1. Injection Waste Management

2. Waste Management is a process Not a technology issue alone It requires a change in way of thinking

3. Introduction Waste management for Pediatricians –At Hospital –At PHC. –Immunization clinic. Waste management at community level

4. 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.

5. 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.

6. 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.

7. 75-90% Non Clinical Waste 10-25% Clinical Waste Pharmaceutical Hospital waste Pathological Genotoxic Pressurized containers Needles Infectious Chemical Waste with heavy Metal content Radioactive waste

8. 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

9. Immunization sharps waste 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)

10. General principles

11. Major Considerations Minimization Segregation Transport Collection Storage Treatment Disposal

12. 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.

13. Color Coding of Waste Collection Bags / Container YellowInfectious Waste for Incineration, Non Plastic, contaminated with body fluids Blue/ WhiteNeedles/Sharps/glass/blades RedInfectious waste for autoclave/ Microwave, Rubber & Plastic catheters,tubes. BlackGeneral/Domestic waste Sanitary Landfill / for composting

14. Segregation – where? Containers should be placed at strategic and easily accessible locations Blue /white translucent puncture proof containers should be used.

15. 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

16. 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.

17. 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.

18. Sharp Containers Unsafe Safe Do not transfer contents to other container Do not overfill

19. Sharp Containers various innovations Leak-proof Closable with narrow neck Puncture- Resistance Clearly labeled with warning (easy for the community to understand)

20. 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.

21. 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

22. Hub Cutter & Needle Puller Advantages  Reduce needle waste tremendously by separating needles from syringes  Allow more flexibility of downstream disposal of sharps  Improve environmental safety  Reduce needle-stick injuries during handling and transport of used syringes  Reduce numbers of safety boxes for syringe disposal  Further prevent syringe reuse

23. 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

24. 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.

25. 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.

26. Disposal at Small Health Units* (SC/PHC/Private Clinics) Disposable Syringes/Needle/ADS Hubcutter/ Needle puller Needle with Hub Disinfection with 1% Hypochlorite Sharps pit / Waste collection agency Mutilated Syringe Disinfection with 1% Hypochlorite Waste collectors *GOI&CPCB guidelines

27. Terminal Disposal Metal equipment – recycle. Shredded plastic – recycle Plastic Syringes – Mutilate and recycle

28. 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.

29. 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.

30. 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

31. Be Needle Smart Do NOT recap Do NOT bend Do NOT remove Do NOT transport Do NOT re-use