Summary SUMMARY ................................................. ...................... ............................ ................................................. 2 0 - INTRODUCTION ............................................... .............. ......

.............................. ..................................... 3 1 WHAT IS WASTE ...... .................................................. ....... ........................................... ............. 5 2 - CLASSES OF WASTE :.............................. ............................................... ... ................................... 6 3 - MUNICIPAL SOLID WASTE ......... .. ................................................ ............................... ........... 7 3.1 - TYPES OF WASTE .. .......................................... ........ .................................................. .................... ..... 8 4 - INDUSTRIAL WASTE .................... .............................. .................... ............................................. 9 5 - HOSPITA L WASTE .................................................. ..................... ............................. ........ 10 5.1: GROUPING OF HOSPITAL WASTE ...... ............................. .................................................. ....... June 10 - SCREENING, AND TREATMENT OF WASTE COLLECTION HOSPITAL ....... .................. 14 6.1 - STORAGE AND SCREENING OF HOSPITAL WASTE ............ .................................... ..................... 14 6.2 - COLLECTION O F HOSPITAL WASTE ...................... ........................................ .......... ........................ 15 6.3 - HOSPITAL WASTE TREATMENT .......... ......... .................................................. ................... ... 15 6.3.1 - Incineration ...................... ............................. ..................... .................................................. ... 15 6.3.2 - Disinfection ......................................... ................. ................................. ................................ 16 6.3.3 - Ch emical disinfection ........... ................................................ .. .................................................. 17 6.3.4 - Thermal Disinfe ction ........................................... .............................. .................... Autoclave ............................... ................. 17 .................................................. ......................... ......................... Microwave ............................................ .. .. 17 .................................................. Incineration versus autoclaving ........................................ 18 ...... ................. ................................. .............................................. July 18 - PROCEDURES TREATMENT ADVANTAGES AND DISADVANTAGES ................... .............. 19 7.3 - A MATTER OF COMMON SENSE .... .......................... ........................ .................................................. 20 . ...... 7.4 - a legal question ..................................... ............ ...................................... ................................... 20 7. 5 - A QUESTION TÉCNICA1 ......... .............................................. .... .................................................. ......... 21 7.6 - an ec onomic issue ................................... ............................... ................... .............................. August 22 - CONCLUSION ...... .......... .................................................. .................. ................................ .................. September 23 - BIBLIOGRAPHY ............................ .................................................. .................................................. .. 25 2 0 - Introduction This paper aims to respond to a moment of evaluation of the discipline of Commun ity Nursing, part of the 1st year of the Bachelor of Nursing School of Health So usa Valley, whose theme focuses on the treatment of medical waste and its effect on global warming. Global warming is a natural phenomenon, due to the release o f gases resulting from human activity has increased. Solar radiation that affect s the land part is reflected by the atmosphere while the other is absorbed by th e Earth generate heat which is radiated in the form of infrared radiation. The g

