Practical Approach of safe Disposal of Hospital Waste Management

Its a practical guide on hospital waste management for the students and faculty of pharmacy and medical and working pharmacists and nursing.

1. Practical Approach of Safe Disposal of Hospital Waste Management K V GOPINATH M Pharm PhD CPhT Hospital Pharmacist TT Devasthanams Tirumala Andhra Pradesh India gopinath.karnam@gmail .com

2. Magnitude of the problem 75,000 Kgs a month of biomedical waste in AIIMS India generated around 33,000 tonnes of covid-19 biomedical waste In Finland, the cost of medical waste is 100 million euro/year An estimated 30000 – 70000 tonnes of waste generated by the antibiotic activity Additional cost of $ 0.50/kg of active ingredient of unprocessed waste Environment polluted with unprocessed waste result in health, wealth and economic loss to the healthcare members, public and to the nation

3. Magnitude of the problem

4. Magnitude of the problem Poor Storage Conditions lead to its spoilage No Scientific Inventory Management of Pharmacy Unit dose Pack VS Multi Dose Pack especially in hospitals No Rationale Drug Prescribing “ may result in Pharmaceutical waste”. Lack of Hospital Waste Management Committee

5. Magnitude of the problem

6. Definition of Hospital Waste Bio Medical waste WHO defines “Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals “ “ by product of healthcare that include sharps, non-sharp blood contaminated items, blood, body parts and tissues, chemicals, pharmaceuticals and radioactive materials “

7. Types of hospital waste Risk Waste Non-Risk Waste Infectious Waste Pathological Waste Sharps Pharmaceutical Waste Genotoxic Waste Chemical Waste Radioactive Waste Paper Card Board Packaging Food Waste Aerosol / Sprays

8. Management of hospital waste “A mechanism of segregation, collection, packaging, storage, transport, treatment and disposal” Ultimate definition “ mechanism of Reduce, Recycle and Reuse “ of waste

9. Segregation

10. Segregation Segregate different categories of waste at source in out colored bins Don’t compact waste materials Discard infectious waste/ non sharp in disinfectant solution Discard sharp waste like needles in a puncture proof plastic container after filling the container 2/3 with hypo solution Discard used lancets in a plastic trey filled with hypo Shred the needles using needle destroyer Do not recap the needle, bent or pass them from one person to another Segregate all positive units and its accessories. Put biohazard label. Send all units for autoclaving and it is disposed as per bio medical waste management Record all details in the discarding register. Enter details of needle stick injury/blood spill in the incident report

11. Materials Required for Waste Management Discarded Units Out colored Bins Hypo solution Soaps and towels Gloves Autoclave Needle destroyer Hot Air Oven Incinerator Paper Shredder

12. B W M - Incinerator Process of Incineration Flair & Care incinerator Thermal process of combustion of organic elements within waste stream Drop hazardous waste/ infectious waste, sharps, surgical waste, clinical waste, laboratory waste, pharmaceutical waste etc in primary chamber Switch on green to temperature 800-1200* C < 600 * c produces toxic like furans and dioxins if poly vinyl chloride are used Collect the ash in secondary chamber while in cool.

13. Shredded Paper Machine All medical records of the patient are highly confidential and legal E.g. Prescriptions, Medical Orders, Discharge summary, Emergency Certificate, Death certificate, Birth certificate, Medical Insurances etc Any of the document is waste, shred and put it in a trash .

14. Disposal of Expiry Medicines Mix Mix medicines with an unpalatable and inedible substances like bleaching powder, dirt, cat litter or used coffee grounds Place Place the mixture in a container such as sealed plastic bag Throw Through the container in trash or suitable method Scratch Out All the product information and personal date on the label and then dispose of the container “ FDA Guidelines in hospital practice”

15. Safe Disposal of Waste : Mercury Source Thermometers, Sphygmomanomers, trace in X-Ray fixers and developers Collect the Hg with a tissue or sulfur . Put it in a zipper bag and seal it. Place the sealed bag in a plastic container with a lid. Pack the container with kitty litter or news papers to prevent breakage. Label the container “ Mercury, Do not touch”.

16. Safe Disposal of Controlled Drugs E.g. Hydrocodone, Morphine,OxyContin, Percocet Flushed down the toilet instead trash Law conflicts – illegal FDA guidelines

17. Safe Disposal of Expired Vitamins and Antibiotics Never through them in trash or flushing down the toilet May lead to water contamination 8 to 10 % of antibiotics found in potable water

18. Safe Disposal of Inhalers Unopened, Unused and Expired Medicines should be returned to Pharmacy All inhalers should not be put in trash Recycled at any pharmacy

19. Disposal of Cytotoxic Waste All chemotherapy medicines, human discharges from patients treated with Cytostatic drugs, Specimen tubes, Radio active materials All Cytotoxic drugs are collected in their original pack Collected in strong, leak proof containers labelled ‘Cytotoxic’ Dispose in yellow bag

20. Action Plan to minimize waste Electronic and Digital Administration in healthcare – no paper work Digital thermometers, Digital BP monitoring equipments and Digital X-ray Plant Effective use of Recycling process /Re Use Process in using Hot Air Oven, Autoclave Drug Take Policy at national level Effective Bio Medical Waste Management by written protocols and tie up with out sourcing / Consulting Services Legislative : Classification of Medical Waste as a hazardous waste Incineration is the only way to dispose medical waste In hospitals , waste management on the spot work Development of National Formulary and Rational Prescribing Guidelines

21. Conclusion Regulated medical waste can be dramatically reduced through fluid management and improved segregation. Otherwise, it is typically end up with land filling, autoclave or incinerator. “ one man’s trash is another’s treasure, therefore Reduce, Recycle, Reuse hospital waste to protect environment, health of healthcare members and community, and animals