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LITERATURE REVIEW (HOSPITAL WASTE MANAGENMENT)

LITERATURE REVIEW

Dr. Muazumuddin Ahmed a renowned hepatologist and President of Pakistan Society of Gastroenterology disclosed this during his lecture on the disease at Peshawar Press Club. Dr. Muazumuddin said out of the 23 million patients 76% got the disease through injection by re-using syringes, 34% through surgery in the hospitals, 18% thrown blood transfusion and 2% through sexual intercourse.

Blood is the prime source of transmission of the disease, he added that healthy one gel the Disease through several means including multiple injection, reuse of syringes, transfusion of unscreened blood, contaminated surgical instruments and other dental instruments (The News, 12^th July 2007).

Dawn dated 4/10/2008 regarding hospitals need framework for safe disposal of solid waste.

The public sector hospitals have yet to develop a proper framework for the safe disposal of hospital waste in apparent violation of the rules laid down in the Environmental Protection Act of 1999, doctors told Dawn.

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STORAGE OF WASTES IN HOSPITALS

STORAGE OF WASTES IN HOSPITALS

No permanent waste storage facilities are present in the hospital. However, some common plastic dustbins are available in and around the wards. But they are not mostly water tight and dust resistant. Besides, the available dustbins are not properly covered from form the top and mostly access to the containers by the users are not within their limits. Furthermore, no facilities or arrangement is provided to store the liquid waste, which is highly infectious. All type of toxic and hazardous liquid containing blood chemicals, germs are discharged through the city sewerage system. In case of refuse lying in the premises for days requires an adequate number of suitable containers with proper coverage. The solid and semisolid wastes are to be stored in the same manner. If standard containers are used with separation of many components of the wastes, it will make very easy the handling of disposable wastes.

COLLECTION OF SOLID WASTE

The collection of solid waste is obviously the initial problem in waste management system. It has been observed that about 80% collection of the total waste is made through the sanitary staff with naked hands using land filling method. And for the remaining 20% incineration method is used. Therefore, collection of solid waste in the hospital is one of the main components in waste management system. Small dustbins and baskets full of various wastes are collected and disposed within the hospital premises. Rough and broken drums or containers are used for collection purposes. They are neither movable nor portable.

RECOVERY AND RECYCLING

Probably we will never be able to recycle all of the wastes but we should try to recycle many of them due to scarcity of raw materials and harmful impacts on human environment.

Recycling of wastes reduce the volume of wastes as well as economically reduce the cost of getting the resources. The selection of recycling technique depends upon the purpose to be achieved. The three main purposes can best be enumerated.

1. To reduce the waste

2. To reuse the usable material

3. To recycle it

Composition of hospital wastes reveals that some items can be recycled, if they are properly separated in the time of generation and collection. If some care is taken under medical supervision then it will make the recycling processes easy. Objects like empty bottles and glasses can be recycled. However, certain disposable items like, urinary bags, drips bags, transfusion sets and disposable syringes collected by sweepers should not be reused. Modern separation techniques are to be applied in hospitals in sorting out non reusable items. Incineration and decomposing techniques are available to dispose the waste.

FAILURE OF THE PRESENT SOLID WASTE MANAGEMENT SYSTEM

Efficient and effective solid waste management needs to ensure that all type of wastes are collected, properly handled and disposed in an economical way with no or very little environmental impacts. Solid waste management is, therefore, thought to be a multifunctional activity based on sound environment principles with an economic efficiency.

THE STORAGE PROCESS

Due to lack of proper education, people of poor country not aware about solid waste management system. People dispose all types of wastes haphazardly and therefore make the condition serious then it needs extra staff to control and over come such situation. To collect certain waste for storage is difficult to handle involving health hazards. Mostly the storage facilities are not enough to overcome the problems of storage. Either the containers are very old and useless or in broke shape. No emergency control system for storage is available which otherwise disturb the sewerage management system.

Storage facilities are very limited. Neither storage containers are suitable, nor do people use it properly which creates many problems for sweepers to perform their duties. All the solid and semisolid waste with different composition is collectively stored for long period of time which creates enormous threats for infection disease. In HMC the containers are not covered from the tops, which cause bad smell and spread pollution. The numbers of waste containers are limited and are extremely dirty, therefore, not fit for wards use.

