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 2000C, 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
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