this file describes how to collect,handle,sort hospital waste at the hospital if you need any assistant do not hisitate to call

1. Waste Management in hospitals Egyptian guidelines perspective With a special thanks to Environmental department in Alexandria High institute of public health By Dr Mohamed ABORAS Alexandria medical school, MBA, Master of hospital administration Tel 0020122176434 medical@alahlyhospital.com

2. Introduction: Health-care medical waste is a by-product of health care facility. Examples: sharps, non-sharps, blood, body parts, chemicals, pharmaceuticals as drugs, medical devices,

3. Why should we manage our hospital waste? 1-Increasing number of hospitals and their wastes volumes due to increasing number of patients. 2- Increasing number of oncology departments and centers creating highly toxic and radio-active wastes. 3- Highly infective bio-hazardous wastes are mis- used and reused illegally. 4- Burning of dumpsites creates highly hazardous emissions from clinical wastes. 5- Household similar garbage is a source of income if properly segregated. 6- Cost of disposal of medical waste more 10 times than cost of disposal of non medical waste.

4. Poor management of health care waste: 1- may expose health care personnel, waste handlers, and the community to infectious agents, to toxic materials, and to an increased risk of injury. 2- It may also damage the environment (e.g., contamination of water, air, and food). 3- In addition, if waste is not disposed of properly, members of the community may have an opportunity to collect disposable medical equipment (particularly syringes) and to resell these materials. Medical waste can potentially be reused without sterilization. This reuse of unsterilized waste material causes a large portion of the diseases that develop due to poor waste management.

6. المرضى.

7. الزائرين للمنشأة.

8. عمال النظافة (المغسلة).

10. 2 مليون عدوى HCV (40%)

12. نباشو القمامة

13. نفايات آكلة تضر بشبكة الصرف

14. زئبق يضر بالبيئة البحرية والمياه الجوفية

15. أدوية سامة للجينات تلوث المجاري المائية

17. Magnitude of Medical Waste in Egypt Egypt generates an average of 24,600 tons of hazardous or infectious waste daily from private, governmental hospitals ( excluding military hospitals).

19. WHO guidelines for worker safety, waste labeling and handling;

20. Nuclear Safety Commission (NSC) for radioactive waste handling

21. Ministry of Health regulations for handling controlled substances

23. COMPOSTION AND QUANTITY OF HCW IN EGYPT

24. General Principles of Waste Management 1- A clear facility policy for waste management should be available for proper implementation of integratedwaste management plan. The policy should describe in detail the methods of waste segregation, collection, storage, and disposal, according to the resources available in each health facility. 2- Roles and responsibilities of the different team members responsible for waste management should be clarified. One main person should be assigned to be responsible for waste management in each facility.

25. 3- All healthcare staff should be aware of the facility’s basic healthcare waste management plan and their role in the plan. This includes management and regulatory staff, medical doctors, nurses and nursing assistants, cleaners, waste handlers, and visitors to the facility. 4- Facility managers should ensure that this plan is in place, with adequate budget and personnel to implement it. 5-Implementation of the healthcare waste management plan and routine monitoring should be carried out in parallel with the information/training program.

26. 6- The waste management plan should be presented in simple terms and displayed in a diagram at all points of waste generation. 7- Better health and environmental working conditions for waste handlers should be addressed in planning resources for waste management. This includes (but is not limited to ) the use of protective clothing and specialized equipment to ensure worker safety as well as safety for the general public.

27. 9- Waste management plan should address four components of waste management . 8-Hands-on staff training in the details of the waste management plan is optimal. Training should include: · Basic information about HCW and the risks of bad management of HCW. · Basic information on the facility’s waste management plan. · Each employee’s responsibility and role in healthcare waste management. · Technical instruction on application of the practices described in the waste management plan.

31. Sorting and Segregation Sorting the waste at the point at which it is generated. Separate containers should be used for disposing of general and medical waste. The person who generates it should segregate the waste by type. Colored plastic bags should be used to help distinguish between general- and medical-waste containers. A three-bin system for waste sorting should be established

34. Hazardous Wastes Containers Bio-hazardous wastes bags and trolleys units

35. Sharps and needles containers

36. Bio-hazardous wastes containers in rooms, wards, laboratories, ICU, OT areas

38. Hazardous wastes has to be weighted for better control after being segregated at the several clinical units in the hospital in order to control the process

40. ملاحظات عند القيام بفصل النفايات يجب أن يكون الفصل عند المنبع. تملأ الأوعية حتى 4/3 حجمها. يجب تمييز جميع أنواع العبوات التي سوف تستخدم لتعبئة ونقل نفايات الرعاية الصحية كالآتى: اللون – الرمز المميز – عبارة ”نفايات طبية“ – اسم المنشأة والقسم المولد للنفايات وتاريخ التحميل والمسئول عن الجمع والنقل.

41. الرموز

44. Handling Medical waste should be handled as little as possible before disposal. Medical waste should not be collected from patient-care areas by emptying it into open carts; this may lead to contamination of the surroundings and to scavenging of waste as well as to an increase in the risk of injury to staff, clients and visitors.

46. Medical waste and sharps containers should be discarded when they are three quarters full or at least once per day or per shift.