Due to enormous rush of patients extra beds are lying in different wards that create a lot nuisance in these ward and simultaneously produce extra waste with no proper disposal arrangements. On the top of it the huge number of visitors provides more chances for creating more waste. No doubt few newly constructed blocks are reasonably clean with good environment but insufficient storage facilities are making the situation vulnerable. Beside, ignorance of the people and the patients are one of the serious problems in high rate of waste generation. Several wards like surgical and chest needs special care in using antiseptic materials and properly designed container to avoid the spreading of many germs. Certain items are recyclable or reusable of these are kept and stored separately in the time of generation. However, no separate storage facilities are provided in the HMC.

DRAW BACKS IN COLLECTION PROCESS

Due to lack of instrumental facilities, storage disorder and poor worker performance makes the collection process more difficult, expensive and risky too. All wastes are stored in one container therefore collection is more complicated. Frequency collection is missing and wastes are removed at will of the sweepers.

Disposable solid waste should be separately made and be properly treated. No facilities are providing for sweepers to protect their bodies during collection and to perform their duties well. The sweepers are not aware about the effects of these infections waste. The bags are often overloaded and floor sweepers are slack in performing their duties to dispose the wastes. Hand carts are limited am: are not properly designed to collect wastes on scientific methods with proper tools and equipment. The collection frequency varies from wards to wards depends on administrator and ward in charge. Round the clock collection services are badly needed to avoid wastes dumping for more than 12 hours.

DRAW BACKS IN TRANSFER STATION

Transfer station is the local dump or temporary station for final disposal, This station is situated with in the premises of the hospital having no fixed walls from where the waste are easily dispersed and the liquid is equally spreading all sides. The waste is lifted from the main station on weekly basis. Sometime this waste is burnt in the open areas which badly affect the hospital wards environment.

OCCUPATIONAL HEALTH AND SAFETY

EQUIPMENT AND CLOTHING

No.	Safety Equipment/Clothing	Use
1.	Heavy duty gloves	Hand protection while moving the bags, hold bag by the neck.
2.	Industrial boots	Feet are protected for spillage of sharps. Protect the feet from falling the bags or container.
3.	Apron	Protect body from bags.
4.	Eyes protestors and nose mask	Protect eyes in accident and spillage operations. Inhalation protection.
5.	Fork	Waste segregation.
6.	Helmets	Protect incinerators while loading incinerator manually or when removing ash for disposal.

PROTECTION AGAINST UNSEALED SOURCES IN MEDICINE

PROTECTION AGAINST UNSEALED SOURCES IN MEDICINE

Diagnostic jade isotope test uses radioactive tracer for studying lungs, I brain, liver, spleen, kidneys, thyroid, bone and blood. The radio nuclide selected depends upon the organ being studied e.g. calcium-47 or strontium-85 is bone seeking nuclides.

Under most circumstances the patient might be discharged immediately because of low activities.

RADIOISOTOPE THERAPY

In this method radiation therapy is carried out by the ingestion or injection of radio-nuclides solution into the body.

The nuclides been is one which concentrates in the organ needing treatment thus minimizing the doze to the rest of the body.

Patients containing therapeutic quantities of radio activity could be nursed under conditions which permit easy containment of radio activity in case of contamination.

Ideally special ward should be available in which all surfaces are designed to permit easy cleaning and filtered extract system are provided, protective gowns and gloves must be worn when handling the patients, contaminated linen or excreta and a special storage area is provided, for contaminated linen waste and samples of excreta.

The radiation safety officer specifies any limitations on time allowable for nursing procedures or visiting periods.

Washing and monitoring facilities must be provided for use when leaving the area and regular radiation and contamination survey have been made of the ward.

STORAGE OF RADIOACTIVE WASTE

Storage of radioactive waste has been regarded as a very useful procedure when ding with nuclides or relatively short half life e.g. up to a few months.

If we keep the waste for a period of having long half life this storage can only be considered ks a temporary solution.

DISPOSAL OF SOLID WASTES

A method practiced by smaller users of radioactive materials (hospitals, factories, universities etc) has been disposal with ordinary trade waste. The principle applied here is dilution, the old package having a small quantity of radio activity being well-diluted and buried among the vast quantities of ordinary trade and domestic waste on the local refuse tip.

RADIO ACTIVE WASTES

On a much smaller scale radio active wastes arise in hospitals, factories, research and teaching institutions because of the many applications of radiation. In such the complex treatment plant used at nuclear power stations would be much expensive and so disposal may be done by the normal refuse collection or sewage system.

