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Biomedical Waste Disposal
Anantpreet Singh, Sukhjit Kaur
CHAPTER 1:
Introduction
CHAPTER 2:
Types of Wastes
WASTE
GENERAL WASTE
BIOMEDICAL WASTE
Infectious Waste
Pathological Waste
Sharps
Pharmaceutical Waste
Genotoxic Waste
Most common genotoxic products used in healthcare
Cytotoxic and Other Drugs
Sources of Cytotoxic Wastes
Chemical Waste
Formaldehyde
Solvents
Photographic/Radiographic Chemicals
Organic Chemicals
Inorganic Chemicals
Anesthetic Gases
Ethylene Oxide
Oxygen
Compressed Air
Sealed Sources
Unsealed Sources
CHAPTER 3:
Major and Minor Sources of Biomedical Waste
WASTE GENERATION
Major Sources of Healthcare Waste
Hospitals
Other Healthcare Establishments
Minor Sources of Healthcare Waste
Small Healthcare Establishments
Specialized Healthcare Establishments and Institutions with Low Waste Generation
Intravenous or Subcutaneous Intervention Activities Other than Healthcare
CHAPTER 4:
Categories and Classification of Biomedical Wastes
OBJECTIVES OF BIOMEDICAL WASTE MANAGEMENT
Notes:
CLASSIFICATION OF BIOMEDICAL WASTE
Hazardous Waste
Nonhazardous Waste
CHAPTER 5:
Hazards of Biomedical Waste
HAZARDS OF BIOMEDICAL/HEALTHCARE WASTE
Types of Hazards
Persons at Risk
Hazards from Infectious Waste and Sharps (Figs 5.2 and 5.3)
Do You Know?
Impacts of Infectious Waste and Sharps
Hazards from Chemical and Pharmaceutical Waste
Impacts of Chemical and Pharmaceutical Waste
Hazards From Genotoxic Waste
Impacts of Genotoxic Waste
Hazards from Radioactive Waste
Impacts of Radioactive Waste
Public Sensitivity
CHAPTER 6:
Need for Disposal of Biomedical Waste
HEALTH REASONS
ETHICAL ASPECTS
ENVIRONMENTAL REASONS
Biological
Chemical Pollutants
Radioactive Emissions
Water Pollution
Land Pollution
CHAPTER 7:
Waste Minimization
DEFINITION
NEED FOR WASTE MINIMIZATION
ADVANTAGES OF WASTE MINIMIZATION
How to do Waste Minimization?
A FEW EXAMPLES OF WASTE MINIMIZATION PROCEDURES
Minimizing Chemical Waste
Chemotherapy and Antineoplastic Chemicals
Formaldehyde
Solvents
Photographic Chemicals
Waste Anesthetic Gases
Toxic Corrosives and Miscellaneous Chemicals
Reuse
Thermal Sterilization
Cold Sterilization/Chemical Sterilization
CHAPTER 8:
Waste Segregation and Labeling
WASTE SEGREGATION
Need for Segregation of BMW at Source
How Does Segregation Help?
Cautions
Role of Waste Segregation
REQUIREMENTS FOR WASTE SEGREGATION
SIGNIFICANCE
PERSONS RESPONSIBLE FOR SEGREGATION
PROCEDURE FOR SEGREGATION
RULES FOR SEGREGATION
Advantages of Color-coded Waste Containers
ADVANTAGES OF SEGREGATION
CONTAINERS FOR WASTE COLLECTION
Types of Containers
Reusable Containers (Fig. 8.2)
Sharps Containers (Fig. 8.3)
Important Points
Plastic Waste Holding Bags (Fig. 8.4)
Cardboard Containers
LABELING
Recyclable Waste (Fig. 8.5)
Tagging System of Waste
CHAPTER 9:
Waste Handling, Collection, Storage and Transportation
WASTE HANDLING
Gloves
Aprons, Gowns, Suits or Other Apparels
Masks/Eye Wear/Face Shields
Boots/Shoes
COLLECTION
Procedure for Waste Collection
STORAGE
Definition
Caution
TRANSPORTATION OF BIOMEDICAL WASTE
On-Site Transport
Off-Site Transportation
Regulation and Control System
Special Packaging Requirements for Off-Site Transport
Inner Packaging
Outer Packaging
Packaging can be done in Two Possible Ways
Routing
Management of Accidents and Spillages
Special Provisions for Needle Stick Injuries
General Procedures to be Followed in Case of Spillages
CHAPTER 10:
Treatment and Disposal
WASTE TREATMENT
Why do we Need Treatment of Hospital Waste?