reenhouse gases absorb part of the infrared radiation of longer wavelengths. The main greenhouse gases released by human activities are CO2 (results from burnin g fossil fuels, the burning of forests to obtain land for farming), methane (ori ginated in rice paddies and livestock), nitrous oxide (derived fuel fossils and chemical fertilizers);€chlorofluorocarbons (used as aerosol propellants and refr igerant gases). Besides the aforementioned, we can find the treatment of medical waste another factor that contributes to global warming. So we do a little on t he approach that these are the type of separation used among others. 3 With the excess waste production, and subsequent treatment of waste, there is an increase of gases released into the atmosphere which promotes the deterioration of global warming, with consequences such as rising sea levels, climate change, which affect the availability of water and food due to prolonged droughts, heat waves, floods and severe storms. 4 1 - What is waste According to Decree-Law No. 152/2002 of May 23, by means waste any substance or object which the holder discards or intends or is required to discard, pursuant to Decree-Law No. 239/97 of September 9 and in accordance with the EU Waste List Europeia.1 1 http://www.aguaonline.co.pt/aguasresid/sobre.htm 5 2 - Classes of Waste: Class 1 - Hazardous Waste: those that pose health risks public and the environment, requiring special treatment and disposal according t o their characteristics of flammability, corrosivity, reactivity, toxicity and p athogenicity. Class 2 - Non Hazardous Waste: waste that are not present danger, but are not inert, may have properties such as combustibility, biodegrad ability and water solubility. Are basically the waste with the characteristics o f household waste. Class 3 - Inert waste: those which, when subjected to Solubilization tests (ABNT NBR-10 007), have any constituents dissolved in conce ntrations above the drinking water standards. This means that when drinking wate r will remain in contact with the waste. Many of these wastes are recyclable. Th ese wastes do not degrade or not decompose when placed in the soil (they degrade very slowly). Fall into this classification, for example, demolition debris, st ones and sand taken from escavações.2 2 http://www.inresiduos.pt 6 3 - Solid Waste Definition: According to Decree-Law No. 239/97 of September 9, are household waste or similar wastes, because of its nature or composition, particu larly those from the service sector or in commercial or industrial establishment s and units providing health care, provided that in either case, the daily produ

ction does not exceed 1100 liters per producer. Origin: Within any urban space can be considered as main sources of waste households (dwellings), trade and services (hotels, shops, offices) and industry (there is a trend away from this sector to the periphery of urban areas). Wastes originating from the set are generated from cleaning pub lic, whether by human activity (markets, stroke vehicles or containers and disca rded object directly to the public highway) or by natural causes (tree leaves, a nimal droppings). Are still considered as waste of public cleaning those resulti ng from treatment of public gardens and other areas verdes.3 3 http://pt.wikipedia.org/wiki/Lixo 7 3.1 - Types of Waste - Glass - Plastics - Organic matter - Paper and Board. 8 4 - Industrial Waste Definition: According to Decree-Law No. 239/97 of September 9 are waste generated in industrial activities, as well as those resulting from the ma nufacture and distribution of electricity, gas and water. Origin: Originated in the activities of various branches of industry such as the metallurgical, chemical, petrochemical, stationery, food industry, etc.. The industrial waste is quite varied and can be represented by ash, sludge, oils , alkalines or acids, plastics, paper, wood, fiber, rubber, metal, slag, glass, ceramics. This category includes a great amount of toxic waste. This type of was te needs special treatment for its potential to envenenamento.4 4 http://www.aguaonline.co.pt/aguasresid/sobre.htm 9 5 - Hospital Waste Definition: According to Decree-Law No. 239/97 of September 9 are waste generated in units to provide health care, including medical activities in diagnosis, prevention and treatment of disease in humans or animals, and even r esearch activities related. From discarded by hospitals, pharmacies, veterinary clinics (cotton, syringes, needles, remnants of drugs, gloves, dressings, clotted blood, organs a nd tissues removed, culture media and animals used in testing, synthetic resin, photographic film X-ray). Depending on their characteristics, requires special a ttention in packaging, handling and final disposal. Must be incinerated and the waste taken to a landfill sanitário.5 5.1: Grouping of hospital waste Clinical wastes are grouped as follows: Group I: do not require special care in their treatment because they are treated as waste. Examples:-wastes from offices, meeting rooms, lounges, toilets