There are three basic principles which may be applied in dealing with radio active waste, these are.

i. Delay and decay,

ii. Concentrate and store and

iii. Dilute and disperse,

CONTROL AND DISPOSAL OF RADIOACTIVE MATERIALS IN MEDICINES

A large hospital may be having a very large number of radio active sources; both sealed and unsealed, and so needs a special storage area located in a position which minimizes the risk of fire or flood damage. Leakage test are needed to be performed on all sealed source at least annually and any source showing significant leakage must be withdrawn from use immediately. Sources not in the main storage area should be kept and transported only in approved containers. These containers must be constructed so as to provide adequate shielding and adequate contaminant to disallow dispersal in the event of damage to the source. They should be clearly marked radio active and carry the standard trefoil symbol.

The general policy on radioactive wastes disposal from hospitals has been to use conventional local methods, whenever possible. Low level solid waste is removed with ordinary refuse and usually finds its way to the local refuse tip. Low level liquid wastes such as laboratory washing or excreta from patients get discharged to the normal sewage system.

As most of unsealed radioactivity used in medical work has been short lived, it is usually practicable to store high level waste until it decays to an acceptable level for discharge to the sewage system. High level waste of long half life whether solid or liquid, can be collected by or sent to the national disposal services of the country.

Records must be kept of all wastes discharges, both solid and liquid.

The data available shows that the number of the patients within the hospital is increasing day by day which create problems like, unhygienic conditions, insufficient health care facilities, delay in treatment and recovery causes' infection. A large amount of pathogenic and hazardous wastes have created numerous social problems resulting into social malaise and epidemic diseases. The load of patients is also increasing day by day on general and teaching hospitals due to lack of health care facilities in rural areas. The HMC, LRH and KTH are such example where solid waste management system is not matching with the available resources to meet the enormous challenge of disposing the wastes properly. It is, however, a fact that the waste produced by the HMC alone consists of many pathogen, hazardous and explosive materials like sputum containing patient's pus, cell excreta, vomiting, bleeding, gangrene organs, contaminated disposable syringes, infectious waste, chemicals, radiation and radio active wastes. Beside the Offensive smell and bad environment these wastes cause gastro intestinal diseases, parasitic disease, insects and pulmonary disease like tuberculosis. Similarly due to lack of proper management facilities and due to over crowding the patients as well as the public receive unnecessary radiation during x-ray and radio therapy.

In solid waste management preference is given to the quality rather than quantity of wastes. Wastes generated in hospitals like the HMC, LRH and KTH, are of various composition and characteristics. Its quantity varies with time and place. However these contain certain infectious and hazardous wastes, therefore, it is necessary to give proper attention for its management.

The liquid wastes produced in the HMC, LRH and KTH contain blood, pus excreta, vomiting, dressing and washing water, laboratories effluents and chemicals are drained in to the city sewerage system without any treatment and process. Throwing hospital water into the drains of the city makes good media for bacteria and other macro organisms. Therefore, where ever these polluted water goes it contaminates our soil and under ground water. Mostly big organs and imputed limbs in hospitals are return to the patients' relatives with great care and arc buried them. Still many diseased parts of the body are disposed off normally with other refuse. Syringes, needles, glucose bags, urine bags are collected by sweepers and are sold in market while there are patients having dangerous and contiguous diseases. Some pharmaceutical companies are involve in the business to purchase these items from bazaar and sold it for reuse. It creates a lot of problems and increases the ratio of post surgery infections. These disposable items play active role in the spread of infectious and killing disease like hepatitis (A, B,C), T.B, AIDS, and Typhoid, Although, the HMC administration have some understanding with some pharmaceutical companies to collect placenta directly from gynecology ward to dispose it. However some time the placenta is mixed with other refuse for final disposal.

ANALYSIS OF THE EXISTING SITUATION

Hospital waste management may be defined as the discipline which deals with the generation, collection, storage, transfer, transport, processing and lastly disposal of wastes in a manner that is in accordance with the principles of environmental & public health engineering, economic, aesthetic and ecological considerations. Hospital waste management needs its own administrative and field staff to remove and mitigate the waste within the available financial resources and legal framework. All of these factors are collectively responsible for a sound waste management set-up.

All hospitals including the HMC, wastes management is the central problem having grave consequences but little care is given to dispose it. The HMC with 681 beds in it, generate 2550 Kg of wastes every day in total and @ 1.75Kg/day. This volume of waste from HMC has increased the threat of causing numerous diseases than that of the total wastes generated in the whole city and cantonment area.