Guidelines for Biomedical Waste Management Facilities
Centralized Facility for Biomedical Waste Management
Disinfection
CATEGORY-WISE MANAGEMENT OF BIOMEDICAL WASTE
Human Anatomical Waste and Animal Waste (Category 1 and 2)
Microbiological and Biotechnological Waste (Category 3)
Waste Sharps (Category 4)
Disinfection
Mutilation
Final Disposal
Advantages
Discarded Medicine and Cytotoxic Drugs (Category 5)
Disposal of Small Quantities of Pharmaceutical Waste
Advantages
Disposal of Large Quantities of Pharmaceutical Waste
Cytotoxic Waste
Soiled Waste (Category 6)
Solid Waste (Category 7)
Liquid Waste (Category 8)
Incineration Ash (Category 9)
Chemical Waste (Category 10)
Disposal of General Chemical Waste
Disposal of Hazardous Chemical Waste
Wastes Containing High Heavy Metals
Pressurized Containers
Radioactive Waste
Recycling and Reuse
Return to Supplier
Treatment and Conditioning
Discharge/Disposal
Management of Individual Radioactive Item
METHODS FOR TREATMENT OF BIOMEDICAL WASTE
Incineration
Definition
Types of Incinerators
Disadvantages
Plasma Pyrolysis
Parts of the System
Nonincineration Technologies
Thermal Processes
Chemical Processes
Irradiative Processes
Biological Processes
Mechanical Processes
Low-heat Thermal Technologies
Autoclave
Waste Types not to be Treated
Microbial Inactivation
Microwave System
Hydroclave
Chemical Processes
Types of Waste Treated
Wastes Which will not to be Treated
Emissions and Waste Residues
Microbial Inactivation
Advantages of the Technology
Disadvantages
Details about the Chemicals Used
Ozone
Sodium Hypochlorite (NaOCl) (Tables 10.6 and 10.7)
Chlorine Dioxide
Ethylene Oxide
Irradiation Technologies
UV-C or Ultraviolet Radiation
Electron Beam Technology
How it Works
Types of Waste Treated
Waste Types not to be Treated
Emissions and Waste Residues
Microbial Inactivation
Advantages of the Technology
Disadvantages of the Technology
LANDFILL
Open Dumping
Sanitary Landfills
CHAPTER 11:
Dental Office Wastes
TYPES OF HAZARDOUS DENTAL WASTES
MERCURY CONTAINING 7WASTES
Disposal Options
Elemental Mercury
Best Management Practice (BMP)
Cautions
Mercury Containment Kit (Fig. 11.3)
Storage and Disposal of Waste Mercury
Scrap Amalgam
Best Management Practice (BMP)
Cautions
Best Management Practice (BMP)
For Traps
For Vacuum Pump Filters
Other Options
Cautions
Always
Never
Empty Amalgam Capsules
Amalgam Separators
Plumbing Replacement and Repairs
Mercury-free Purchasing
For Economical Recycling of Mercury
SILVER CONTAINING WASTES
Spent X-ray Fixer
Disposal Options
Best Management Practice (BMP)
Cautions
Recycling X-ray Fixer Solution/Silver Recovery
Disadvantages of Evaporation
X-ray Developer
X-ray Film (Fig. 11.8)
Cleaners for X-ray Developer Systems
Developed Film (Figs 11.9A and B)
Disposal Options
Undeveloped Film
Disposal Options
Best Management Practice (BMP)
Advanced Radiography
Caution
LEAD CONTAINING WASTES
Lead Foil Packets
Best Management Practice (BMP)
Cautions
Lead Aprons
Disposal Options
Best Management Practice (BMP)
BIOMEDICAL WASTES
Disposal Options
Anatomical Wastes (Human Tissue)
Best Management Practice (BMP)
Caution
Nonanatomical Wastes (Blood Soaked Materials)
Best Management Practice (BMP)
Caution
Sharps
Nonanatomical Wastes (Sharps, Needles, Scalpels, etc.)
Best Management Practice (BMP)
Cautions
CHEMICALS, DISINFECTANTS AND STERILIZING AGENTS
Disposal Options
Best Management Practice (BMP)
Cautions
Autoclaves/Chemiclaves
Drugs and Pharmaceutical Chemicals
Some Other Dental Wastes
Best Management Practice (BMP)
POLLUTION PREVENTION FOR DENTISTS
CHAPTER 12:
Training of Healthcare Workers
AIMS OF TRAINING
WHO NEEDS TRAINING?
