BIOMEDICAL WASTE MANAGEMENT UNIT2 Syllabus UNIT II Biomedical

BIOMEDICAL WASTE MANAGEMENT (UNIT-2)

Syllabus (UNIT II ) Biomedical Waste Management: Types of wastes, major and minor sources of biomedical waste, Categories and classification of biomedical waste, hazard of biomedical waste, need for disposal of biomedical waste, waste minimization, waste segregation and labeling, waste handling and disposal. 1/7/2019 2

Biomedical waste • Generated during diagnosis, treatment, immunization of human being or animals, in research activities, in production & testing of biological. – Human anatomical waste like tissues, organs and body parts – Animal waste generated during research from veterinary hospitals – Microbiology and biotechnology waste – Waste sharps like hypodermic needles, syringes, scalpels and broken glass – Discarded medicines and toxic drugs – Soiled waste such as dressing, bandages, plaster casts, material contaminated with blood, tubes and catheters – Liquid waste from any of the infected areas – Incineration ash and other chemical waste 1/7/2019 3

Absence of waste management • Inadequate, inappropriate and improper waste management leads to foul odor, environmental pollution, and multiplication of disease carrying organisms like insect, rodents & worms. • Transmission of disease likes typhoid, cholera, hepatitis, HIV through contact with infected waste & in particular through accidental injuries from used sharps. • It impact on environment by adding toxic pollutants to water, air & soil. These can potentially damage our flora, fauna & eco system. • Waste management has more impact on human healthcare. 1/7/2019 4

Types of Biomedical Waste • • • Infectious waste Pathological Waste Sharps Pharmaceutical waste Genotoxic waste Chemical Waste with high content of heavy metals Pressurized containers to hold Gases Radioactive waste

Infectious waste • Contains pathogenic organism (bacteria, viruses or fungi) in sufficient quantity to cause disease. • This includes – Cultures & stocks of infectious agents from clinical lab – Waste from surgery & autopsies done on infected patients corpse – Dressings, clothes with human blood from infected patient in isolation ward. – Dialysis equipment (filters, gowns, gloves, disposable items) – Infected research animals from lab

Pathological Waste • Consist of tissues, organs, human fetuses, animal carcasses, blood, body fluids • Anatomical waste-recognizable healthy body part (amputated limb, placentas from healthy mothers or expired blood may not be infectious, but unless it status is known)

Sharps • Items that cause cuts or puncture wounds – Needles (eg: body piercing) – hypodermic needles (hollow needle used with a syringe to inject substances into the body) – scalpel (small and extremely sharp bladed instrument used for surgery ) – other blades & knives, – broken glass & nails. – infusion set (connects insulin pump delivery device to body) • Considered as highly hazardous healthcare waste irrespective of infection potential.

Pharmaceutical waste • Includes expired, unused, split & contaminated pharmaceutical products, drugs, vaccines. • These are no longer required & need proper disposal. – Bottels, boxes with residues, – Gloves, masks – Connecting tubes, drug vials.

Genotoxic waste • Highly hazardous • May have a mutagenic, teratogenic or carcinogenic properties. – Carcinogenic substances causing or promoting cancer in humans and animals. – Mutagens substances change the genetic information of an organism, usually by changing DNA. – Teratogens substances cause harm to the fetus during pregnancy, causing birth defects while the mother shows no signs of toxicity • Poses serious threats both inside hospital & after disposal. • Includes cytotoxic drugs (Azathioprine, Bleomycin, cyclosporin, mitomycin, progesterone), chemicals (benzene), radioactive materials. • The principle substance have ability to kill or stop growth of certain living cells used in chemotheraphy of cancer. • Genotoxic waste derives from drugs generally used in oncology or radiotherapy units that have a mutagenic or cytotoxic effect.

Source of cytotoxic waste • Contaminated material during preparation/administration of drugs (i. e. syringes, needles, gauges, vials) • Outdated drugs, leftover solutions return from ward. • feces, urine or vomit from patients treated with cytotoxic drugs. • Waste should be considered Genotoxic for at least 48 hours – 1 week after drug administration. • 1% waste from oncological hospitals.

Chemical Waste • Consist of discarded solid, liquid & gaseous chemical • Generated from diagnostic & experimental work, from procedures like cleaning, housekeeping & disinfection. • It may be hazardous & non-hazardous (amino acids, certain organic & inorganic salts). • Waste consist of any one of the following properties will be considered as hazardous waste. – – Toxic or Genotoxic Corrosive (acids of p. H<2 & bases p. H>12) Flammable Reactive (explosive, water-reactive, shock-sensitive) • Hazardous chemicals are most commonly used in maintenance of healthcare centers. • Categorized as Formaldehyde, solvents, photo/radiographic chemicals, organic & inorganic chemicals.

Chemical Waste Continued… • Formaldehyde – major part of chemical waste – Range of usage varies from cleaning & disinfection of equipments (surgical & hemodialysis), preservation of specimens, disinfecting liquid infectious waste – Used in autopsy, pathology, dialysis, embalming & nursing units • Solvents – Generated by various departments (pathology, histology lab, engineering) – Either halogenated compounds (methylene chloride, chloroform, refrigerants) & non- halogenated compounds (methanol, isopropanol, acetone) • Photo/radiographic chemicals – Fixer & developer solution used in x-ray. Fixer contains hydroquinone (5 -10%), potassium hydroxide (1 -5%), silver (<1%) & acetic acid. Developer solution contains glutaraldehyde (45%) & acetic acid as hazardous chemical. • Organic chemical – Disinfecting & cleaning solution (phenol based chemical, perchlorethyleneused in laundries) – Oils – vacuum pump oils, used engine oils. – Insecticides & rodenticides. • Inorganic chemicals – Consist mainly of acids (sulfuric, nitric, hydrochloric), alkalis (ammonia, sodium hydroxide), oxidants (potassium dichromate) & reducing agents (Sodium sulfite).

Waste with high content of heavy metals • • • Mercury, cadmium, lead, arsenic are usually highly toxic. Mercury Spillage from broken clinical equipment Elemental mercury Scarp amalgam from dental offices Volume of waste is decreased with substitution of solid-state electronic sensing instruments, alternative restorative materials in dentistry. Cadmium – from discarded batteries Lead – reinforced wood panels used for protection against x-ray & in diagnostic departments. Arsenic causes skin lesions & carcinomas of bladder, kidney, liver, lung, neurological effects. Arsenic tioxide used for treatment acute promyelocytic leukemia who are unresponsive to chemotheraphy agents.

Pressurized containers to store Gases • Cartridges, cylinders & aerosol cans (disposable) • May explode if incinerated or accidentally punctured – handled with extra care. • Commonly used gases • Anesthetic gases-nitrous oxide & volatile halogenated hydrocarbons(child birth, ambulance, painful procedures, dentistry sedation) • Ethylene oxide-(store in gaseous or liquid form) – inhalation supply for patients • Compressed air (in lab, inhalation therapy, maintenance equipment, environmental control system)

Radioactive waste • Includes solid, liquid & gaseous waste contaminated with radionuclide from nuclear medical diagnostic & therapeutic procedures. • Disposal requires special techniques. • Generated in low volume from large medical & research lab – Sealed sources – Unsealed sources