This much waste is generated from wards of and other Depts., while a large amount of waste is generated in the OPD, but mostly the waste is non infectious and there is no proper way of at source segregation. The hospital administration is trying best to dispose off the waste materials properly and in time but due to certain problems and difficulties they are not able to dispose off the waste in an efficient and proper way. As the hospital waste contains infecting waste special care should be taken while disposing of the waste of such nature. Due to over-crowding of hospital, visitors and patients awareness of the harmful effects of the infectious waste is highly unsatisfactory. The unhygienic environment in and around the hospital has the potential danger in creating greater complication for highly vulnerable patients. With no proper system and arrangement of waste collection, storage and transfer especially from hospitals have lethal effects and cause cross-infection. It is commonly being observed that the waste is lying in the premises of hospital in open area for several days. The organic nature of the waste undergoes into decomposition, so the public in general and the sanitary workers in particular are exposed to serious health hazards. The ultimate disposal of the waste result in an open dumping is a dangerous practice both for short and long time duration.

The present system of hospital lack proper planning and supervision. No scientific methods or treatment facilities like steam sterilization or incineration arc applied. Neither the hospital neither has its own proper arrangement nor has required equipment nor did it make any arrangement with the Municipal Corporation to give a special care while handling the hospital waste. Several carcinogenic compounds and chemicals, mercury and other heavy metals, X-Rays and other radiation materials are fond in abundance in affecting the community al large.

The situation in KHYBERPAKHTOONKHWA is very serious because of unawareness about the waste problems due to overcrowding in hospital with rapid increase in population. This problem has further deteriorated compounded because of rural migration to the urban centers and due to the huge influx of Afghan refugees and their settlement in and around the vicinity of Peshawar city. The migration and settlement of Afghan refuges have not only increased the burden on HMC, LRH, KTH and its sister organizations, but these refuges have brought different diseases like, oral carcinoma and certain skin diseases and tuberculosis with them. If proper guidelines and scientific methods are not adopted, it will have disastrous consequences for the people of Peshawar.

WASTE MANAGEMENT PLAN

WASTE MANAGEMENT PLAN

Every hospital shall have a waste management plan which include

1. A plan of the hospital showing the waste disposal points for every ward and department, indicating whether each point is for risk waste or non-risk waste, and showing the sites of the central storage facility for risk waste and the central storage facility for non-risk waste;

2. Details of the types, numbers and estimated costs of containers, waste bags and trolley required annually.

3. Time-tables including frequency of waste collection from each ward and department.

4. Duties and responsibilities for each of the different categories of hospital. Staff members who will be involved in the management of the waste.

5. An estimate of the number of staff members required for waste collection.

6. Procedure? for the management of waste requiring special treatment such as autoclaving(sterilize) before final disposal;

7. Contingency plans for storage or disposal of risk waste in the event of breakdown of incinerator, or of maintenance or collection arrangements.

8. Training courses and programmers; and

9. Emergency procedures.

10. The representatives of the local council responsible for the collection and disposal of waste from the hospital shall be consulted in drafting and finalization of the waste management plan.

11. The waste management plan shall be regularly monitored, reviewed, and revised and updated by the waste management Team as and when necessary

Waste management team/ committee

For proper disposal and management of hospital waste every hospital shall be have its own waste management team/ committee which includes the following members.

1. The medical superintendent

2. DMS (Adm)

3. The heads of all hospital departments

4. The infection control officer

5. The chief pharmacist.

6. The senior Matron

7. The hospital engineer

8. The head of the sanitation staff

9. Public representative of the local district administration.

British standard’s institution Classification of Wastes

Class A: Ward Wastes

1. Ward and sanitary general ward wastes.

2. Disposable waste paper articles and floor sweeping excluding uncontaminated tins’ bottles, food wastes plastic and disposable bed pans.

Class B: Plastics material and Dirty Papers

1. Operation Theatre waste and human tissues.

2. Disposable Theatre garments hand plaster coats.

3. Pathological Lab wastes, specimens and animals.

Class D: Maternity Wastes

1. Placenta and maternity dressing

2. Disposable napkin and general maternity ward waste excelling uncontaminated articles like bottles.

Class E: Kitchen wastes

Class F: Clean Paper

1. Newspaper, letter, Card Board that have not been in contact with infections patients.

PROPER LITERATURE REVIEW FOR HOSPITALS (HOSPITAL WASTES)

