An ideal hospital requires infection free environment not only to treat the patient but also to keep the visitors safe and surrounding areas infection free. Hospital generates biomedical waste in both forms solid and liquid. Liquid waste generated from all the departments are infected in nature. So it is obligatory on the part of hospital not to discharge any water to the public drain without prior treatment in the effluent treatment plants. The clear guideline has been provided by Central Pollution Control Board for the treatment of both solid and liquid waste.
Biomedical waste are generate during treatment, surgical intervention, immunization, dressing of wounds, Pathological investigation and Radiological investigations. Biomedical waste management more of an administrative problem less of technical. The training for handling of hospital waste is generally restricted within the waste handlers (Sweeper) this is the main obstruction to established a good INTEGRATED HOSPITAL WASTE MANAGEMENT PLAN. Biomedical waste generated by Doctors and paramedical staffs and segregation of waste at site of generation is the key factor to reduce the quantity of infected waste. If the infected waste is mixed with non-infected waste the quantity of infected waste becomes huge, unmanageable and almost impossible to dispose effectively.
So Paramedical staff must be trained by the knowledgeable person so that they can handle the infected waste in efficient manner. Due training should be given with refresher course in certain intervals. Color coated bins and bin liners should be placed at the points of generation. For better understanding of segregation.
Matter should be placed in such a manner that the staffs should feel that following the system will give them a better life to live with their families.
The necessary equipments should be given to them. If the segregation system is up to the mark than this has been observed that 85 to 90% of the total waste becomes non infected only 10 to 15% are infected waste which need special disposal system. Incineration/Deep burial. Per day in-house patient generate 1.5Kg of waste only 10 to 15% of which is infected waste. Radiology department generate radioactive waste. Handling of radioactive waste requires special attention and skill.
What is infected waste?
Any waste contaminated by blood or body fluids can be termed as infected waste. Municipal wastes on the other hand do not require any special treatment. It should be handed over to municipal board disposal unit. There is a specific rule to handle, segregate, transport and disposal of biomedical waste. It was set up in 1998 and on 24th August 2011 it has been amended for better and more effective implementation. In rural area taking the permission of the prescribed authorities’ disposal of infected waste can be done by deep burial method as specified by CPCB. But in towns incineration is the only option. Before incineration, no chemical treatment should be done. The trained staffs should be placed in to service and periodical health checkup and immunization should be provided to them.
Training; –
Started from nursing student who responded well and question answer format is the ideal format for such audience. I have seen they enjoy doing so and eager to participate in such interactive season to display their knowledge. Students are very open to know what is happening in the fresh world. I make the session as a problem solving session through dialog.
Training to word boys:-
They respond well when it connected to their day to day problem. The best idea is to listen to their problem sympathetically then they will be more open to the session. Written words are best abandoned with this group. Best way to create interest is audio/visual method. This group can come out with valuable suggestions if proper attention is given to them.
Training to the Doctors:-
Without having national and international research report in hand /audiovisual format it will create very very less effect to them. They require more academic approach with working example to other institution. Often this has been observed that doctors feel s that this type of season is imposition to them. Their time should be respected.
Training to the paramedical:-They are the backbone of the waste management system of the hospital. To train them is a critical subject. Nurses are interested, active but due to duty schedule they are in hurry. Time should be chosen when they are free and a smart and good commutating skilled trainer should be placed to this group with audiovisual system to demonstrate the good practices effectively. Language sometime become problem. Trainer should know the local languages or he/she can take help.
Equipments:-
To manage the biomedical waste effectively you are to provide the mandatory equipments. Colored bins, Bin liners, Wheel Barrow, 1%sodium hypochlorite, Gloves, Gumboots, Autoclave, Shredders, Needle Burners, Needle-Cutter,Flipper,Record book, Covered Color coated segregation area, Effluent treatment plant, Incinerator, Mopers.
Training of hospital Staff:-
Training and creating awareness among all the hospital staff is the key to having good waste management system. Orientation to the all staffs to a practical system. Part by Part training to all the departments makes the hospital as a model hospital.
Who needs training:-
Not a single person should be missed out while training is imparted. BMW requires participation of entire hospital staffs in some form or other. Starting from administrator storekeeper and other involved departments also required training to ensure that the waste is carried responsibly from the cradle to the grave. Training covers the following aspect sensitization, discussion and feedback.
In the first session, sensitize the audience on the need to manage the hospital waste. In the second session, the audience is made aware of the various aspects of hospitals management-segregation, disinfection, etc.The last session is taken only after the trainees have implemented the scheme about one to two weeks. Then they are asked about the problems they have faced during the implementation. Training program should be lively. After each season there must be question answer session to evaluate the effect of the season.
Know your waste:-
according to various estimates and surveys around 80 to 90%hospital wastes general waste. 10 to 20% is infectious waste/hazardous waste.15 to 20% is pathological waste and 1 to 2% is sharp waste. Approximately 3% Pharmaceutical waste/chemical waste. This figure may be high and low depending on hospital and implementation of segregation system. Radioactive waste also available in both solid and liquid waste. Radioactive waste generate in invitro analysis of body tissue & body fluid including tumor localization. Then cytotoxic drugs have the ability to stop the growth certain living cells.
Impact of hospital waste: – All individuals exposed hazardous healthcare waste is potentially at risk. The group at risk include doctor nurses patients visitor to the hospitals, service provider like laundry, workers in waste disposal facilities etc.
What are sharp:-Anything cause cut or a puncture wound is termed as sharp waste. For example needles scalpel blades knife infusion sets saws broken glass etc.If it is infected or non infected but it is considered to be highly hazardous hospital waste. Because it cause injury and Trans mission of disease i.e. double risk caused by the sharps hence it is considered to be very hazardous waste.
Reuse: –
Improper injection practices transmit blood born pathogen Such as Hepatitis B, hepatitis and HIV all over the world. Improper injection practices about a lack people per year annually.reuse of syringe and needle without sterilization exposes millions of people to the risk of infection.
Mercury: –
It is used in medical equipments and in dental amalgams. This is a neuro and nephrotoxic. It affects the nervous system and can impair the way we talk, hear, see, walk, and feel things. Human are exposed to mercury through contaminated air water or food. May be directly through the skin.
The Rules:-The hospital generates many different wastes. For effective waste management the hospital would have to follow several waste management and guide lines including the (municipal solid waste Management and handling) rules, atomic energy act, and hazardous waste rules. The other acts that hospital would need to follow the water and air act.
A VOICE IN THE WILDERNESS 