injection waste management. waste management is a process not a technology issue alone it requires a...
TRANSCRIPT
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Injection Waste
Management
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• Waste Management is a process
• Not a technology issue alone
• It requires a change in way of thinking
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Introduction• Waste management for Pediatricians
– At Hospital
– At PHC.
– Immunization clinic.
• Waste management at community level
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Problem
• Hazardous needle waste generated at clinics &
hospitals needs to be secured and prevented from
being accessed.
• This is possible by:1.Bringing awareness among health workers, community about
potential hazards of sharp waste.
2.Minimizing, segregating, decontaminating (disinfecting) the
hazardous waste at site
3.Destroy (mutilate) used items to prevent their reuse.
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Current Scenario• Segregation of hazardous needle waste in many health
facilities, is not well established
• In some cities, small towns & villages common facility for disposal or proper open land for digging deep pits does not exist.
• Needle waste is frequently dumped along with the municipal
garbage.
• Few large hospitals are have incinerators
• Some hospitals are segregating, disinfecting and mutilating and
disposing to authorized private vendors or in pits.
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WHAT IS NEEDED?All Biomedical waste has to be
– Minimized.
– Segregated.
– Disinfected.
– Transported and
– Disposed off in a environmental friendly manner.
Biomedical waste should not be mixed with other
wastes.
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75-90%Non Clinical Waste
10-25%Clinical Waste
Pharmaceutical
Hospital waste
Pathological Genotoxic
Pressurized containersNeedles
Infectious
ChemicalWaste with heavy Metal content
Radioactive waste
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Challenges for Sharps Waste
Fear of HIV transmission
through Dirty needles
Funding for Curative injection equipment &
it’s Disposal
Mass immunization campaign
Environmental concerns
Over sharp waste disposal
Funding for Health Care Waste Disposal
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Immunization sharps wasteWaste from hospital and clinical
1%
1%
3% 80%
15%
Pathological and infectious wasteSharps wastechemical pharmaceutical wasteSpecial waste (radioactive, cytostatic)non-infectious
• Needles represents 1% of Health Care Waste
• Immunization injections represents approximately 5 % of injections
• Immunization sharps waste has to be integrated into the overall Health care Waste management
Source: Safe Management of wastes from Health Care activities (geneva, WHO, 1999)
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General principles
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Major Considerations
• Minimization
• Segregation
• Transport
• Collection
• Storage
• Treatment
• Disposal
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Segregation
• Needles should be segregated at source.
• Clinical staff is responsible for segregating the waste at
source.
• Appropriate container and different type of waste containers
have to be placed at different points as per the act. e.g.: in
the ward, OT, ICU’s, clinics.
• Awareness program is essential and posters for segregating
should placed at the site.
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Color Coding of Waste Collection Bags / Container
Yellow Infectious Waste for Incineration, Non Plastic, contaminated with body fluids
Blue/ White Needles/Sharps/glass/blades
Red Infectious waste for autoclave/ Microwave, Rubber & Plastic catheters,tubes.
Black General/Domestic waste
Sanitary Landfill / for composting
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Segregation – where?
• Containers should be placed at strategic
and easily accessible locations
• Blue /white translucent puncture proof
containers should be used.
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Segregation – where? • Needles:
– Should not be re capped, mutilated by hand – Should be disinfected first – Needle should not be disconnected from the
syringe by hand
• Needle and syringe destroyer/Hubcutter should be used at the site of generation
– To disinfect – To reduce the bulk– To prevent reusing
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HANDLING • Containers with needle waste should be picked up
and carried by the handle provided.
• They should not be supported at the bottom with
hands or carried on the back.
• They should not be dropped/thrown
• Containers should be labeled with Biohazard Symbol
• Vehicles used should be authorized.
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CONTAINERS • Sharp decontaminating units (SDU’s) for
syringes and needles are plastic ,puncture
proof containers with handles
– To be filled 1/3 with hypochlorite solution
– Needles after chemical disinfection should be
transferred to puncture proof containers for
shredding
– Should be labeled as sharps only.
