HOSPITAL WASTE

MANAGEMENT

Dr. Sehrish Zehra

EMERGING AND RE-
EMERGING INFECTIOUS
DISEASES
EMERGING INFECTIOUS DISEASES.
• Emerging infectious diseases are those whose incidence in
humans has increased during the last two decades or which
threaten to increase in the near future.
• The term also refers to newly-appearing infectious diseases, or
diseases that are spreading to new geographical areas.
• Examples includes: Covid-19 Pandemic, Ebola virus disease,
SARS, hanta virus pulmonary syndrome etc.
Reasons:
• Previously unknown or undetected disease
• Known agents spreading to new geographical locations.
• Previously known agent whose role in specific disease has
been unrecognized.
RE-EMERGING INFECTIOUS DISEASES
• The term re-emerging diseases refers to the diseases which
were previously easily controlled by chemotherapy and
antibiotics, but now they have developed antimicrobial
resistance and are often appearing in epidemic form.
Reasons:
• The increasing use of antimicrobials in sub therapeutic doses.
• Changes in lifestyle(including injecting and non-injecting drug
use)
• The practices of modern medicine also contribute. For e.g
spread of viral hepatitis related to kidney dialysis and multiple
blood transfusions.
• Relaxation in immunization practices can quickly result in the
resurgence of diseases,
• Travel causing increase human mobility
CONTROL OF EMERGING & RE_EMERGING
DISEASES:

1. Early diagnosis & prompt treatment

2. Vector control measures and prevention of epidemics for
malaria & DOTS for tuberculosis
3. Investigation to identify the source of transmission
4. Research for treatment, diagnosis, drugs and vaccine
5. Strengthening epidemiological surveillance
HOSPITAL-ACQUIRED INFECTION
• It is a cross infection of one patient by another or by doctors,
nurses and other hospital staff, while in hospital.
• A high frequency of nosocomial infection is evidence of a poor
quality of health. service delivery.
Definition of nosocomial infections:
• Nosocomial infections, also called "hospital-acquired
infections", are infections acquired during hospital care which
are not present or incubating at admission.
• Infections occurring more than 48 hours after admission are
usually considered nosocomial.
• The four most common nosocomial infections are urinary tract
infections, surgical wound infections, pneumonia, and primary
bloodstream infection.
Preventive measures
• The main preventive measures are :
(a) Isolation :
• Infectious patients must be isolated.
• Patients susceptible to infection should not be placed in beds
next to infectious patients.
(b) Hospital staff :
• Those who are suffering from infection like skin diseases, sore
throat, common cold, diarrhea etc, should be kept away from
work until completely cured.
• They should be careful about personal hygiene and in regular
changes of aprons and outer clothing.
(c) Hand-washing :
• When dealing with patients, hand-washing must be thorough.
• If needed, a suitable alcohol-based disinfectant must be used.
(d) Dust control :
• Hospital dust contains numerous bacteria and viruses & is
released during sweeping, dusting and bed making.
• Suppression of dust by wet dusting and vacuum cleaning can
be done
(e) Disinfection :
• The articles used by the patient as well as patient's urine,
faeces, sputum should be properly disinfected.
• SProper sterilization of instruments should be enforced.
(f) Control of droplet infection :
• Use of face masks, proper bed spacing, prevention of
overcrowding and ensuring adequate lighting and ventilation
are important control measures.
(g) Nursing techniques :
• Barrier nursing and task nursing have also been recommended
to minimize cross infection.
(h) Administrative measures :
• There should be a hospital "Control of Infection Committee"
to formulate policies relating to control of hospital acquired
infection
Bio-Medical Waste/ Hospital
Waste/ Health care waste:
Definition:
Any waste which is generated during the diagnosis, treatment or
immunization of human beings or animals, or in research
activities and has any potential to produce biological, chemical,
radioactive or physical hazard is called health care waste.
Sources of health-care waste
Government hospitals, private hospitals, nursing homes.
Physician's office/clinics. Dentist's office/clinics. Dispensaries.
Primary health centres. Medical research and training
establishments. Mortuaries. Blood banks and collection centres.
Animal houses. Slaughter houses. Laboratories. Research
organizations. Vaccinating centres, and Bio-technology
institutions/production units.
Amount of health care waste
• High income countires generate on average upto 0.5 kg of
hazardeous waste per bed per day
• Low income countires generate on average upto 0.2 kg of
hazardeous waste per bed per day
Classification of health-care waste
1. Non- hazardous or General waste :
• Between 75 to 90 per cent of the waste produced by the
health-care providers is non-risk or "general" health-care
waste
• It does not pose any biological, chemical, radioactive or
physical hazard.
• It comes mostly from administrative and house keeping
functions of the healthcare establishments, and may also
include waste generated during maintenance of health-care
premises.
2. Hazardous waste :
• The remaining 10-25 per cent health-care waste is regarded as
hazardous and may create a variety of health risk
Classification of Hazardous health-care waste
Health hazards of health-care
waste
1. Hazards from infectious waste and sharps
• Pathogens in infectious waste may enter the human body
through a puncture, abrasion or cut in the skin, through
mucous membranes by inhalation or by ingestion.
• There is particularly the risk of HIV, hepatitis virus B and C.
2. Hazards from chemical and pharmaceutical waste
• Many of the chemicals and pharmaceuticals used in health-
care establishments are toxic, genotoxic, corrosive,
flammable, reactive, explosive or shock-sensitive.
• Although present in small quantity they may cause
intoxication, either by acute or chronic exposure, and injuries,
including burns. Disinfectants when used in large quantities
and are often corrosive
3. Hazards from genotoxic waste
• Hazardous waste that may have mutagenic, teratogenic or
carcinogenic properties
• The severity of the hazard is governed by a combination of the
substance toxicity itself and the extent and duration of
exposure.
• Exposure may also occur during the preparation of or
treatment with particular drug or chemical.
• The main pathway of exposure is inhalation of dust or
aerosols, absorption through the skin, ingestion of food
accidentally contaminated with cytotoxic drugs, chemicals or
wastes etc.
4. Hazards from radio-active waste
• The type of disease caused by radio-active waste is
determined by the type and extent of exposure.
• It can range from headache, dizziness and vomiting to much
more serious problems.
• Because it is genotoxic, it may also affect genetic material.
5. Public sensitivity
• Apart from health hazards, the general public is very sensitive
to visual impact of health-care waste particularly anatomical
waste.
Bio-Medical Waste Management
• The hazardous waste should be separated from non-
hazardous waste at the point of waste generation. For e.g OT,
labour room, laboratory etc.
• This can be achieved by segregating the bio-medical waste
into specific colour containers/bags.
• In Pakistan, mostly, three colour bins are used:
1. Yellow:
• Waste type that should be disposed in yellow containers
include human waste, tissue, organs or bodily fluids and all
sharp materials
2. Red:
• It should be used to dispose hazardous waste materials like IV
tubes, catheters, tubing or syringes (without needles) and
blood stained swabs.
3. Green:
• Non- infected plastic material like papers, cardboards, office &
food waste and disposed in it.
WHO recommended segregation and collection scheme

