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Essay on Medical and Hospital Wastes
Essay # 1. Introduction to Medical and Hospital Wastes:
It is ironical that hospitals which provide succour to the ailing can also create health hazards. Indiscriminate disposal of hospital wastes is indeed one of the major sources for spread of pollution and infection.
Bio-medical wastes from the hospitals, nursing homes and clinics include a variety of wastes, such as hypodermic needles, scalpel blades, surgical gloves, cotton, bandages, clothes, medicines, blood and body fluid, human tissues and organs, body parts, radio-active substances and chemicals.
Some of these contain harmful organisms and disease causing agents. For instance, reuse of discarded syringes/needles without disinfection can transmit lethal diseases, like AIDS and hepatitis.
Similarly, indiscriminate recycling of used cotton, clothes and medicines can pose a host of health hazards. Also, improper incineration of wastes, particularly chlorinated organic compounds, can result in noxious emissions, including dreaded dioxin.
Hence, there is no option but to ensure that the wastes of different categories are properly segregated and rendered harmless through physical separation, disinfection, disposed in secure landfill and incinerated, depending on the nature of the wastes.
However, the bio-medical wastes are not handled with the clinical care as needed to avoid the problems otherwise caused. More often than not, mixed biomedical wastes of different kinds are discarded together for disposal along with the municipal wastes.
A good amount of reusable materials, such as needles, syringes, plastics and bottles, is picked up by ragpickers, and are recycled back into the market without any treatment for disinfection the consequences of which could be anybody’s guess.
Bio-medical waste may be defined as any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals and the animal waste from slaughter houses or any other like establishments.
It is of utmost importance that the medical waste is managed in an environmentally sound manner. Environmentally-sound management of the medical waste requires proper understanding of risks associated with the disposal of such wastes, and methods for proper segregation, storage, handling, treatment and disposal.
The medical wastes, which are amenable to specific treatment/disposal methods, are grouped into the following categories:
(i) General Waste – All non-hazardous hospital wastes, similar in nature to domestic wastes.
(ii) Sharps – These include hypodermic needles, syringes, scalpel blades, blood specimen tubes, Pasteur pipettes and broken glass that have been exposed to infectious agents.
(iii) Culture and stocks of infectious agents and associated biological – Specimen cultures from medical and pathological laboratories; cultures and stocks of infectious agents from research and industrial laboratories; wastes from the production of biological; and discarded live and attenuated vaccines; culture dishes and devices used to transfer, inoculate, and mix cultures.
(iv) Bulk human blood and blood products – Human blood, products of blood, items saturated and with the potential for dripping blood, serum, plasma, and other blood components, including the soiled waste.
(v) Pathological wastes – Human tissues, organs, body parts and body fluids that are removed during surgery and postmortem procedures, with the exception of teeth, faeces, excreta and corpses and body parts intended for interment or cremation.
(vi) Isolation wastes – Wastes contaminated with blood, excretions, exudates, or secretions from sources isolated to protect others from highly communicable infectious diseases.
(vii) Animal waste – Contaminated animal carcasses, body parts, fluids and bedding of animals that have been exposed to infectious agents during research (including research in veterinary hospitals), production of biological, or testing of pharmaceuticals.
(viii) Radio-active waste – From administering radio-pharmaceuticals and performing nuclear medicine procedures and radio-immunology procedures.
(ix) Antineoplastic (cytotoxic) drugs – Trace contaminated materials and contaminated human excreta (cytotoxic chemicals are hazardous pharmaceuticals used in chemotherapy, which in addition to being toxic are mutagenic and/or teratogenic when discarded or spilled).
(x) Chemical waste – Showing ignitability, corrosivity, reactivity or the ability to produce toxic leachate in a landfill.
According to a WHO report, around 85% of the hospital wastes are actually non-hazardous, 10% are infectious, and 5% are non-infectious but hazardous.
In India, no proper quantification of hospital wastes has been done. A study conducted by Vatavaran, a non-government organisation, in Delhi, shows an average waste generation rate of 1.5 kg/bed/day, and around 45.5% of the total wastes is infectious in nature.
Essay # 3. Segregation, Storage and Transportation of Medical and Hospital Waste:
Segregation of wastes is the most important prerequisite in the process of wastes management. Segregation of waste allows special attention to be given to the relatively small quantities of wastes and thereby reducing the risks as well as cost of handling and disposal.
For the purpose of segregation, the bio-medical wastes can be broadly classified into the following categories:
(i) General or non-hazardous/non-infectious medical waste, which is not contaminated with blood, body fluid or other infectious agents or materials, or which does not contain toxic/hazardous chemicals, e.g. paper, fabrics, glass, food residues, containers etc. Such waste needs no special management technique, but can be managed as required in case of any domestic waste.
(ii) Infectious/hazardous medical waste, which needs special/careful management.
Proper segregation of infectious/hazardous wastes from the general waste is important for efficient and economic treatment and disposal.
Infectious/hazardous waste is characterised by-
(i) The potential of the waste to transmit infection, and
(ii) Properties of toxicity and/or low level radioactivity.
The World Health Organisation (WHO) has recommended following classification for segregation of bio-medical wastes:
(a) General non-hazardous wastes.
(b) Sharps (whether infected or not).
(c) Infected waste not containing sharps.
(d) Chemicals and pharmaceuticals other than cytotoxic drugs.
(e) Other hazardous wastes (includes radioactive wastes, cytotoxic drugs, and high pressure containers).
Segregated wastes of different categories need to be collected in identifiable containers.
Sharps need special attention while segregating and storing-because needles can act as reservoirs of pathogens in which they can survive for a long time due to the presence of blood. Sharps can also provide a direct route for pathogens into the bloodstream through any cut in the skin.
Syringes and needles should be damaged before putting them into the containers so that rag-pickers are dissuaded from collecting them for resale. This saves the needles from getting recycled at a later stage. Sharps must always be kept in puncture-proof containers to avoid injuries and infection to the workers handling them.
Plastic bags for storing the waste may be suspended inside a frame or be placed inside a sturdy container. A lid should be provided to cover the opening of the bag at the top.
Every room, such as ward, laboratory, operation theatre etc., should have containers/bags for the types of wastes that are generated in that room.
In all rooms, except isolation wards, there should be a container for general waste. All wastes from isolation wards should be regarded as infectious and treated as such.
Each container may be clearly labelled to show the ward or room where it is kept. The reason for this labelling is that it may be necessary to trace the waste back to its source. For example – if a porter is injured by a syringe or blade that has been put into a bag rather than into the correct sharps container, it is possible to determine the origin of that waste and identify the member of staff who was responsible for that ward. It may also help in knowing the type of infection that may have been transmitted.
For storage of different types of wastes, the colour coding and types of containers have been proposed in the draft notification of the Ministry of Environment and Forests. (Table 35.1).
Yellow – Infectious wastes and/or wastes for incineration
Blue – Waste for autoclaving/equivalent treatment
Red – Human anatomical wastes for burial
Orange – Animal wastes for disinfection and burial
Black – Non-infectious wastes for municipal dumps
The medical wastes, except the general and non-hazardous wastes, should never be transported with general municipal wastes, and these should be kept separate at all stages. Special vehicles must be used so as to prevent access to and direct contact with the waste by the transportation operators, the scavengers and the public. The transport containers should be properly enclosed.
The effects of traffic accidents should be considered in the design, and the driver must be trained in the procedures he must follow in case of an accidental spillage. It should also be possible to wash the interior of the containers thoroughly.