Polytechnic Institute of Guarda

HIGHER SCHOOL OF HEALTH GUARD VI Degree in Nursing 4th Year / 2nd Semester
Hospital Solid Waste
Fábio Gonçalves Dinis Eiras
Povoa de Varzim 2006
Polytechnic Institute of Guarda
HIGHER SCHOOL OF HEALTH GUARD VI Degree in Nursing 4th Year / 2nd Semester
Hospital Solid Waste
Hospital Povoa de Varzim and Vila do Conde
Pediatrics and Neonatology
Work done by: Fábio Gonçalves Advisor: Enf. Nd Cristiane Costa
Povoa de Varzim
2006
INDEX Leaf 0 - INTRODUCTION ............................................. ......
............................................ ............ 4 1 - CLASSIFICATION O
F SOLID WASTE HOSPITAL ......................... 6 2 - Management of medical sol
id waste ............................................... .................... Ma
rch 12 - Completion .......................... .................................
................. ........................................ March 15 - A Critical
Review ..... .................................................. ...............
................................... ... April 16 - REFERENCES ..................
........................ ............................. 18
0 - INTRODUCTION This paper was prepared by a student of 4th year / second semes
ter of the sixth course in Bachelor of Nursing School of Health Guard, stage VII
I, to be held on 9 January 2006 to February 10, 2006 in in the service of Pediat
rics and Neonatology Center Hospital of Povoa de Varzim and Vila do Conde. Once
I got over the stage with the perception that the practices developed under the
screening and management of hospital waste, were not the most correct, I decided
to develop this work in order to introduce some changes in service. "The medica
l solid waste is waste produced in units to provide health care, including medic
al activities in diagnosis, prevention and treatment of disease in humans and an
imals, and yet related activities" (Decree-Law No. 239/97 of September 9). It is
appropriate that all health professionals, demonstrate in their daily practice
a spirit of management and screening of medical solid waste in order to preserve
not only the environment but also public health. Thus this work was prepared wi
th the aim of: • • To synthesize a body of knowledge regarding the current class
ification of hospital waste, their screening and management; Motivating health s
ervice professionals of Pediatrics and Neonatology to develop appropriate manage
ment practices and sorting Medical solid waste; • Undertake a review of practice
s developed in the service and provide some suggestions for change. Underlying t
he development of this work is a descriptive analysis based on use of library re
sources and internet and observation. This work is divided into parts: one part
where I discuss the current classification of hospital waste, a second part wher
e I address the screening and management. By way of completion do a brief review
of
practices developed in the service of Pediatrics and Neonatology proposing some
suggestions for change. I hope that this work can be a vehicle for raising aware
ness and changing practices of screening and management of medical solid waste i
n their department.
1 - CLASSIFICATION OF SOLID WASTE HOSPITAL One of the nightmares that affront to
today are medical waste and what to do with them ... The existence of waste fro
m health care to human beings, including medical activities for prevention, diag
nosis, treatment and research constitutes an important public health issue and e
nvironmental determining the increased attention to safeguard the negative effec
ts on public health. Waste is any substance or object which the holder discards
or intends or required to discard. (Decree-Law No. 239/97 of September 9). Solid
waste can be classified as to origin: Solid Waste (MSW) Medical solid waste
- Urban and hazardous industrial solid waste - Urban, hazardous and inert. An
d as to the nature can be classified into: Municipal solid waste; inert soli
d wastes; hazardous solid wastes. The medical solid waste is waste produced in
units to provide health care, including medical activities of diagnosis, preven
tion and treatment of disease in humans and animals, and yet related activities
(Decree-Law No. 239 / 97, September 9).€Improper practices in the deposition, co
llection, disposal and transportation of solid waste in hospitals, inside and ou
tside of health facilities, carry potential risks for humans and the environment
.