In hospitals we are concerned mainly to the pathological wastes. The biological wastes are hazardous due to contamination with pathogens. Tubercular lungs are particularly hazardous due to potential for air borne release of pathogens. The organism, mycobacterium tuberculosis has been found especially prevalent and dangerous in these wastes as have the bacteria of the posteusellas and psittacosis group as well as certain viruses. Surgical and autopsy wastes contain pathogens and present danger if not handled properly. Certain of the other contaminated waste may also be classed as hazardous sine they contain blood, pus, and sputum which can infect the air with many microbiological agents. Some special wastes also contain radio activity such as C¹⁴, Cr⁵¹, Au¹⁹⁸, I¹⁵¹ and Na²⁴. These must the segregated and handled. The pathological and contaminated wastes usually comprise less than 10% of the total hospital-wastes.

The potentially infectious wastes are also found in laboratories, clinic and small Medical treatment centers. These include needles, syringes, and dressing gowns besides tubing and used blood storage bags.

According to the U.S Envoi-protection agency, (EPA) in its draft manual for infectious waste following wastes are considered infectious:-

§ Isolation wastes.

§ Cultures and stocks of etiologic agents.

§ Blood and Blood products. Pathological wastes.

§ Other wastes from surgery and Autopsy.

§ Contaminated Laboratory wastes.

§ Sharps (hypodermic needles etc.).

§ Dialysis-unit wastes.

§ Animal Carcasses and body parts.

§ Animal bedding and other wastes from rooms.

§ Discarded biological.

§ Contaminated food and other products.

Most recently in 1986 these categories were amended into the following infections waste categories.

§ Isolation wastes.

§ Cultures and stocks of infections agents and associated biological.

§ Human blood and blood products.

§ Pathological wares.

§ Contaminated shrills.

§ Contaminated animals carcasses body parts and bedding.

§ Miscellaneous contaminated waste.

An infectious waste is one that present, the hazard of causing disease. Although infectious wastes are generated at many facilities. The largest generations are.

§ The health care industry

§ Academic and industrial research lab.

§ The pharmaceutical Industry.

§ The food, drug and cosmetics Industry.

§ Veterinary facilities.

CLINICAL WASTES

These include human and animal tissue on excretions, drugs medicinal products, swabs and dressing etc.

This classification is expended due to their importance and the fact that these affect our Environment and ecological system, ultimately effect on our health.

A study based on a survey of some 17 hospitals indicates that solvent and chemicals are the predominant toxic or hazardous waste generated and that these materials may be generated at a rate of some 21 ml /bed per day 90.056 Ib/bed per day

LITERATURE REVIEW FOR HOSPITAL RADIATION

Experimental Radii Therapeutics

Much of the Experimental work on the Biological effects of radiation has some relation to the treatment of cancer. The aim of radio therapy in malignant disease is to destroy the cancerous tumor by the administration of a measured quantity of radiation which, although sufficient to bring about the destruction or sterilization of the tumor cells. Abnormal cells are more susceptible to the action of radiation. This slight difference in sensitivity from normal cell causes its exploitation. The physical variables are radiation, dose rate and time interval.

The Biological factors include the histological type of tumor, its site, the degree of advancement and spread in the body

Sealed sources of radio active materials used in hospitals are a very different matter. While they remain scaled they are so well shielded that correct operation involves no hazard. However, occasional accidents show that sealed sources can leak. Cobalt sources may contain many thousands of curies of cobalt-60.

This is usually in the form of small nickel-plated granules, which are unlikely to escape from their container without serious mistreatments. But glass vials and metal capsules containing smaller amounts of cobalt-60. An accident to large galled sources could lead to a serious contamination and clean up problems with resultant radio-active wastes requiring special disposal techniques.

The excreta of some patients need more precautions. Dressings and bed linen, Instruments and equipment, floor coverings and furniture, can all become contaminated.

In nearly all cases reasonable periods of storage are sufficient to ensure safe disposal by conventional means.

Many hospitals use radio nuclides for the diagnosis and treatment of cancer and other diseases of the radio isotopes used, about half is gold 198, a quarter 1-131 and most of the remainder sodium 24, phosphorus-32 and bromine-82.

Due to short half life of 2.7 days for gold-198, the hospital physicist may store the waste until most of the activity has decayed, or highly diluted when discharged to the sewer. The gold seeds or needles may constitute a solid waste. Unused seeds are stored to become inactive waste.

In all cases three quarter of the iodine-131 administered is eliminated in the urine. This is usually discharged to the sewer, but in certain cases, where the dilution on discharge would be small. The urine is stored to allow the activity to decay to an acceptable level.

