Post on 29-Mar-2015
Section B
Implementing waste management system in a hospital
Section BImplementing
Waste Management Systemin a Hospital
Section B
Implementing waste management system in a hospital
Project planStage1 – Inputs: Knowledge of the infrastructure of the
hospital/hospital layout Survey of the existing waste
management practices followed in the hospital
Waste survey in the hospital Formation of waste management
committee Setting up of Model Ward Procurement of waste treatment
equipmentB1
Section B
Implementing waste management system in a hospital
Project plan
Stage 2: Training of staff Installation of the waste management
system Regular training and awareness for
the hospital employees Monitoring the system
B2
Section B
Implementing waste management system in a hospital
Flow chart of the work planSurvey:Meeting with the heads of all departments
Forming a waste management committee
Rounds of wards to see the functioning
Creating a model ward
Suggest equipment procurement
Formal training for the nursing staff
Implementing the system throughout theHospital
B3
Section B
Implementing waste management system in a hospital
Waste management committee
Director and Medical Superintendent Infection Control Committee head Representative from Purchase
Department Nursing Supervisor Housekeeping Supervisor Representative from Personnel
Department
B4
Section B
Implementing waste management system in a hospital
Waste management policy
Each hospital should have policy that describes:
Steps taken to comply with the Rules Waste categorisation Staff’s training content and status Policy adopted on segregation, collection,
transport and storage of waste Names and duties of waste management
committee members Immunisation status of staff Format of accident reporting and follow
ups Overall monitoring formats of the system
B5
Section B
Implementing waste management system in a hospital
Occupational safety and health plan: a step towards safety
Requisite training Protective gear-should ensure safety,
should be well fitting and easy to use, to ensure usage
Safe work practices Administrative controls Immunisations Monitoring and evaluation of work
practices
B6
Section B
Implementing waste management system in a hospital
Why do a waste audit?
Helps in classification of waste Avoids and helps rectify over-
classification Highlights area specific
problems/needs Reflects on the level of segregation Possibility of exploring waste
minimisation Scopes of economic gains Helps locate points of
intervention/need based solutions Subsequent evolution of best
practices B7
Section B
Implementing waste management system in a hospital
Setting up a model ward
Choosing a ward Imparting training to all its staff Implementing the system: segregation
of waste, disinfection of infected plastic waste and sharps management
Monitoring and suggesting corrective measures
Implementing the system in the entire hospital
B8
Section B
Implementing waste management system in a hospital
Components of hospital waste management
Training and awareness of hospital staff
Initiating segregation of waste Disinfection and mutilation Secure storage and transportation of waste Sharps and hazardous waste management Final treatment and disposal Monitoring of the system
B9
Section B
Implementing waste management system in a hospital
Segregation
Different types of waste should be collected separately
Should be done at the point of generation
Different colored bins used to make it easy
Segregation ensures occupational & health safety
Segregation also reduces the cost of treatment and disposal
B10
Section B
Implementing waste management system in a hospital
Segregation: make a difference
Tips to ensure good segregation: Optimum number of bins; neither less
nor more All bins equally easy to use in terms
of handling and placement Clean bins Easy operation Different coloured
bins for each category of waste Proper labeling of bins Posters in the work area as a
constant reminder B11
Section B
Implementing waste management system in a hospital
Disinfection and mutilationDecentrally Chemical disinfection: bleach is a
good disinfectant WHO recommended concentration 1%
solution (10gms of bleach in 1 litre water) for 30 minutes
Centrally Alternative technologies, like
autoclave, microwave, hydroclave are preferable
Mutilation Mutilation to avoid illegal reuse
B12
Section B
Implementing waste management system in a hospital
Collection
Some thumb rules for collection: Designate different people for
collection of each type of waste Collection time preferably different Collection bins properly labelled and
different for each category Collection in closed containers Trolleys to be provided for movement Protective gear is a must during
collection
B13
Section B
Implementing waste management system in a hospital
Storage Rules prohibit storage of waste
beyond 48 hrs
Storage site:
Should have proper warning in front Should be accessible by vehicles Should not be accessible to animals or
visitors Should be covered and lockable The surface should be cleanable Should have water and electricity
supply Proper drainage outlet
B14
Section B
Implementing waste management system in a hospital
Transport Avoid patient/crowded areas Avoid using lifts meant for patients
and/or movement of sterile equipment Selection of time important-Select time
of minimum movement (Not while doctors are on rounds; Not during visiting hour)
Preferably use the hospital ramp Ergonomics to be taken into
consideration: avoid lifting, prefer trolleys
Waste bags should be sealed or tied properly
Hazardous and non-hazardous waste should be carried in separate vehicles
B15
Section B
Implementing waste management system in a hospital
Waste movementWARD/
NURSING STATION
INFECTIOUS WASTE
PLASTIC WASTE
GENERAL WASTE
SHARPS
YELLOW BAG
ONE PERSONDESIGNATED
PICKED ONCE
BAGSCOLLECTED IN A TROLLEY
WITH A BIN
INCINERATED
TRANSPARENT BAG
ONE PERSONDESIGNATED
PICKED ONCE
DISINFECTED INWARDS & THE BAGS TAKEN
IN A LARGE BIN
MUTILATEDGIVEN TO A
CONTRACTOR
BLACK BAG
WARD BOY
PICKED TWICE
BAGS TAKENTO A CENTRAL
POINTBY WARD BOYS
MUNICIPALBIN,
PIGGERY
NEEDLEDESTROYER &
BREAD BOX
ONE PERSONDESIGNATED
PICKED ONCE
DISINFECTED IN WARDS, CONTENTS
SIEVED &COLLECTED IN A BUCKET
COLLECTEDIN THE
HOSPITAL
B16
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Implementing waste management system in a hospital
Special cases
Operation theatre Laboratory Emergency Nursing station Kitchen Laundry
B17
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Implementing waste management system in a hospital
Monitoring
Monitoring on a daily basis:
Monitoring of the system by sister in charges and senior hospital personnel
Monitoring sheets to be filled up Take up waste survey before and
after establishing the system
B18
Section B
Implementing waste management system in a hospital
Conduct routine waste assessment
Report findings to department heads Note variations and recommendations
o Staff participation in accurate segregation
o Effectiveness of collection scheduleso Adequacy of containers o Errors in disposal
Offer assistance to rectify problems
B19
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Implementing waste management system in a hospital
Keep score!
