HEALTH CARE solid WASTE MANAGEMENT Presented By: SANITARIAN BALOGUN S.A (Env./Domestic Services Dept.)

DEFINITION Health care solid wastes can be defined as the by-products of health care service delivery that includes sharps, non-sharps, blood, body fluids, body parts, chemicals, pharmaceutical products, medical devices, corpse, radioactive materials etc. Poor management of HCSW exposes health care workers and service providers, waste handlers, patients/relatives, the immediate community etc. to infections, toxic effects and injuries.

KEY FACTS Of the total amount of solid wastes generated by health care activities, about 85% are general and non- hazardous. The remaining 15% are considered hazardous materials that may be infectious, toxic or radioactive in nature. Every year an estimated 16 Billion injections are administered worldwide, but not all of the needles and syringes are properly disposed afterwards. Health care solid wastes contains potentially harmful microorganisms, which can infect hospital patients, health care workers and the general public. Health care solid wastes in some circumstances are incinerated, while dioxins, furans and other toxic pollutants may be produced as emissions. Health care activities protects, restore health and safe lives. But what about the waste and by- products they generate?

TYPES OF SOLID WASTES Majorly we have two broad categories of solid wastes, which are HAZARDOUS AND NON- HAZARDOUS, but can be subdivided into smaller divisions because waste and by- products cover a diverse range of materials, as the following lists illustrates: HAZARDOUS Infectious wastes: Wastes contaminated with blood and other bodily fluids (e.g. from discarded diagnostic samples), cultures and stocks of infectious agents from LAB or wastes from patients in isolation wards and equipment e.g. swabs, hand gloves, bandages and disposable medical devices. Pathological wastes: human tissues, organs or fluids, body parts and contaminated animal carcasses, bloods (used or contaminated ones) Sharps: used syringes and needles, disposable scalpels, blades, broken injection bottles etc. Chemicals: Solvents used for laboratory preparations, disinfectants, and heavy metals contained in medical devices (e.g. mercury in broken thermometers,) and batteries.

TYPES OF WASTES CONTD’ Pharmaceuticals: Expired, unused and contaminated drugs and vaccines. Genotoxicals: Highly hazardous, mutagenic, teratogenic and carcinogenic, such as CYTOTOXIC DRUGS, used in cancer treatment and their metabolites. Radioactive: Such as products contaminated by radionuclides including Radioactive diagnostic materials or radiotherapeutical materials. NON HAZARDOUS OR GENERAL WASTES These are wastes that do not pose any particular biological, chemical, radioactive or infectious hazards e.g. Papers, nylons, bottled drinks containers, cans etc.

SOME HEALTH RISKS OF HCSW Health care solid wastes reserves so many risks, which by implications means that health care workers and service providers particularly wastes handlers and clinicians needs to be very wary of them during the discharge of their duties and the managerial procedures. Most prominent of these risks includes; Radiation burns Sharps inflicted injuries Poisoning and pollution through the release of toxic elements / compounds into the environment through waste water e.g. mercury or dioxins and those release by pharmaceutical products. Sharps related: Research shows that despite several progress, in 2010, unsafe injections were still responsible for as many as 33,800 new HIV infections, 1.7 million HBI AND 315, 000 HCI. Outbreak of diseases is also one of the prominent risks that can be identified. And majorly, wastes hazards occur during the manual sorting of hazardous wastes from health care facilities where the wastes handlers are at the immediate risks of needle- stick injuries and exposure to toxic or infectious materials.

HEALTH CARE WASTE MANAGEMENT Literarily, this concept can be defined as the comprehensive efforts or measures put in place to avert any possible health risks associated with health care wastes right from the point of generation or source, segregation (sorting) ,storage (in receptacles rightly color coded), transportation down to the disposal at the facility refuse house or dumpsite from where the public operators e.g. LAWMA agents come for evacuation to the final dumpsite where they can undergo advance waste management techniques and from there can be reduced, recycled and reused. Of course the good news is that, the so to say wastes, if properly managed and adequately engineered, the concept of WASTE TO WEALTH AND WASTE TO ENERGY can actually be practicable in developing countries that our very dear nation falls into.

