ahmed alassf muwayed al-khnaini. abstract introduction identifying risk factors in the hospital...

Ahmed alassf Muwayed Al-Khnaini

Abstract

Introduction

Identifying Risk Factors in the Hospital (waste ,environment ,technology , people, system)

Focus on medical waste & different type

How we dispose these waste

Abstract Our goal in this research are to focus on very important issue in

medical field.

A lot of people does not realize the sensitivity and important of this issue. But the big problem is that some of the people who works in the medical field (staff) do not consider the dangerous of carelessness in this issue.

Finally, we hope to be part of the persons who contributed to awareness of the importance for this subject.

Scope & definition

What is healthcare safety? Q Is it a matter of checking the resistivity of the electrical wiring system? Or is it focusing on infection control? Or is it ensuring proper water and air

quality within the hospital environment ?

So what does safety mean? Or in other words, when can we say that a certain hospitals is safe?.Let us say that a hospital is safe so, long as it complies with all of the internationally recognized safety standards.

Identifying Risk Factors in the Hospital

There is unlimited number of risk factors.

we try to categorize these factors in five main sources of risk that exist in hospital, waste, environment, technology, people and system.

Let us also keep in mind that these sources of risk are not necessarily mutually exclusive, i.e., they may

interact to cause compound risk

A. Waste

Waste is a general term which refers to material which is produced as-a byproduct or remainder of a certain process not all waste is harmful For instance, biodegradable waste is harmless so long as it is disposed of in a sanitary way.

NOHazardous WasteDescreiptionWhere?

1Infectious wasteContain pathogensCommon infected items are lab cultures, swabs, dinnerware, …

etc

Labs, isolation wards,

operating rooms ...etc.

2Pathological wasteHuman tissue or fluids such as blood or urine.OR, pathology labs ...etc.

3Pharmaceutical wasteDrugs which expired or not Consume fully, Drug containersPharmacies, patient wards.

ICU.OR, ...etc . 

4Radio-pharmaceutical waste

Radioactive substance(inject in blood &out with urine)

Nuclear medicineDept

5Chemical wasteMedical gases, used or expired lab Reagents, film developerOR's, Labs, dark rooms

6Heavy metal wasteLead-acid batteries, mercury from broken thermometersPortablequip ICU,OR

7Skin penetrating hard objects waste

Sharps, needles, broken glassAnywhere in hospital

B. Environment

refer to the ambient conditions in certain space.

temperature, pressure, humidity, air quality, building design and material, electrical supply and water supply.

NOEnvironmental FactorPrecaution & Hazardous Effect

1Ambient ClimateOR temperature must be in the lower twenties (? C)OR pressure must be positive

OR humidity must be set at such a value

2Air qualitybacteria and dust, should be minimized By using HEPA filters , (UV) ultraviolet radiation lamps at OR entrances

3Water qualityDifference between Drinking water quality & water used in hemodialysis

we must concern the purity of water (particulates, ionic level)

4Electrical Supplystability in varying loads, ability to absorb excess charges, its ability to fail safely

5Building DesignIt has direct effects on infection control, fire control, and personal safety such as emergency exits and hazardous area access limitation

6OtherAudio noise, vibration, and electromagnetic waves.

C. Technology

Technology is responsible for producing healthcare hazards through undesirable byproducts or secondary effects which occur simultaneously with the use of technology itself.

TechnologyInherent Hazard

Electrical Supply Electric shock

Medical gasesTank explosion - fire

Electro surgery deviceBurning and scarring of surrounding tissues

Gamma CameraIonizing radiation

Ventilation systemInfection spread'

D. People

The Institute of Medicine (IQM) has recently published a report which shocked both healthcare policymakers and citizens. the report stated that at Least (44.000) Americans die annually from medical error , (70% ) which are preventable . great percentage of these medical errors are purely human errors.

So , become obvious that without highly qualified people, it is impossible to maintain a safe environment.

E. System

The system is the collection of Policies, procedures and practices in the workplace. The system also includes P3 factors dictated by governmental and accredited organizations.

it is essential for any given healthcare facility, regardless of its size and location, to have a safety committee.

Safety committee policies

*The safety committee sets standards on what constitutes a hazardous effect.

*Hazards are ranked and classified according to health risk level.

*The committee must approve sites to host hazardous equipment prior to installation.

*Training of users and technicians on new equipment must include safe operation , emergency actions and essential ppm.

*All health care employees must immediately report any signs of hazardous conditions to designated committee members .

Procedures

* Election of committee members .

*Meeting calendar for the committee.

*Voting on disputed issues.

*Documentation Of findings.

*Survey procedures ( suddenly visits, …)

*Warning signs and labels: size, color, disposal methods,…etc.

Risk factor QAQC

Waste #Use biodegradable or environmentally friendly reagents .

#Dispose of waste safelyand efficiently

Environment #Design the building accordingto safety standards.

#Maintain building regularly .

Technology #Purchase medical equipment which is approved by internationally recognized bodies .

