).
Don't install smoke alarms near windows, doors, or ducts where drafts
might interfere with their operation.
 Never paint smoke alarms. Paint, stickers, or other decorations could
keep the alarms from working.
For the best protection, interconnect all smoke alarms. When one
smoke alarm sounds they all sound. Interconnection can be done using hard-
wiring or wireless technology.
When interconnected smoke alarms are installed, it is important that
all of the alarms are from the same manufacturer. If the alarms are not
compatible, they may not sound.
There are two types of smoke alarms ionization and photoelectric. An
ionization smoke alarm is generally more responsive to flaming fires, and a
photoelectric smoke alarm is generally more responsive to smoldering fires.
For the best protection, both types of alarms or combination ionization-
photoelectric alarms, also known as dual sensor smoke alarms, are
recommended.
Keep manufacturers instructions for reference.

Installing smoke detectors

1. Install smoke detectors on every level of your home, in each bedroom and
outside every sleeping area of your home. They should either be installed on
the ceiling at least 4 inches (10 centimeters) away from the wall or high up on
a wall 4 to 12 inches (10 to 34 centimeters) from the ceiling

2. Install dual sensor smoke alarms that combine ionization and photoelectric
fire detection methods

3. Have a professional electrician install each unit that's wired directly to your
home's electrical system. Hard-wired smoke alarms should
have battery backups in case of power failures. Consider having your smoke
alarms interconnected so that when one alarm is tripped, every alarm will go
off to provide an early warning to those in other parts of the house.

4. Install your battery-powered smoke detectors by simply screwing them into

the ceiling or wall. Some smoke detectors come with an adhesive-like
mounting tape for even easier installation. Follow the manufacturer's
instructions to make sure you do everything right.
 5. Test your newly installed smoke alarm. Directions for testing the smoke
alarms are usually included with the manufacturer's instructions, and often
involve simply pressing a button.

6. Test your smoke alarm once a month and replace the batteries every year.

Figure A.29.8.3.1 from NFPA 72, National Fire Alarm and Signaling Code (2013 edition).