Phosphorus 32 is used for the treatment of blood disorders, most of which is eliminated in the urine during the week after administration at roughly constant rate. Teletheropy source contain several hundred curies of cobalt-60 or cesium- 137 (half 33 year) and are used instead of x-ray therapy units. After a period, probably less than one half lives, the activity of these sources will have drooped to a useless level. The cobalt-60 sources will probably be reradiated, but the cesium- 137 may become a waste if an economic outlet for the lower activity source cannot be found.

RADIOGRAPHY (SEALED SOURCE)

High active cobalt-60 sources are used in external radiation therapy in a manner similar to x-rays. This requires the focusing of the gamma radiation from the cobalt on a particular area, e.g. the lymph nodes in the neck region, for a prescribed period of time. This type of therapy makes use of the penetrating power of the gamma rays from the isotope. Although the treatment makes cell damage, the patient does not carry any radio-activity after the treatment period is completed. Co-60 used in metallic form exists in the form of seeds, needles, or wires which are implanted into certain body cavities. This type of isotope therapy is in the treatment of advanced stages of cancer involving the cervix. Vagina, uterus and bladder.

It has also & en used in carcinoma of the mouth, tongue and lip.

The following are the common methods of utilizing isotopes for therapeutic benefit.

A procedure known as teletherapy employing gamma-emitting isotopes e.g. Co-60, with activity as high as 2000_C, focuses radiation directly on the area under treatment. The patient is exposed to the radiation for a prescribed period of time through a f. mote-controlled shutter.

Implantation therapy describes various procedures involving direct introduction of scaled radio active sources into tumor tissue; e.g. ⁶⁰Co, ^1S Ta. The sources are small "seeds" needles or wires.

Contact therapy through the use of applicators containing beta emitting isotopes re used for dermatological areas or ophthalmic tumors. This can be ¹ removed as necessary and placed where desired

LANDFILL FOR HOSPITAL WASTE

LANDFILL FOR HOSPITAL WASTE

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WASTE TREATMENT METHODS

WASTE TREATMENT METHODS

INCINERATION

Incineration is the controlled combustion of waste originating form Municipal Commercial and industrial sources in order to destroy it or transform it in to less hazardous materials. Organic constituents break down to give CO₂, steam and other gases such as Sulphur dioxide and Nitrogen Oxide. While inorganic constituents are dehydrated and calcite.

In incineration of Municipal and commercial waste the main objective is to reduce volume and so to save the transportation cost associated with landfill and extending the life of the landfill. In incineration of industrial and hospital waste the objectives are to destroy any hazardous or infectious or organic material present and also to reduce volume. There are incinerators which are used to destroy different waste that is waste which contains hazardous material and these incinerators are used in hospital for destroying clinical waste. Properly managed incineration will reduce the volume of the initial waste but there will be gaseous emission and inorganic residues left at the end of the process. The hazardous organic materials are destroyed in the process. The Municipal and commercial waste is incinerated at a temperature up to 850 °C in the presence of air but for hazardous waste higher temperature of about 1200- 1250^oC is required. The residual ash so collected should be carried and disposed off on the landfill site.

The incinerator used for hospital infectious waste should consist of two chambers i.e. primary and secondary chamber. The primary chamber is operated under reduced mode. Under theses conditions the controlled air is supplied in the primary chamber which is less than the required quantity of complete combustion. The combustion gases produced form the primary chamber is used as fuel in the secondary chamber. Sufficient quantity of air is supplied in the secondary chamber along with auxiliary fuel for complete combustion. Most commonly used auxiliary fuel is diesel oil or natural gas

Depending on fuel case. The natural gas is more economic for incineration and is used for incineration in H.M.C

Following are the figures of different waste treatment processes.

EXHIBITS THE FUNCTION OF THE INCINERATOR OPERATOR

WASTE STORAGE

WASTE STORAGE

The waste of all types is stored in the respective zones before transporting to the waste treatment facilities. The storage area may fulfills the following criteria,

1. It should be located in each zone/ward and secured from scavengers and stray (Homeless cat) animals.
2. The area may be properly ventilated
3. The storage area may have masonry walls.
4. The storage area may be large enough to accommodate excessive waste in case of collection shutdown.
5. The waste storage area is screened (Test or examine for the presence of disease or infection) properly.