The workers and users of healthcare facilities, workers who handle such waste ou
tside health facilities and the general population, are at permanent risk. Can b
e considered as a risk to public health: Biological - diseases (waste that con
tains pathogens) and accidents with cut-drilling; Physical - non-communicable
diseases (accidents flammable substances, radioactive and explosive); Chemical
- noncommunicable diseases (toxic chemical substances and cytotoxic drugs). The
impacts of such waste on the environment, resulting from poor conditions of its
disposal, can manifest itself through: Infectious diseases in living beings;
Soil contamination; Air contamination; Contamination of surface and ground
water. Until recently, most medical waste contaminated or not, were collected by
municipalities and sent to uncontrolled waste dumps. Some years later, some hos
pitals have begun to separate and dispose of wastes in the orange bags to protec
t one took them, although their fate continues to be the municipal dumps. Curren
tly, the separation of waste tends to be more efficient, being carried in bags a
nd containers of different colors, which identifies the type of waste present, p
roviding your disposal as appropriate. The imperative to create conditions that
favor the one hand, the continued protection of the health of populations and, s
econdly, to recognize the important role that accounts for both the preservation
of the environment, it is necessary to redraft the rules that regulate the clas
sification of medical solid waste. Given the progress that has been observed in
this area, it is important to integrate the actions aimed at eliminating these w
astes that technical progress has provided, allowing the use of different treatm
ent technologies, making it necessary to make a classification requiring their s
elective separation at source.
The medical solid waste to be classified in accordance with the provisions of Or
der No. 242/96 of 13 August, the Ministry of Health Accordingly, it is determine
d that the medical solid waste are subject to appropriate treatment and differen
tial for different groups the following areas. Are considered non-hazardous wast
e those in Group I and Group II hazardous waste and group III and group IV, as t
he following classification. NON-HAZARDOUS WASTE GROUP I assimilated to municipa
l wastes, are those who have no special requirements in its treatment. Contain t
his group: a. Waste from general services (such as offices, meeting rooms, loung
es, toilets, changing rooms, etc.). B. Wastes from support services (such as wor
kshops, gardens, warehouses and others); c. Packaging and casings common (such a
s paper, cardboard, and other mixed bag of a similar nature); d. Wastes from the
hotel resulting from dressing and leftover food served to patients but not in G
roup III. GROUP II non-hazardous hospital wastes, are those that are not subject
to specific treatments and may be treated as urban. Included in this group: a.
Orthopedic material: splints, plaster casts and bandages not contaminated and no
 traces of blood; b. Disposable diapers and no guards and no traces of contamina
ted blood; c. Personal protective materials used in general support services, ot
her than the one used in waste collection d. Empty containers of drugs or other
products from clinical or policy, except in Group III and Group IV, e. Uncontami
nated serum bottles, with the exception of group IV.
HAZARDOUS WASTE GROUP III hospital biohazard waste, waste is contaminated or sus
pected of contamination, likely to incineration or other pre-effective treatment
, enabling subsequent disposal as household waste. Belong to this group: a. All
waste from patient rooms or wards for infectious or suspected of hemodialysis un
its in operating rooms, treatment rooms, rooms and autopsy pathology, clinical p
athology and research laboratories, with the exception of the group IV, b. All m
aterial used in dialysis; c. Anatomical parts unidentifiable d.€Residues resulti
ng from the administration of blood and its derivatives, e. Systems used in the
administration of serums and medicines, with the exception of group IV, f. Bags
traps fluids and related systems; g. Orthopedic material: splints, plaster casts
and bandages or contaminated with traces of blood, material removed prostheses
to patients, h. Disposable diapers and railings or contaminated with traces of b
lood i. Shielding material used in individual care and support services in gener
al there is contact with contaminated products (such as gloves, masks, aprons an
d other). GROUP IV specific hospital waste, as waste incineration of various typ
es of binding. Belong to this group: a. Recognizable anatomical parts, fetuses a
nd placentas, until publication of specific legislation; b. Dead animals in labo
ratory experiments;
c. Cutting and piercing materials: needles, catheters, and all the stuff invasiv
e d. Chemicals and pharmaceuticals discarded when no subject specific legislatio
n and e. Cytostatic and all materials used in handling and administration. Packa
ging Waste This classification also includes the principles that should govern t
he handling of waste and its storage conditions. The packaging waste must meet t
he following requirements: The sorting and packaging must take place near the
production site; The hospital waste must be packaged appropriately so as to al
low clear identification of its origin and your group: - Waste in groups I and I
I in black containers - waste receptacles in group III white, with indications o