HEALTH CARE WASTES MANAGEMENT WITHIN THE HOSPITAL FACILITY This can summarily be illustrated as follows: SOURCES OF GENERATION Clinical activities by Doctors, Nurses, Pharmacists, Scientists and other clinicians, which can either be hazardous or non- hazardous e.g. injecting, blood sampling, dispensing etc. Domestic activities bringing about general non-hazardous wastes e.g. activities of the sweepers, health attendants, gardeners, patients and relatives domestic activities, kitchen wastes etc. Use of adequate PPE.

SEGREGATION Identification of waste types Proper disposal into appropriate color coded waste bags and approved boxes for sharps Avoidance of wastes comingling E.g. dropping of gloves inside sharps, dropping of needles or syringes inside waste bags, storing of papers, nylons and other non- hazardous wastes inside other waste bags other than the black ones etc. Proper sorting of wastes. Use of adequate PPE

STORAGE Wastes properly bagged in prescribed color coded waste bag, placed inside a tightly fitted waste bin with proper flap. Use of adequate PPE.

TRANSPORTATION Waste properly tied and moved to the dumpsite with wheelie bins or prescribed trolleys Use of adequate PPE.

DISPOSAL General wastes placed rightly at the black waste compartment at the dumpsite. Hazardous wastes comprising of either the YELLOW OR RED WASTE BAGS, rightly placed inside the BIOHAZARD WASTE COMPARTMENT at corresponding spots therein at the dumpsite. Sharp boxes neatly placed and tightly covered at the sharps compartment as indicated inside the biohazard waste compartment. Use of adequate PPE.

EVACUATION LAWMA personnel comes in to pick the domestic non-hazardous wastes to the nearest government approved dumpsite, on specified days or as the need might arise. LAWMA Biohazard medical wastes collectors comes in to pick the hazardous wastes and the sharp boxes too on designated days and other days too as need may arise for urgency. Both should be evacuated promptly to promote hygiene and curb infection spread. Use of adequate PPE.

SANITATION Refuse house cleanliness AND disinfection after evacuation must be ensured to prevent spread of diseases and infections. Waste receptacles must be tidied up after each usage or probably after the day’s job. Proper hand wash after each activity.

WASTE SEGREGATION According to WHO, designated color coded waste bags and sharp boxes are needed to be acquainted with, so that the concept of waste management wouldn’t be defeated. Below are the respective color codes and the wastes types that conform with them: BLACK: General wastes e.g. nylons, papers, tissue papers, cans and all other non-hazardous wastes. RED: Anatomical wastes, pathological wastes (Highly infectious). YELLOW: Infectious wastes e.g. gloves dressings, body fluids, used specimen containers etc. YELLOW WITH RADIOACTIVE LABELS: Any solid, liquid or pathological wastes with radioactive isotopes of any kinds. BROWN: Chemicals e.g. formaldehyde, batteries, photographic chemicals, solvents etc. SAFETY BOXES: Mainly sharps e.g. needles, syringes, scalpels, blades, knives, etc.

IMPORTANCE OF COLOR CODING Defeats the menace of wastes comingling. Aides effective and efficient waste disposal. Easy identification of waste types. Promotes safety through proper identification and storage approach. Completes and complements the health care waste management aims and objectives which includes safety and preservation of life.

IMPORTANCE OF HEALTH CARE SOLID WASTE MANAGEMENT Lastly, we have to look at the importance of health care waste management itself. Amongst these includes; Curbs waste comingling. Improves the general aesthetics of the health care facility. Reduces injuries from sharps. Infection control. Strengthens the safety of clinical staff and waste handlers.

IMPORTANCE OF HEALTH CARE WASTE MANAGEMENT CONTD’ Elimination of offensive odor. Elimination of flies and rodent infestation. Curbs air pollution. Prevents food poisoning and contamination. Strengthens the aims and objectives of service charter. Promotion of healthful living of the members of staff, patients, relatives, and members of the public at large.

CHALLENGES Finance: If the concept is not properly funded, it might be a great factor militating against HCWMT success. Staff strength: Inadequate personnel is also a militating factor. Level of awareness of various level of personnel involved in the process, if not strong would hamper the concept. Non-challant attitude across all concerned. Work ergonomics.

CHALLENGES Inadequate supply of materials, equipment and other aides to trade. If the policies and contingency plans are not properly implemented would also affect the concept. Enforcement had always been a leading challenge for every policies and concept in the country. Inadequate training sessions for all inclined personnel to waste management.

SOLUTIONS Putting all the aforementioned and so identified challenges and many more others into consideration and putting relevant measures that can counter them, are keys to sustaining HCWM.

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