WASTE COLLECTION

The waste may not be collected at the generation point or zone level. The sanitary staff/sweepers must use all precautionary measures while handling waste. It includes

1. wearing protective clothing at all times including face masks, aprons, leg protectors, long boots and disposable or heavy duty gloves as required. Sanitary staff and sweepers may ensure that.

1. Waste is collected at least daily, but more often if necessary.
2. All waste bags are labeled before removal, indicating the point of generation, ward, hospitals and contents.
3. The waste bags and containers which are removed may be immediately replaced with new once of the same type.
4. When a waste bag is removed from a container, the container is properly cleaned before a new bag is fitted therein.

WASTE TRANSPORTATION

For on-site transportation the waste collection trolley shall be free of sharp edges, easy to load and unload, easy to clean and preferably a stable three or four wheeled design with high sites to avoid damage to the user and spillage of the waste. The trolley shall not be used for any other purpose. The trolley should be clean properly and regularly. The sealed waste bags shall be carefully loaded by hand on to the trolley, to minimize the risks of puncture or tears.

The Risk waste and Non Risk waste shall be collected on separate trolley. The collection route must be the most direct one from the final collection point to the central storage facility. The collected waste shall not be left temporarily any where except central storage facility. The Risk waste is taken to the incinerator, while non risk to the site of storage.

WASTE STORAGE

A separate storage facility for the yellow bag waste with a biohazard symbol showing that the facility is used only for risk waste. The designated central storage facility shall be:

a. be located with in the hospital premises close to the incinerator.

b. The facility will be large enough to accommodate all the risk waste generated by the hospital.

c. the space should have a spare capacity to cater for collection or incineration break down.

The area will be easy to clean and disinfect, with an impermeable hard standing Base, with plenty water supply, good drainage, lighting and ventilation, it may have adequate cleaning equipment, protective clothing with the waste bags and containers nearby.

§ The area should be easily accessible to authorized vehicles and staff but totally enclosed and secure from unauthorized access and especially inaccessible to animals, insect’s and birds.

§ Only yellow bagged waste shall be stored in the central storage facility.

§ No waste shall be store for more than 24 hours at central storage facility.

§ Chemical waste shall be stored I separate area.

§ The area shall be thoroughly cleaned and ventilated.

WASTE DISPOSAL

After the waste storage, the waste should be properly disposed off, depending upon the type and nature of the waste materials. The risk waste should be inactivated or rendered safe before the final disposal by a combination of any of the above method involving proper validation and monitoring procedures.

Yellow bagged waste shall be disposed of by burning in an incinerator or by burying in a landfill. All risk waste delivered to and incinerator shall be burned with in 24 hours. Ash and residues from incineration should be disposed of in risk waste landfill site. The landfills should be located at sites with minimal risk of pollution of air, ground water or rivers. Access should be allowed to authorize personals only. Risk waste shall be buried in a separate area of landfill at least one meter thickness which shall then be compacted. The landfill site shall be examined regularly to check for contamination of water and air pollution. Radioactive waste after decaying shall be buried or incinerated.

Waste collected from the hospital is taken by the Municipal Authorities to their landfill dumps which are a few kilometers outside the city. The waster is carried for final disposal by Municipal trucks, some of which covered while others are not covered leading to spread of infection to the community. As in most of the cases there is no differentiation between the risk and non risk waste and trucks are fully loaded so that spillage of the infected materials or accident may occur. In case of spillage and accident the following measures should be taken:

1. The contaminated area is evacuated immediately if required.
2. The contaminated area shall be cleaned and disinfected if necessary.
3. The exposure of staff shall be limited during the clean up operation and appropriate immunization carried out.
4. All hospital staff shall be properly shall be properly trained and prepared for emergency response.

SOME WASTE DISPOSAL RECORDS OF H.M.C

Table – A2: Infectious Waste Disposal Record of Hayatabad Medical Complex, Peshawar

Date: 4/1/2010

Shift: Night:

Day: Monday

S.NO	Ward/Unit	Wt. in Kg	S.NO	Ward/Unit	Wt. in kg
1	CCU	2.5	19	G ALR	3
2	NSW	1.5	20	CH. AB	3
3	CT W	3.5	21	G BLR	3.5
4	CSW	3.55	22	COT	6.5
5	CFR	2	23	P SOT	12.5
6	CMR	4	24	GALR	3
7	MSA	2	25	FER	4.5
8	MSB	4.5	26	MMC	3
9	MSC	3.5	27	MUW	3
10	FS AB	3.5	28	DYLAYSIS	5.5
11	MMA	2	29	MMA	3.5
12	FMA	2.5	30	GBLR	4
13	CHEST	2.5	31	GB2W	4
14	MUW	1.5	32	GBIW	4
15	MMB	1.5	33	FMC	1.5
16	COT	3.5	34	GOT	11.5
17	GA 1	32	35	GB2	3.5
18	P S W	3.5
	Total Waste 73 kg