f biological risk; - Waste of group IV in containers of red, with the exception
of cutting and piercing material. The waste cut-perforating and perforating shar
ps must be packaged in appropriate containers and waterproof. These containers s
hould not be filled to more than two thirds of its capacity. Must be placed in l
ocations that are both safe and functional and should be tightly closed at time
of collection to avoid opening and extravasation during removal and transportati
on. Are deposited in yellow containers proposed by the successful tenderer. In t
his type of container can be deposited the following wastes: a. Needle puncture
of all kinds, including needle-carrying wire sutures, syringes and needles in pu
ncture and blood collections b. Catheters and catheter conductor c. Scalpel blad
es, razor and clipper surgical d. Ampoules and vials - from administration of th
erapy;
e. All residues which are potential risk of accidents by the bite or cut. Cytost
atic waste Waste from the preparation and administration of cytotoxic drugs shou
ld not be mixed with other waste and must be clearly identified to ensure compul
sory incineration (incineration at a minimum temperature of 1100 ° C). Currently
, these wastes are collected in container gray. The containers are rigid, imperm
eable and allow standardization of the collection of all cytotoxic waste in one
container. Storage of waste storage conditions should be as follows: Each heal
th unit should have a specific storage location for the waste of groups I and II
waste separately in groups III and IV, which must be properly marked; What st
orage site should be sized according to the frequency of collection or disposal,
and its ability to meet minimum three days of production; If you missed the d
eadline stated above, until a period of seven days, you should have refrigerated
conditions; The storage area will have the structural and functional conditio
ns suitable for easy access and cleaning. Where appropriate, there should be a
specific plan of emergency.
2 - SOLID WASTE MANAGEMENT HOSPITAL The solid waste management can be defined as
the discipline associated with control of production, storage, collection, tran
sfer, transport, treatment and final disposal of waste, so while respecting the
public health, environment environment, economics, aesthetics and engineering. T
he improvement of knowledge and management technologies applied led to the appli
cation of the concept of integrated management. The integrated management of sol
id waste can be defined as the application of appropriate technologies,€as well
as an appropriate management program to achieve specific objectives and the fulf
illment of some basic principles and in the case of hospital waste from combinin
g operations such as: Reduction and sorting at source; Recycling and reuse;
Packaging, collection and transport ; Treatment and final disposal of waste
reduction and screening at the origin consists of a way to prevent waste generat
ion, which includes activities such as: - Reduce use of single use devices, maki
ng the substitution for reusable materials and new products and less hazardous -
Reduce the amount of waste generated by classifying the type of risk and charac
teristics of the waste - Making the separation or sorting on production sites -
Matching equipment used to collect the features and risks of waste. Recycling an
d reuse of materials to use multiple use of containerization for packaging waste
;
- Recycling of products that you can use as raw material: plastic, paper, glass,
metal, etc.. - Establish and implement internal rules of organization through i
nformation and awareness of producers / users of the system to manage these wast
es. Packaging, collection and transport The basic principle that should govern t
he disposal, collection and transportation of medical solid waste is the separat
ion of hazardous waste non-hazardous. Treatment and final disposal of waste - Us
e of appropriate treatment technologies and the specificity of each type of haza
rdous waste at the expense of a unique technology to treat all waste, and less d
emanding in terms of collection and sorting, forwarding to waste treatment requi
ring no treatment. - Consider that the quality of care also involves the use of
equipment, logistical and human resources and technologies with better value for
financial and environmental cost. - The stations of treatment of hospital waste
should include methodologies for post processing such as crushing and compactio
n of waste prior to final disposal (landfill). For, hazardous waste, there are t
wo technological options for treatment: disinfection and incineration. Disinfect
ion - may be accomplished by thermal or chemical. Thermal processes - autoclave
disinfection and disinfection by microwave; Chemical processes - with a chemical
disinfection in the form of gas or steam baths and disinfecting chemicals. Inci
neration - the destruction of waste by a thermal process within a furnace or com
bustion chamber. According to WHO (1980) incineration is to "reduce solid waste
to an inert fuel combustion at high temperature."
Given the changes arising in the combustion process becomes necessary that the f
acility is equipped to adequately control the resulting fluent and not a transfe
r of pollution. For this there are the following: post combustion gases, cooling
the ash and dust removal and treatment of combustion gases.
Figure 1 - Diagram of a station incinerator.