Selection of Participants
RECOMMENDATIONS FOR TRAINING OF HEALTHCARE PERSONNEL
RECOMMENDATIONS FOR TRAINING OF WASTE HANDLERS
TRAINING FOR WASTE TRANSPORTATION STAFF
TRAINING OF OPERATORS OF TREATMENT PLANTS
TRAINING OF LANDFILL OPERATORS
PUBLIC AWARENESS ON HAZARDS OF HEALTHCARE WASTE
CHAPTER 13:
Immunization of Healthcare Workers
MANAGEMENT OF OCCUPATIONAL BLOOD EXPOSURES
1st Step
Immediate Care to the Exposure Site
2nd Step
Risk Assessment
3rd Step
Evaluation of the Exposed Person
4th Step
Postexposure Prophylaxis
5th Step
Follow-up Testing and Counseling
HBV Exposures
HCV Exposures
HIV Exposures
Tetanus and Diphtheria Vaccination
Measles, Mumps, Rubella (MMR)
Rubella Component
Varicella Vaccination
HEPATITIS A VACCINATION
Prophylaxis Against Hepatitis A Virus Infection
Immunoglobulin (IG) (Passive Immunization)
Hepatitis A Vaccine (Tables 13.3 and 13.4)
Twinrix
Contraindications and Precautions
Postexposure Prophylaxis with IG
HEPATITIS B VACCINE DOSE AND ADMINISTRATION (TABLES 13.5 AND 13.6)
Hepatitis B Immunoglobulin (HBIG) Dose and Administration
Unknown or Uncertain Vaccination Status
Interrupted Vaccine Schedules
Minimum Dosing Intervals and Management of Persons who were Vaccinated Inadequately
Postvaccination Testing for Serological Response
Booster Doses
Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection
For HBsAg Positive Exposure Source
Exposure Source with Unknown HBsAg Status
Contraindications and Precautions
MANAGEMENT OF OCCUPATIONAL EXPOSURES TO HIV AND RECOMMENDATIONS FOR POSTEXPOSURE PROPHYLAXIS
RECOMMENDED HIV POSTEXPOSURE PROPHYLAXIS (PEP) FOR PERCUTANEOUS INJURIES
For HIV Positive, Class 1 Source
For HIV Positive, Class 2 Source
For Source of Unknown HIV Status
If the Source is Unknown
If the Source is HIV –ve
HIV PEP (TABLE 13.7)
Selection of Drugs for HIV PEP
Follow-up of Exposed Healthcare Personnel
Adverse Effects of the Initial PEP Regimen
OCCUPATIONAL TRANSMISSION OF HCV
Postexposure Management for HCV
Management of Exposures to HCV
RABIES
Dose Schedule
Postexposure Rabies Vaccines
H1N1 FLU (SWINE FLU)
Live Attenuated Intranasal H1N1 Vaccine (Tables 13.8 and 13.9)
Indication
Examples of Intranasal (Nasal Spray) Vaccines
Med-Immune LLC
Procedure of Administration
Swine Flu Vaccine Dosage
H1N1 Vaccine During Pregnancy or Breastfeeding
Reactions to the Injection Vaccine
Side Effects of Antiviral Drugs
CHAPTER 14:
Infection Control Practices in Waste Management
INFECTION CONTROL
Why do we Need Infection Control?
Who Should Use Personal Protective Equipment?
STANDARD PRECAUTIONS
Handwashing and Antisepsis (Hand Hygiene)
Use of Personal Protective Equipment (Fig. 14.1)
Full Personal Protective Equipment
Principles for Use of Personal Protective Equipment
Gloves (Fig. 14.2)
Masks
Protective Eyewear/Goggles/Visors/Face Shield (Fig. 14.3)
Gowns and Plastic Aprons
Caps and Boots/Shoe Covers
Handling of Patient Care Equipment and Soiled Linen
Patient Care Equipment
Linen
Prevention of Needle Stick/Sharps Injuries
ADDITIONAL (TRANSMISSION-BASED) PRECAUTIONS
Airborne Precautions
Droplet Precautions
Personal Protective Equipment Used for SARS (Severe Acute Respiratory Syndrome)
Contact Precautions
Appendix
1. SHORT TITLE AND COMMENCEMENT
2. APPLICATION
3. DEFINITIONS
4. DUTY OF OCCUPIER
5. TREATMENT AND DISPOSAL
6. SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE
7. PRESCRIBED AUTHORITY
8. AUTHORIZATION
9. ADVISORY COMMITTEE
3[9A. MONITORING OF IMPLEMENTATION OF THE RULES IN ARMED FORCES HEALTHCARE ESTABLISHMENTS
10. ANNUAL REPORT
11. MAINTENANCE OF RECORDS
12. ACCIDENT REPORTING
13. APPEAL
214. COMMON DISPOSAL/INCINERATION SITES
STANDARDS FOR WASTE AUTOCLAVING
STANDARDS FOR LIQUID WASTE
STANDARDS OF MICROWAVING
STANDARDS FOR DEEP BURIAL
Abbreviations
References
INDEX
TOC
Index
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