Table – A3: Infectious Waste Disposal Record of Hayatabad Medical

Complex, Peshawar

Date: 22/1/2010

Shift: Night:

Day: Friday

S.NO	Ward/Unit	Wt. in Kg	S.NO	Ward/Unit	Wt. in kg
	FMA	1.5	12	PSW	1.5
	MSB	2	13	MUW	2
	MSC	1.5	14	CTW	1.5
	G OT	8.5	15	NSW	1.5
	FS AB	1.5	16	CCU	1.53
	MA	1.5	17	MB	1.5
	CFR	2	18	CMR	2
	GALR	4	19	GA 1	1.5
	GB2	1.5	20	CHEST	1.5
	CSW	2	21	COT	4
	CHAB	1.5	22	------	------
	Total WASTE 46 kg

Table – A4: Infectious Waste Disposal Record of Hayatabad Medical Complex, Peshawar

Date: 5/2/2010

Shift: Night:

Day: Friday

S.NO	Ward/Unit	Wt. in Kg	S.NO	Ward/Unit	Wt. in kg
	SOT	9.5	22	GA 1	2
	PSW	1.5	23	GA	1.5
	COT	7.5	24	FMA	1
	CMR	1.5	25	NEPH	1.5
	G OT	14.5	26	CHEST	1.5
	NS ICU	4.5	27	NS OT	5.5
	CT ICU	5.5	28	FMC	1.5
	CSW	1.5	29	CCU	2
	MSB	2	30	MSB	4.5
	MMA	3.5	31	CSW 1	1.5
	GB 1	2	32	GB 2	2
	TRAMA	2	33	CFR	2
	E DCC	2	34	FOW FSC	1.5
	M OA	1.5	35	CS OT	8
	BULASIS	4.5	36	ENT	20
	EYE OT	5	37	ISLATION	2
	G AB	1.5	38	CH A	1.5
	PSCHETRY	2	39	CH B	1.5
	FC ROOM	2	40	M LAB	8.5
	G ICU	6	41	MM B	1.5
	BL. BANK	3.5	42	MMC	1.5
	Total WASTE 149 Kg

Table – A5: Infectious Waste Disposal Record of Hayatabad Medical Complex, Peshawar

Date: 23/2/2010

Shift: Night:

Day: Tuesday

S.NO	Ward/Unit	Wt. in Kg	S.NO	Ward/Unit	Wt. in kg
	SOT	10	22	FMC	3
	ORTH OT	14.5	23	NEPH.	3.5
	CATH.LAB	8	24	MSA	5.5
	GOT	16.5	25	MOA	4
	MSB	4	26	CCU	3
	FS AB	3	27	F CYE	2
	CFR	4	28	F ENT	2.5
	E DCC	3.5	29	NURSING	4
	CMR	4	30	ISOLATION	4
	TRAMA	4.5	31	MSC	4
	CT OT	7.5	32	FOW FSC	3.5
	CT ICU	7.5	33	U OT	8
	CTW	3.5	34	U OT	8
	CSW	3.5	35	NS ICU	8.5
	MMB	3	36	NB PR	2.5
	CJEST	3	37	N S W	3
	MAIN LAB	12	38	GAIW	3
	B BANK	6.5	39	GB2W	3.5
	G ICU	8	40	FMF	2
	CU A	3	42	F S W	3.5
	Total WASTE 267.5 Kg

Table – A6: Infectious Waste Disposal Record of Hayatabad Medical Complex, Peshawar

Date22/3/2010

Shift: Night:

Day: Monday

S.NO	Ward/Unit	Wt. in Kg	S.NO	Ward/Unit	Wt. in kg
	MUA	2.5	12	MSA	3.5
	CFR	4	13	CMR	4.5
	GALR	4	14	G OT	6.5
	PSW	3	15	CHEST AB	3.5
	CHEST	3	16	CCU	2.5
	MA	1	17	MB	1.5
	CSW	4	18	FPS AB	3
	MS B	3	19	GA 1	4
	GB 2	4	20	GB LR	3
	COT	6.5	21	MUW	2
	CTW	3	22	MS	4
	Total WASTE 80 Kg