, and others-waste from shops, gardens, warehouses and others; 5 http://www.aguaonline.co.pt/aguasresid/sobre.htm 10 Packaging and common-wrappers;-Waste from the activities of restaurants and hote ls, and debris resulting from preparation of food served to patients than in Gro up III. Packaging and common-wrappers;-Waste from the activities of restaurants and hotels, and debris resulting from preparation of food served to patients tha n in Group III. Group II: Do not require special care in their treatment because they are treated as waste. Examples:-Material orthopedic uncontaminated and without trace s of blood, disposable diapers and no guards and no traces of contaminated blood -personal protective equipment used in general support services, other than the one used in waste collection;-empty packaging of drugs or products or common cli nical use, except in Group III and Group IV, non-contaminated vials of serum, wi th the exception of group IV. 11 Group III: contaminated wastes that are expected, and with biological risk. In these cases it is demanding the use of more effective treatments (incineratio n or pre-treatment). Examples:-waste from patient rooms or wards (or suspected) infection, hemodialysis units, the operating units, the treatment rooms, autopsy rooms, among others, all materials used in dialysis, non-anatomical parts ident ifiable;-waste resulting from the administration of blood and blood products;-sy stems used in the administration of serums and medicines, with the exception of group IV;-collecting bags of fluids and related systems;-infected orthopedic mat erial;-guards and disposable diapers contaminated personal protective equipment, used in healthcare and support services in general there is contact with contam inated products. Group IV: specific hospital waste - waste of various types of incineration mandatory. Examples: 12 -Recognizable anatomical parts, fetuses and placentas, until publication of spec ific legislation;-corpses of animals (laboratory experiments);-cutting and pierc ing materials: needles, catheters, and all the stuff invasive;-chemicals and pha rmaceuticals discarded when not subject to specific legislation;-Cytostatic and all materials used in handling and administration. Of the four groups of hospita l waste, only groups III and IV are considered hazardous. The former are biohaza rd waste, contaminated, and material used in dialysis, napkins and scraps of blo od, and can be incinerated or receive pre-treatment for disposal as waste. In gr oup IV are specific hospital waste, including fetuses and placentas, needles, ex pired medicines, and is required for incineration and treatment. 13 6 - Sorting, Collection and Treatment of Hospital Waste 6.1 - Screening and storage of Hospital Waste The sorting and packaging of medical waste should be done with the place where h e gave his production, and packaged so as to clarify its origin and group: Not a ll wastes are present the same danger, so it is ranked second largest or lower r isk that their presence implies Group I and II - black containers. Group III - showing white biohazard up IV - red (except cutting and piercing material, which Gro

must be stored in containers or containers imperfuráveis). It should be noted al so that the containers used in group III and IV should be easily manageable, dur able and waterproof, keeping airtight, washable and desinfectáveis if they are m ulti-purpose storage of clinical waste must be carried out at a specific site an d signaled, in order to separate the Group I and II of III and IV.€The storage a rea should be sized according to the frequency of collection and / or eliminatio n, and its ability to meet minimum three days of production. If this deadline is exceeded, up to 7 days, there should be refrigerated conditions in the storage area. 6 6 http://www.netresiduos.com/cir/rhosp/introrhosp.htm 14 The fate of the medical waste poses serious problems in view of its nature - a c onsiderable portion is contaminated by biological or chemical is hazardous and r adioactively. 6.2 - Disposal of Hospital Waste They are also blamed the management bodies of each health unit the following mea sures: awareness and training of personnel engaged in general and that particula r sector, particularly in aspects related to personal protection and the correct procedures, signing of protocols with other units health or resource to entitie s duly licensed, when do not have a treatment capacity of its waste; date regist er of waste produced. 7 6.3 - Treatment of Hospital Waste 6.3.1 - Incineration Currently, medical waste produced are mostly subjected to treatment by incinerat ion. Incineration is a treatment process of industrial solid waste, defined as t he chemical reaction in which combustible organic materials are gasified in a pe riod of time fixed in advance, giving an oxidation of the waste with the help of oxygen contained in air that is supplied in excess of stoichiometric needs. Thi s process of thermal decomposition of waste has, over recent years, technologica l advances, and the modern design of pyrolytic incinerators two stages governed by the following principles: temperature, residence time and turbulence. In the first stage, called 7 http://www.netresiduos.com/cir/rhosp/introrhosp.htm 15 pyrolysis, the residues are subjected to temperatures of 650-800 º C, in an envi ronment with lack of oxygen which gives complete combustion, with formation of g aseous fuels. In the second stage (the term reactor), takes place the combustion gases from the pyrolysis temperature of 1100 ° C for 2 seconds at least, in the presence of excess oxygen to ensure complete combustion. The operation of an in cineration plant can be considered correct if the solid waste from combustion ash and slag - and the gases emitted into the atmosphere is sterile and does not contribute to environmental pollution of soil and air, thus facilitating soluti ons final destination. It is therefore necessary to treat the gaseous emissions due to the type of waste (chlorinated) from the material incinerated. The therma l energy, originated in the burning of waste can be used to heating by steam, or be used to produce electricity, and we can recover half the energy dissipated. Because of their environmental risks and costs, the incineration process should be used only when no other alternative technologies for the treatment of certain types of resíduos.8