Review every bill from waste vendors
Track monthly waste totals comparing to patient census, outpatient and inpatient procedures
B20
Section B
Implementing waste management system in a hospital
Graph it!
Monthly Volumes Biomedical Waste
0
10000
20000
30000
40000
50000
60000
Months
Kg
s o
f w
as
te
kgs
B21
Section B
Implementing waste management system in a hospital
Waste Monitoring SheetWaste Monitoring Sheet – Nursing Superintendent At the Point of Generation WARD/ PLACE DATE: Name of the Doctor / Sister -in-charge: _____________________________ Name of the House Keeper: ______________________________________ Time and Shift : _______________________________________________ S.No
Work Comments
1.
Waste Properly segregated
2.
Disposables mutilated and treated
3.
Needle destroyer working
4.
Chlorine solution replaced for treating mutilated plastic and rubber waste
5.
Bins lined with plastic bags a) infectious waste bin with yellow
bag b) general waste bin with black bag c) plastics bin with translucent
6.
While handling waste, gloves are always worn by the nurses and the house keepers
7.
Needles ,blades, lancets collected in bread box and treated with chlorine solution
8.
Syringe with barrel and plunger separated dipped in bleach solution
9.
Urine ,blood bags, IV sets cut before putting in chlorine soln.
10.
Ampoules in separate carton
B22
Section B
Implementing waste management system in a hospital
Waste Monitoring Sheet Waste Monitoring Sheet - Sanitary Supervisor Name of person : _____________________________________________ Name of the House Keeper: ____________________________________ Date: ______________________________________________________ Area, Time and Shift: _________________________________________ S.No
Work Comments
1.
Separate bins for different waste types
2.
Plastic bags with waste sealed
3.
Is the area around the bins cleaned
4.
Are bins routinely disinfected
5. Waste from bin routinely picked up 6.
Kitchen waste being composed a) Kitchen waste being segregated b) Is the biodegradable waste being
composted c) General waste being thrown in
designated bin d) Is the composting pit smelling e) Slurry of cow dung being added
at regular intervals f) Contents of the pit being mixed g) Is the pit being covered.
Signed (Designation)
B23
Section B
Implementing waste management system in a hospital
Economics of waste management
Treatment technology: Technology option/size of the facility
(central facility economically viable)Equipment: Needle destroyers, scissors and
forceps, bread box, bins Chemical disinfectantProtective clothing: Boots, gloves, face mask, glassesDifferent coloured bags: Size, quantity and quality
B24
Section B
Implementing waste management system in a hospital
Problems faced
Doing the initial trainings at the work place
Changing the attitude of the staff- the initial attitude can be really cold but over the time they appreciate the system
Deciding the equipment for waste management: every place has its own needs and thus procurement can be difficult. Start working on equipment immediately after waste audit and before training
B25
Section B
Implementing waste management system in a hospital
Lessons learnt
Initial training sessions should not be carried out at the work place
Purchasing of equipment takes time- should be decided before starting trainings
While planning the scheme, time should be kept for factors such as purchasing and staff availability
Model Ward should be set up as a pilot system
B26
Section B
Implementing waste management system in a hospital
Reduce, reuse, recycle
Sold for recycling o Glass (I.V. bottles, ampoules, etc.)o Paper and cardboard o Disinfected and mutilated plastics o Discarded linen for paper recyclingo X-ray films o Photographic developer
Kitchen waste sent to piggery Garden waste composted
B27
Section B
Implementing waste management system in a hospital
Waste minimisation
Segregation Source reduction Substitute hazardous
processes/substances Reducing losses by good practices Preferential purchases Resource recovery and recycling Treatment Proper disposal
B28
Section B
Implementing waste management system in a hospital
Monitoring
Section B
Implementing waste management system in a hospital
Secure transportation
Section B
Implementing waste management system in a hospital
Disinfection & Mutilation
Section B
Implementing waste management system in a hospital
Sharps Management
Section B
Implementing waste management system in a hospital
Unclean bins
Section B
Implementing waste management system in a hospital
Uneasy Operation
Section B
Implementing waste management system in a hospital
Different coloured bins
Section B
Implementing waste management system in a hospital
Collection
Section B
Implementing waste management system in a hospital
Non-infectious waste segregation
Section B
Implementing waste management system in a hospital
Recycling of glass & plastics
Section B
Implementing waste management system in a hospital
Recycling of cardboard
Section B
Implementing waste management system in a hospital
Vermi composting of garden waste