According to Decree-Law No 242/96 of 13 August, the management bodies of each he
alth unit is responsible for: Comply with the established in Decree-Law; To
sensitize and train the staff in general and in particular on aspects related pe
rsonal protection and the correct procedures; Celebrate protocols with other h
ealth units or entities duly licensed to use, when do not have a treatment capac
ity of its waste; Maintain a register of waste produced.
3 - CONCLUSION The alternative treatment for the "garbage" hospital based on a s
creening effective. It is increasingly urgent that professionals recognize the t
ype of garbage and the place of proper packaging, so it is necessary to bet on t
his type of training in the area of hospital waste. The sorting of waste is an a
ctivity with many benefits because: • • • • • Increases security professionals,
patients and visitors; Prevents accidents in service (chopped); Reduces the nega
tive environmental impacts, preserves the image of the Hospital Institution; All
ows cost containment.
Since the treatment of hospital waste is a problem at all, greater accuracy and
timeliness, it is important that all health professionals to collaborate in this
process of separation and management of waste in a responsible and conscious. I
t is thus urgent that the environmental concerns of professionals and nomeadamnt
e of nurses,€are put into practice in day-to-day. This is because the world is i
n our hands and usually what you do is what he rewarded us.
3 - CRITICAL ANALYSIS Throughout my internship, I was noting that the practices
developed either by professionals or by medical auxiliaries, as concerns the scr
eening and management of hospital waste was not the right one. At first sight, j
ust starting with the initial screening of waste, the nursing staff did not demo
nstrate good practice, ie, sorting the waste was only performed in two parts: ho
spital waste contaminated or not contaminated. Contaminated waste were placed in
black garbage bags and cut-spiked deposition in the container will obeyed excep
t the yellow light bulbs that were deposited in another container itself. The wa
ste is not contaminated in turn were also deposited in black garbage bags. At th
e outset, we observe an inefficient sorting of waste. My suggestions in the fiel
d of initial screening are: Use garbage bags of different colors: Black or Trans
parent (non-hazardous waste), White (hazardous waste) and red (hazardous waste)
so that professionals can properly perform the screening. Clear Garbage Bags: wo
uld be intended only for waste that can be recycled such as paper and plastics.
So the officials, who are responsible for rubbish collection service, can later
put these bags in waste containers for recycling (without having to open them to
confirm the type of garbage bag that contains and also mix them with avoiding w
aste deposited in trash bags that can not be recycled) and further processed as
waste. My suggestion would be to place a transparent bag for paper and one for p
lastics. - A transparent garbage bag Plastic: Plastic • • Sheathing of syringes
and related material, plastic ampoules of distilled water;
- A Transparent Garbage Bag for Papers: • • • • Role of the Hands; Roles of Shea
thing syringes, and related materials; sheets of paper, empty boxes of medicines
and leaflets.
Regarding the trash bags, were placed at various sites of service and would be i
ntended for all other waste listed in non-hazardous waste (groups I and II) exce
pt for the aforementioned; also suggested the use of bags that Whites will go to
waste or hazardous waste in Group III. The bags and containers Red Yellow aim w
ould be to waste listed in Group IV and cut-spiked respectively; Another my sugg
estion would be to acquire more buckets of trash to the service and proper ident
ification of the type of waste to be deposited ; After providing all the basic a
nd essential conditions for a screening and we can move to a stage of incentives
and demands on health professionals responsible for the sorting of waste. In a
second analysis of the problem, I noticed that the officials collect all the gar
bage service and wrap all in the same bag which demonstrates inefficient managem
ent in the field of collection and preparation stage. My suggestion in this cont
ext, goes to motivate these professionals and also to alert the proper collectio
n, packaging and disposal of wastes. I think about encouraging professionals and
assistants, will make possible for that to happen with the training that I will
accomplish.
4 - REFERENCES
Gazette No. 208/97 of September 9, 1997. ESTEVÃO, Maria Manuela - Hospital Solid
Waste - Characterization of solid waste management of solid waste sanitary prob
lems in the management of hospital waste; Legislation. Bureau of Sanitary Engine
ering, Subregion Health Ranger. Leaflets of SUCH.
Identification of waste containers for wards of the Department of Pediatrics and
Neonatology of CHPVVC