6.3.2 - Disinfection Disinfection, chemical or thermal energy, appears as a treatment alternative to incineration. The disinfection technologies is best known for chemical treatment , autoclaving and microwave. These alternative technologies for treatment of a m edical waste permit routing of processed waste to the normal waste 8 https: / / repositorium.sdum.uminho.pt/bitstream/1822/361/2/Corpo + of + tese.pd f 16 Solid (MSW) without any danger to public health and may represent a lower cost t o the institutions without incineration itself. The main disadvantage of this te chnology is that only disinfect the waste, which makes its implementation relati vely inefficient chemical and radioactive material. 6.3.3 - Chemical Disinfection The chemical treatment consists of a series of cases in which the waste is invol ved and / or injected with solutions disinfectants and germicides such as sodium hypochlorite, ethylene oxide and formaldehyde, although recently they are being put to use disinfectant cleaner. The processes can be complemented with a crush ing, prior or subsequent, and / or compression, always needing treatment of liqu id and gaseous effluents. This treatment is used primarily for the decontaminati on of waste from microbiology laboratories, waste of blood and body fluids as we ll as cutting and piercing. 9 6.3.4 - Thermal Disinfection Autoclaving Autoclaving (moist heat disinfection) is a treatment that is quite usual to keep the contaminated material at an elevated temperature and in contact with water vapor for a period of time sufficient to destroy potential pathogens, or reduce them to a level which does not pose risk. The process includes autoclave cycles of compression and decompression in order to facilitate contact between the vapo r and waste. 9 https: / / repositorium.sdum.uminho.pt/bitstream/1822/361/2/Corpo + of + tese.pd f 17 The usual values of pressure are the order of 3 to 3.5 bar and the temperature r eaches 135 º C. Values This process has the advantage of being familiar to healt h professionals, who use it to sterilize various types of hospital supplies. Microwave The microwave irradiation is a newer technology for treatment of hospital waste and consists of disinfection of the waste to a high temperature (between 95 and 105 ° C), which are crushed before or after this operation. The heating of all s urfaces is achieved by creating a mixture of water and waste .10 Incineration versus autoclaving Medical waste biohazard belonging to group III can be incinerated or subject to an effective treatment that would allow its disposal as waste, whereas group IV includes specific hospital waste incineration mandatory. In this study there was an area of about incineration to autoclaving as final treatment of waste of gro up III, there are also two cases where chemical disinfection is used. Since the incineration and sterilization are the most used treatments in our country for t reatment of group III, is presented in Table 1 summarize the advantages and disa dvantages of each.

