CLINICAL WASTE MANAGEMENT By NADIRATUL NOZIANA ABD MAJID

CLINICAL WASTE MANAGEMENT By: NADIRATUL NOZIANA ABD MAJID EXECUTIVE ENGINEER

AIMS & OBJECTIVE Provide information on the correct method of clinical waste management & handling. To develop awareness so as to appreciate health , safety and environmental protection issues relating to clinical waste.

PMSB VISSION PMSB WILL PROVIDE QUALITY SERVICE IN THE HEALTHCARE AND RELATED SERVICE INDUSTRIES WITH UNSURPASSED DEDICATION TO CUSTOMER SATISFACTION THROUGH INNOVATION AND A MOTIVATED, COMMITTED AND EFFICIENT WORKFORCE WHO TAKE PRIDE IN THEIR WORK.

PMSB CUSTOMERS GH Private Hosp/Clinics

BIOHAZARD SIGN

LEVEL OF BIOHAZARD l Level 1 - Varicella, Canine hepatitis l Level 2 - Hepatitis A, B and C, Influenza A l Level 3 - SARS, Yellow fever l Level 4 - Ebola, Dengue fever

HOSPITAL WASTE CATEGORY l Clinical waste- scheduled waste l Radioactive waste- scheduled waste l Chemical waste- scheduled waste l Pressurized containers l General waste

COMPOSITION OF CLINICAL WASTE l l l l 5% Pathological 3% PVC 30% Plastic other than PVC 32% Paper including wax Paper 10% Hospital dressing 10% Miscellany-flowers, rags etc. 10% Non combustible-glass, sharps, metal

DEFINITION OF CLINICAL WASTE Clinical waste - Any waste which consists wholly or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it.

DEFINITION OF CLINICAL WASTE Clinical Waste -Any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research, or the collection of blood for transfusion, being which may cause infection to any person coming into contact with it.

CATEGORY OF CLINICAL WASTE

Category A l l l l Blood Body fluids excretions Soiled surgical dressings Swabs Material from infectious diseases

Category B Discarded syringes, needles, broken glass, and other contaminated disposable sharp instruments

Category C Lab or post mortem room waste

Category D Pharmaceutical and cytotoxic waste

Category E Used disposal bed pan liners, urine containers, incontinence and stoma pads

PMSB: CRADLE TO GRAVE SERVICE Incineration User Training Pottering Service Transport Service Store Management & Consumable Supply

CONSUMABLES Yellow Plastic Bags Blue Plastic Bags Cable Ties CW Label Bag Holder Paddle Bin Sharp Container Trocar Container

PMSB CONSUMABLES Consumables are supplied to all hospital site. They must be used correctly and not misused.

WASTE SEGREGATION: DOS & DON’TS Nursing and clinical staff responsibilities: • Segregation at SOURCE: Clinical Waste correctly segregated from General Waste. • ONLY CW is deposited in yellow bags. • ONLY SHARPS in sharps container. • Seal bags when 3/4 FULL using cable ties. Never seal bags by stapling.

WASTE SEGREGATION: DOS & DON’TS l l l Waste Cat. A, C, D, & E throw into yellow bags. Infectious waste, do prior treatment by autoclave & throw into blue bags. Waste Cat. B throw into Sharp containers are firmly pressed prior to disposal. Don’t force needle/syringes into the sharp container.

WASTE SEGREGATION Oops!! I terr. . throw clinical waste into the black bag…. What should I do?

CLINICAL WASTE GUIDELINE… If clinical waste and domestic waste are mixed, it should be treated as schedule waste… Clinical Waste + Domestic Waste Clinical Waste

WASTE SEGREGATION

CLINICAL WASTE GUIDELINE… • Place contaminated waste bag into another bag of the correct color (yellow bag). • Under no circumstances should incorrectly segregated waste be taken out of a waste bag or container once deposited.

MANUAL HANDLING OF CLINICAL WASTE BAG l l l l l Check if it is properly sealed. Check label and ensure it shows the source of waste. Pick the bag up by the neck only. Bags should not be clasped against the body. Do not attempt to carry too many bags at one time. Do not throw or drop the bags. Do not support the bag from the bottom. Do not leave the waste unattended. Conduct spillage clean-up when the need arise.