*Source: https://apps.who.int/iris/bitstream/handle/10665/259491/WHO-FWC-WSH-17.05-
eng.pdf?sequence=1
• Labelling of waste containers is used to identify the source,
record the type and quantities of waste produced in each area
• A simple approach is to attach a label to each filled bag with
the details of the medical area, date and time of closure of the
bag and the name of the person filling out the label.
• It is also recommended to use an international hazard symbol
on each waste bag if not already applied.
• the label for bio-hazards symbol and cytotoxic hazard symbol
which should be prominently visible and non-washable.
Treatment and disposal
technologies for healthcare waste
I. Incineration
• Incineration is a high temperature dry oxidation process, that
reduces organic and combustible waste to inorganic
incombustible matter and results in a very significant
reduction of waste-volume and weight.
• The process is usually selected to treat wastes that cannot be
recycled, reused or disposed off in a land fill site.
• Incineration requires no pre-treatment, provided that certain
waste . types are not included in the matter to be incinerated
• Waste types not to be incinerated are :
(a) pressurized gas containers;
(b) large amount of reactive chemical wastes;
(c) silver salts and photographic or radiographic wastes;
(d) Halogenated plastics such as PVC;
(e) waste with high mercury or cadmium content, such as
broken thermometers, used batteries, and lead-lined wooden
panels;
(f) sealed ampules or ampules containing heavy metals
TYPES OF INCINERATORS
(a) Double-chamber pyrolytic incinerators:
• These are especially designed to burn infectious health-care
waste
Advantages:
• Very high disinfection efficiency.
• Adequate for all infectious waste and most pharmaceutical
and chemical waste.
Disadvantages·
• Incomplete destruction of cytotoxins.
• Relatively high investment and operating costs.
(b) Single-chamber furnaces with static grate:
• These should be used only if pyrolytic incinerators are not
affordable
Advantages:
• Good disinfection efficiency.
• Drastic reduction of weight and volume of waste.
• The residues may be disposed off in landfills.
• No need for highly trained operators.
• Relatively low investment and operating costs.
Disadvantages·
• Significant emissions of atmospheric pollutants.
• Need for periodic removal of slag and soot. ·
• Inefficiency in destroying thermally resistant chemicals and
drugs such as cytotoxins.
(c) Rotary kilns operating at high temperatures:
• These are capable of causing decomposition of genotoxic
substances and heat-resistant chemicals.
Advantages:
• Adequate for all infectious waste, most chemical waste and
pharmaceutical waste.
Disadvantages·
• High investment and operating costs.
II. Chemical disinfection
• Chemicals are added to waste to kill or inactivate the
pathogens it contains, this treatment usually results in
disinfection rather than sterilization.
• Chemical disinfection is most suitable for treating liquid waste
such as blood, urine, stools or hospital sewage.
• However, solid wastes including microbiological cultures,
sharps etc. may also be disinfected chemically with certain
limitations.
III. Wet and dry thermal treatment
A. WET THERMAL TREATMENT :
• Wet thermal treatment or steam disinfection is based on
exposure of shredded infectious waste to high temperature,
high pressure steam, and is similar to the autoclave
sterilization process.
• The process is inappropriate for the treatment of anatomical
waste and animal carcassess, and will not efficiently treat
chemical and pharmaceutical waste.
B. SCREW-FEED TECHNOLOGY :
• Screw-feed technology is the basis of a non-burn, dry thermal
disinfection process in which waste is shredded and heated in
a rotating auger.
• The waste is reduced by 80 per cent in volume and by 20-35 %
in weight.
• This process is suitable for treating infectious waste and
sharps, but it should not be used to process pathological,
cytotoxic or radio-active waste.
IV. Microwave irradiation
• Most microorganisms are destroyed by the action of
microwave of a frequency of about 2450 MHz and a wave
length of 12.24 nm.
• The water contained within the waste is rapidly heated by the
microwaves and the infectious components are destroyed by
heat conduction.
• The efficiency of the microwave disinfection should be
checked routinely through bacteriological and virological tests.
V. Land disposal
MUNICIPAL DISPOSAL SITES :
• If a municipality or medical authority genuinely lacks the
means to treat waste before disposal, the use of a landfill has
to be regarded as an acceptable disposal route.
• There are two types of disposal :
1. Land-open dumps
2. Sanitary landfills
• Health-care waste should not be deposited on or around open
dumps.
• The risk of either people or animals coming into contact with
infectious pathogens is obvious.
• Sanitary landfills are designed to have at least four advantages
over open dumps :
I. geological isolation of waste from the environment,
II. appropriate engineering preparation before the site is ready
to accept waste
III. staff present on site to control operations
IV. organized deposit and daily coverage of waste.
VI. Inertization
• The process of "inertization" involves mixing waste with
cement and other substances before disposal, in order to
minimize the risk of toxic substances contained in the wastes
migrating into the surface water or ground water.
• A typical proportion of the mixture is: 65% pharmaceutical
waste, 15 % lime, 15 % cement and 5 % water.
• A homogeneous mass is formed and cubes or pellets are
produced on site and then transported to suitable storage
sites.