10 https: / / repositorium.sdum.uminho.pt/bitstream/1822/361/2/Corpo + of + tese.pd f 18 7 - Procedures for the processing advantages and disadvantages 7.1 - Incineration - effective in treating all waste; - Weight reduction to 10% - Reduction of volume to 3% - Recovery and / or energy production; - No smells - High cost of investment and exploitation; - significa nt need for treatment of waste gases - Negative Feedback population. 7.2 - Autoclavegem - low operating cost; - Reduced volume (20%) - Case considered clean, not requiring environmental impa ct assessment - Use restricted to biohazard waste; - Production of liquid and ga seous effluents, although minor 19 7.3 - A question of good senso11 The separation of medical solid waste is primarily a matter of common sense, res ponsibility and habit. The success of screening of medical solid waste depends o n all health professionals, who as producer of medical solid waste has the neces sary training to identify and separate waste correctly and efficiently - not tre ated as hazardous or municipal - Hazardous point microbiology and / or chemical, the waste likely to cause disgust sensitivity and negative public opinion, shou ld be careful separation and packaging. 7.4 - A question legal12 The medical solid waste are subject to specific rules published in the Official Gazette. The orders of the State Gazette No. 242/96, of August 13 and No. 761/99 of August 31, establish rules for the management of medical solid waste in part s of the sorting, packing selective collection, storage, transportation and trea tment. The hospital waste must be separated into groups. December 11 Infection Control Committee of the Hospital Padre Américo - Penafiel 20 7.5 - A question técnica1 To implement an efficient screening and operational, it is necessary to provide clinical services institutions and their means of handling solid waste hospital needed to perform this activity. The containers for packaging of medical solid w aste currently in Health Care are: - Plastic bags - cardboard boxes and containe rs of high density polyethylene reusable - plastic containers for single use, co ntainers for storing solid waste in hospitals, should include features to allow a clear identification of their origin (the service and date) and waste group, f rom actors. The adoption of color codes for the containers is essential for this purpose, according to the order 242/96, of August 13. 21 7.6 - A question económica13 By carefully separating the waste produced,€savings achieved due to: - Reduce th e amount of waste likely to specific treatment - Reduction of treatment costs Separate collection of recyclable waste - promoting green image of the Instituti

on of Health; 13 Infection Control Committee of the Hospital Padre Américo - Penafiel 22 8 - Conclusion The preparation of this work provided an explanation on hospital waste, the trea tment to which they are subject and its effect on the environment. The treatment of hospital waste causes besides a prior willingness of professionals to an eff icient screening, high costs and negative environmental impact. An awareness of certain medical waste (blood, secretions, ionized material, chemicals and human tissues), while outbreaks, constitute a danger to public health has become more acute from the development of serious diseases, such as AIDS and hepatitis B. Th is led to increased concerns about the care of hospital waste. Indeed, the heter ogeneity of the mass of medical waste and lack of preparation for incineration p lants for the processing of increasing amounts of waste have led to the impossib ility of compliance with emission limits for gases increasingly strict. Efforts to remedy this situation and that include the installation of incineration large r and adequate treatment of gaseous emissions that cause costs currently contrib uting to a significant increase in costs of medical institutions. Thus, it has b ecome necessary to develop different management practices of hospital waste whic h allow reducing the amount of waste to be treated and the introduction of alter native treatment processes for incineration. 23 The developments that occurred in the concepts that support the management of ho spital waste determined the need for a classification that would guarantee a mor e selective separation at source and enable the use of diverse processing techno logies. He qualified medical waste into four distinct groups, and the waste trea ted differently according to the appropriate group to which they belong. 24 9 - Bibliography

http://www.aguaonline.co.pt/aguasresid/sobre.htm http://www.inresiduos.pt http:/ /pt.wikipedia.org/wiki/Lixo http://www.aguaonline.co.pt / aguasresid / sobre.htm http://www.aguaonline.co.pt/aguasresid/sobre.htm http://www.netresiduos.com/cir /rhosp/introrhosp.htm http://www.netresiduos.com/ cir / rhosp / introrhosp.htm h ttps: / / repositorium.sdum.uminho.pt/bitstream/1822/361/2/Corpo + of + TES e.pd f Control Commission of Hospital Infection, Hospital Padre Américo - Penafiel

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