Injection
Waste
Management
• Waste Management is a process
• Not a technology issue alone
• It requires a change in way of
thinking
Introduction
• Waste management for Pediatricians
– At Hospital
– At PHC.
– Immunization clinic.
• Waste management at community level
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.
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.
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.
Hospital waste
75-90%
Non Clinical Waste
Pharmaceutical
Pathological
10-25%
Clinical Waste
Genotoxic
Infectious
Pressurized containers
Needles
Chemical
Waste with heavy
Metal content
Radioactive waste
Challenges for Sharps Waste
Fear of HIV
transmission
through Dirty needles
Mass immunization
campaign
Funding for Curative
injection equipment &
it’s Disposal
Environmental
concerns
Over sharp waste
disposal
Funding for Health
Care Waste Disposal
Immunization sharps waste
Waste from hospital and clinical
1%
80%
3%
1%
15%
• 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
Pathological and infectious waste
Sharps waste
chemical pharmaceutical waste
Special waste (radioactive, cytostatic)
non-infectious
Source: Safe Management of wastes from Health Care activities (geneva, WHO, 1999)
General principles
Major Considerations
•
Minimization
•
Segregation
•
Transport
•
Collection
•
Storage
•
Treatment
•
Disposal
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.
Color Coding of Waste Collection Bags /
Container
Yellow
Infectious Waste for Incineration,
Non Plastic, contaminated with body
fluids
Blue/ White Needles/Sharps/glass/blades
Red
Black
Infectious waste for autoclave/
Microwave, Rubber & Plastic
catheters,tubes.
General/Domestic waste
Sanitary Landfill / for composting
Segregation – where?
•
Containers should be placed at strategic
and easily accessible locations
•
Blue /white translucent puncture proof
containers should be used.
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
•
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.
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.
Sharp Containers
•Do not transfer contents to other container
•Do not overfill
Unsafe
Safe
Sharp Containers
• Leak-proof
various innovations
• Closable with narrow neck
• Puncture- Resistance
• Clearly labeled with warning (easy for the
community to understand)
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.
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
Hub Cutter & Needle Puller
Advantages
Reduce needle waste
tremendously by
separating needles from
syringes
Reduce needle-stick
injuries during handling
and transport of used
syringes
Allow more flexibility of
downstream disposal of
sharps
Reduce numbers of
safety boxes for syringe
disposal
Improve environmental
safety
Further prevent
syringe reuse
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
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.
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.
Disposal at Small Health Units*
(SC/PHC/Private Clinics)
Disposable Syringes/Needle/ADS
Hubcutter/
Needle puller
Needle
with Hub
Mutilated Syringe
Disinfection with
1% Hypochlorite
Disinfection with
1% Hypochlorite
Sharps pit /
Waste collection agency
Waste collectors
*GOI&CPCB guidelines
Terminal Disposal
• Metal equipment – recycle.
• Shredded plastic – recycle
• Plastic Syringes – Mutilate and recycle
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.
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.
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
Be Needle Smart
Do NOT recap
Do NOT bend
Do NOT remove
Do NOT transport
Do NOT re-use