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Sharp Containers
UnsafeUnsafeUnsafeUnsafe SafeSafeSafeSafe
•Do not transfer contents to other container
•Do not overfill
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Sharp Containers various innovations
• Leak-proof • Closable with narrow neck
• Puncture- Resistance
• Clearly labeled with warning (easy for the community to understand)
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Selection of Puncture Proof Container (PPC)
The principle
– Diameter of the puncture proof container should be less than
half the length of the smallest syringe’
– This is crucial for preventing needle stick injuries.
– The syringes getting collected (needle pointing down) in the
PPC should not fall horizontally.
– The lid should close tightly and the container should be leak
proof.
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MUTILATION / DESTRUCTION / SHREDDING
• This will reduce the bulk of the waste.
• What types of waste required to be mutilated?
– Needles/syringes
– Plastic disposable
• Hub cutters and Needle/syringe destroyers
mechanical or electrical
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Hub Cutter & Needle Puller Hub Cutter & Needle Puller AdvantagesAdvantages
Reduce needle waste tremendously by separating needles from syringesAllow more flexibility of downstream disposal of sharps
Improve environmental safety
Reduce needle-stick injuries during handling and transport of used syringesReduce numbers of safety boxes for syringe disposal
Further prevent syringe reuse
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MUTILATION / DESTRUCTION / SHREDDING
Specification of electrical destroyers:
1. Should be low voltage electrical equipment
2. Temperature range of 1600 – 1700 c so that
needle is turned to ash in 1-2 sec
3. Should have a receptacle to collect use
4. Should have a cutter to cut the needle of syringe
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TREATMENT & DISPOSAL
• To prevent hazardous to human health &
environment, it is necessary to treat certain wastes
before disposal.
• Onsite treatment is preferred than Offsite
• Chemical disinfectants like 1% Hypochlorite solution
can be used to treat the needle wastes.
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TREATMENT & DISPOSAL • How to disinfect?
– Syringe with needle should be dropped in to
Sharps Disposal Unit, so that both parts are
completely immersed in disinfectant.
– Give a contact time of 30 mins
– When Sharps Disposal Unit is 1/3 full the syringes
and needles are shifted to puncture proof
containers for shredding.
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Disposal at Small Health Units* Disposal at Small Health Units* (SC/PHC/Private Clinics)(SC/PHC/Private Clinics)
Disposable Syringes/Needle/ADSDisposable Syringes/Needle/ADS
Hubcutter/Needle puller
Hubcutter/Needle puller
Needle with HubNeedle
with HubMutilated SyringeMutilated Syringe
Disinfection with 1% Hypochlorite
Disinfection with 1% Hypochlorite
Disinfection with 1% HypochloriteDisinfection with 1% Hypochlorite
Sharps pit / Waste collection agency
Sharps pit / Waste collection agency
Waste collectorsWaste collectors
*GOI&CPCB guidelines
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Terminal Disposal
• Metal equipment – recycle.
• Shredded plastic – recycle
• Plastic Syringes – Mutilate and recycle
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GUIDELINES FOR CLINICS AND CONSULTANTS
• Health waste management at Individual Clinics :– Minimize the use of injections
– Segregate at source
– Treat with disinfectant
– Dispose off to Authorized Waste Management agency
• All health clinics in cities should have proper health waste management.
• The doctors, nurses and attender’s should have awareness and motivated to follow the guidelines to prevent health hazard.
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DO’S 1. Do minimize use of Injections
2. Do segregate infectious sharps waste
3. Do collect in a blue /white transparent colour coded container
4. Do decontaminate all sharp & plastic waste
5. Do train & educate all categories of staff in proper
segregation & handling of waste.
6. Do use Hub cutters & needle destroyers
7. Do use authorized persons/agencies to handle/dispose the
needles.
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Dont’s 1. Don’t mix the infectious & non infectious waste.
2. Don’t throw sharps in the trash/ non puncture proof
containers
3. Don’t recap the needle
4. Don’t disconnect the needle from syringe by hand
5. Don’t use open buckets for infectious waste /sharps
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Be Needle SmartDo NOT recapDo NOT bendDo NOT removeDo NOT transportDo NOT re-use
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