47. Never put hands into a container that holds medical waste.

49. Larger Mobilization Containers Tightly Covered

50. Open hazardous waste containers and unidentified bags should be completely avoided

51. Staff who is handling the waste should be well protected and their clothing daily washed in hospital laundry to insure its disinfection

52. ON-SITE STORAGE AND LARGE TRANSPORTATION CONTAINERS FOR HCW Bar fenced Trolley

53. Interim storage Waste should be transported at the end of every shift. WHY?? - To reduce the risk of infection and of injury - To minimize the amount of time waste is stored at the health care facility.

56. Never throw waste into an open pile.

58. SHREDDING AND SECURED STORAGE OF HCW

60. Availability of sites for waste treatment and disposal (space on HCF premises and distance to the nearest residential areas);

61. Social acceptance of treatment and disposal method

62. Possibility of treatment in a central facility with a HCW treatment system within reasonable distance; Final treatment

64. Availability of human, financial and material resources

65. Existence of a reliable power supply;

68. Objectives of final treatment Effective reduction of the infectious hazards of health-care waste and prevent scavenging. Which means transforming infectious waste into non risk waste. At the same time reduce the bad environmental outcome of the treatment method.

69. Hospital hazardous wastes should not reach dump sites or solid sanitary landfill without shredding and sterilization to prevent their illegal and health hazardous reuse of reusable components

75. Incineration Three basic kinds of incineration technology are of interest for treating health-care waste: • double-chamber pyrolytic incinerators, which may be especially designed to burn infectious health-care waste; • single-chamber furnaces with static grate, which should be used only if pyrolytic incinerators are not affordable; • rotary kilns operating at high temperature, capable of causing decomposition of genotoxic substances and heat-resistant chemicals.

76. Egyptian Experience with Incinerators Egypt with foreign donations has installed more than 80 incinerators for household and clinical wastes All of them did not operate as stated and were highly rejected by the surrounding communities and finally stopped because of their severe air pollution Hospital environment were badly Affected

77. Burning and high temperature Exposures were a main concern Storage areas for incinerators fuel were always contaminated with oils and formed a hazardous site very hard to decontaminate after scraping the incinerators. Formed ash has to be disposed as hazardous material because of its high content of heavy metals

78. OPEN BURNING OF HCHCW

79. INCINERATION OF HCW

80. Medical waste incinerator in USA placed within green areas to absorb the generated toxic gases. Do we have this privilege in our country areas?

81. Landdisposal

83. BURIAL PIT FOR HCW

86. Burial pit should be 1-2 meters wide and 2-5 meters deep. The bottom of the pit should be at least 1.8 meters above the water table.

87. Erect a fence or a wall around the site to keep out animals.

88. Every time solid medical waste is added to the pit, cover it with 10-30 cm of dirt.

89. When the level of waste reaches to within 30-50 cm of ground level, fill the pit with dirt, seal it with concrete, and dig a new pit. In order to bury medical waste in Egypt, a facility must apply for a license.

90. Landfill Cover

91. Shredding of waste before disinfection Shredding of solid health-care waste before disinfection ( chemical or thermal) is essential for the following reasons: • to increase the extent of contact between waste and disinfectant by increasing the surface area and eliminating any enclosed spaces; • to render any body parts unrecognizable to avoid any adverse visual impact on disposal; • to reduce the volume of waste.

92. Waste Management II: Safe Sharps Disposal

93. Introduction - “Sharps” refers to any object that can cut or puncture the skin including, but not limited to, needles,scalpels, lancets, broken vials or glass - The primary cause of occupational exposure to blood-borne pathogens in all health care personnel (HCP) is needle sticks injury or other sharp objects. - At least 20 pathogens have been known to be transmitted following percutaneous exposure to blood. .

94. Introduction- Cont - The most important of these pathogens are hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV. - Infections with each of these pathogens are potentially life threatening – and preventable

95. Frequency and Causes of Needle stick Injuries in Egypt - Almost 70% of all HCP have been exposed over their lifetime to needle stick injuries. - Needle stick and sharps injuries (NSSI) rate of 33 per 1000 HCP. - The highest proportion of exposures was to nurses at the point of use.

96. Most needle stick injuries occur during the following activities:

97. One-hand Recapping (“Scoop”) Technique To safely recap needles use “the one-hand” technique: Step 1 Place the cap on a flat surface, then remove your hand from the cap. Step 2 With one hand, hold the syringe and use the needle to “scoop up” the cap. Step 3 When the cap covers the needle completely, use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the bottom only (near the hub).

98. Hands-free Technique for Passing Sharps

99. Tips for performance criteria of sharps containers 1- Functionality: Containers should remain in a good state during their entire usage. They should be leak resistant on their sides and bottoms, and puncture resistant until final disposal. Individual containers should have adequate volume and safe access to the opening. 2- Accessibility: Containers should be accessible to all workers who use, maintain, or dispose of sharp devices. Containers should be placed in all areas where sharps are used and, if necessary, portable within the workplace.

100. 3- Visibility: Containers should be plainly visible to the workers who use them. Workers should be able to see the degree to which the container is full and proper warning labels. 4- Accommodation: Container designs should be convenient, environmentally sound, and easy to store.

101. Thank you

102. Thank you for listening