MANUAL HANDLING OF SHARP CONTAINERS l l l No darting needles into the bin. Sealed when 3/4 full. Syringes with attached needles shall be discarded together. Do not shed needle. Do not press down the bin lids when closing. Shake the container gently before closing. Check if bin is labeled with date and site of origin. Keep out of reach of children. Intravascular guidewires, cannulae, blood taking sets, glass slides, glass dry vials & ampoules shall be discarded into the correct size containers.

Syringes/needles in yellow bag - Big Mistake… Result in deadly consequences!!!

LABELLING All bag and sharp containers shall be labeled for identification purpose. WHY? ? Should any problem arise, the waste can be easily traced.

LABELLING Labels should have: • Date waste first generated • Name, Add & Contact no. of waste generator • Marked with biohazard symbol and code SW 404

STORAGE OF CLINICAL WASTE l l l Designated area for storage. Locked & attended at all time. Separated from general waste store. Minimum 2 days storage capacity. Accessible only by authorized person. Facilities for washing hands made available. Connected to sewerage system. PPE made available. Refrigerated storage required if stored for >24 hours. Free from vermin, droppings, etc. Odour control. Good housekeeping.

STORAGE OF CW- THEN “Old mortuary house turn domestic waste store…. Temporarily utilised as CW storage in 1996”

STORAGE OF CW-NOW

CLINICAL WASTE DISPOSAL l l l Landfill Autoclave (Steam treatment) Irradiation Microwave Treatment Chemical Disinfection • Incineration

WHAT IS INCINERATION Combustion of waste at high temperature with O 2 to produce inert ash, CO 2, H 2 O and trace levels of pollutants.

NEED FOR INCINERATION · · · Because generation of waste increases daily. Scarcity of landfill sites. Sustain clean environment. Reduces pollution due to open burning. Ensures total destruction of pathogen & organic material. Complies with DOE emission control standard.

CW DISPOSAL-THEN

CW DISPOSAL - NOW

PMSB INCINERATOR PLANT l l l l Malaysia’s 1 st Clinical Waste Incinerator Located at Bukit Rambai, Melaka Operation since October 1996 Stepped hearth technology, capacity 2 x 250 kg/hr ISO 9001: 2000 (Nov 1997) ISO 14001: 1996 (Dec 2001) OHSAS 18001: 1999 (May 2003)

PLANT PROCESS Waste Receive Cold Room Burning Bin Washing Preparing Clean Bins Ash Handling Process Control Ash Removal for Disposal

PMSB INCINERATOR PLANT

CLINICAL WASTE MANAGEMENT IS A JOINT EFFORT - TO SUSTAIN GOOD HEALTH, SAFETY & ENVIRONMENT….

WRONG PRACTICE

REVISE BACK…. YELLOW BAG CLINICAL WASTE CATEGORY…. A? . . B? . . C? . . D? . . E? . .

REVISE BACK…. SHARP CONTAINER CLINICAL WASTE CATEGORY… A? . . B? . . C? . . D? . . E? . .

SEGREGATION (PENGASINGAN) Clinical Waste Groups Group A Wool · Cotton · Gloves, Swabs · Plasters and bandaging · Soiled surgical dressing · Materials used to clean spillage. Group B Sharps instruments and objects · Syringes Group C Clinical Waste arising from laboratories / infectious wastes · Pathology · Haematology · Human biopsy materials · Human tissues Yellow Bag · Blood, Urine, (Beg Kuning) Stools · Organ, Limbs · Body parts · Placenta · Needles Sharp · Cartridges · Scalpel blades Container (Bekas Tajam) · Blood Light Blue Bag transfusion (Beg Biru · Microbiology Muda) · Post -mortem room wastes

SEGREGATION (PENGASINGAN) Clinical Waste Groups Group D Pharmaceutical wastes · Expired drugs · Sera Low level radioactive waste · X-ray dept. Group E · Disposable pads · Disposable bed -pan liners · Disposable diapers Cytotoxic waste · Treatment of cancer patient Sharp Container (Bekas Tajam) · Vaccines · Incontinence pads · Urine containers · Stoma bags Yellow Bag (Beg Kuning)