#Use technology within the context of safely.

#Perform routine maintenance and calibration( PPM).

People #Hire highly qualified personnel. #Train personnel regularly and effectively.

System #Set your objectives in accordance with safety.Monitor adherence documenting performance & Correction

Medical Waste

refers to material which is produced as-a byproduct or remainder of a certain process not all waste is harmful For instance, biodegradable waste is harmless so long as it is disposed of in a sanitary way.

How does hospital waste affect us ?

Infectious waste can cause diseases like Hepatitis, AIDS, etc.

When waste containing plastics are burnt, Dioxin is produced, which can cause Cancer, birth defects, hearing defects.

DIFFERENT TYPES OF WASTE:1 .Biohazard Waste

defined as materials of biological origin that are capable of producing an infectious disease in humans and includes at a minimum blood, body fluids.

*Biohazard Sharps Wasteconsists of discarded items such as derived from human patient

diagnosis, care, or treatment.

These items include hypodermic needles, glass containers.

*Biohazard Non-Sharps WasteBlood, blood products, and body fluids classified as infectious.

2.Chemical and Hazardous Waste

Is any chemical material for disposal and includes both hazardous and non-hazardous chemicals.

like lead acid batteries and aerosol cans.

3 .Radioactive Waste

Radioactive waste is any material with detectable radioactivity above background levels.

4 .Universal Waste

a. Batteries

b. Mercury containing lamps

c. Mercury containing items (thermostats, switches, manometers, etc).

d. Electronic items (circuit boards, computer monitors)

5 .General waste General waste is anything which does not fit into other waste categories.

Waste Streams

a. Facilities Management/Engineering *fluorescent bulbs.

* Waste batteries .

* Lithium, Mercury and Silver.

*Used TV monitors .

b. Laboratory/Histology/Pathology* Waste solvents from tissue processing (Example: Formalin).

* Waste tissue stains containing Mercury.

* Discarded or waste diagnostic test reagents.

c. Pharmacy *Waste solvents (Examples: Acetone, Ethyl

Alcohol, Phenol.)

*Outdated or discarded pharmaceuticals.

d. Radiology* Discarded X-ray film.

*Radioactive isotopes being decayed on-site.

Solution for waste disposal

Incinerators: a solution or a threat ?Incineration is treatment method for medical waste for two important reasons. First, incineration is best method of eliminating any infectious organisms in medical waste.

Second, incineration has been economical for hospitals because it substantially reduces the volume to be disposed of in

landfill .

Waste is burnt at very high temperatures, that produce emissions full of acidic gases, heavy metals and toxic organisms, so Incinerators affect on pollution.

Non-incineration Technologies

The technologies will be categorized based on the fundamental processes used to decontaminate waste.

The three basic processes are:

1 .Thermal processes.

2 .Chemical processes.

3 .Irradiative processes.

1-THERMAL PROCESSES That use thermal energy to destroy pathogens in the waste.

This category is further subdivided into low-heat, medium-heat, and high-heat thermal processes. This classification depends on physical and chemical mechanisms of the waste.

AUTOCLAVES: consists of a metal chamber sealed by a charging door and surrounded by a steam jacket. The removal of air from the chamber is essential to ensure penetration of heat into the waste.

Types of Waste Treatedcultures and stocks, sharps, materials contaminated with blood and limited amounts of fluids.

Autoclaves advantages: *Autoclaves are available in a wide range of sizes, capable of

treating from a few pounds to several tons per hour.

*Costs are relatively low compared with other technologies.

Disadvantages: *If hazardous chemicals such as phenol, or mercury are in the

waste, these toxic contaminants are released into the air.

*If the technology does not include a way of drying the waste, the resulting treated waste will be heavier because of condensed steam.

2 .CHEMICAL PROCESSESChemical processes employ disinfectants such as dissolved chlorine dioxide, bleach, peracetic acid, or dry inorganic chemicals.

Types of Waste TreatedCultures and stocks, sharps, isolation and surgery wastes, laboratory waste.

Chemical advantages: *Well-automated and easy to use.

*No combustion byproducts are produced .

Disadvantages: *Chemical hazards are a potential problem with chemical-based

systems.

*Noise levels can be very high.

3 .IRRADIATIVE PROCESSESIrradiation-based technologies involve electron beams or UV irradiation. These technologies require shielding to prevent occupational exposures.

Types of Waste TreatedSoft wastes (bandages, drapes, bedding, …etc.)

Irradiative advantages: *The technology is well-automated and requires little operator

time.

*This technology is noiseless & low operating cost.

Disadvantages: *Personnel must be protected from radiation exposure.

*Any large, hard metal object in the waste can damage any shredder or grinder.

FACTORS TO CONSIDER IN SELECTING A TECHNOLOGY

*Capacity & Cost.

*Types of waste treated.

* Space requirements.

*Reduction of waste volume and mass.

* Noise and odor.

* Community and staff acceptance.