Training on Standard Operating Procedures for Health Care Waste Management Swaziland 12 May, 2011

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1 Training on Standard Operating Procedures for Health Care Waste Management Swaziland 12 May, 2011 Safe Infectious Waste Handling and Transport

2 Objective Waste Overview Roles and Responsibilities of Waste Handlers Bloodborne Pathogen Training Universal Precautions Personal Protection Equipment (PPE) General Hand Hygiene Post-Exposure Procedure Handling and transport of infectious waste. Disinfection and cleaning process Medical waste spillage Questions and Answers 2

3 Waste Overview General Waste Pharmaceutical Waste Infectious Waste Sharps Waste 3

4 Waste Overview 4

5 Waste Handler and Transporter Responsibilities Maintain segregation Remove waste from facility in accordance with regulations Safely transport waste to final disposal site. Transport waste in safe and acceptable manner in accordance with contractual protocols. Prepare appropriate (Emergency) SOPs and Train Drivers and Load Assistants 5

6 Bloodborne Pathogen Training Video: Workplace Bloodborne Pathogens for Healthcare Bloodborne diseases Preventing exposure Personal Protective Equipment (PPE) Exposure Procedures Signs & labels associated with BBP Quiz 6

7 Universal Precautions US Centers for Disease Control and Prevention: Presumes that all blood and certain body fluids (semen, vaginal secretions, saliva, etc. excluding sweat) are potentially infectious. 7

8 Hepatitis B Vaccine Does not contain blood products and a person CANNOT contract hepatitis B from the vaccine Recommended for: health care professionals emergency personnel high risk group due to occupation Three doses : First Injection At any given time Second Injection At least one month after the first dose Third Injection Six months after the first dose 8

9 Personal Protective Equipment (PPE) Rubber or Plastic Apron Rubber Gloves Rubber Boots OR OR Face Shield Goggles + Mask Face Mask + Shield 9

10 General Hand Hygiene 10

11 Post-Exposure Plan WHO recommends the following: Immediately bleed the wound and wash the area with soap under clean running water If blood or body fluids have gotten into eyes, splash eyes with clean water. Immediately report the incident (to your supervisor for action and the MOH for reporting purposes) Retain the item involved and get details of its source Seek additional medical attention Initiate post-exposure prophylaxis Get blood tests or other tests and counseling Record the incident. 11

12 Post-Exposure Incident Report Hand out form 12

13 Summary of Methods for Reducing Waste Handler Risk Hepatitis B vaccine Wash hands after working with waste or infected material Handle all sharps with care Wear all appropriate PPE Do not re-sort waste Know procedures for treating injuries, cleaning of contaminated areas Report sharps injuries or accidents Post-exposure prevention treatment Maintain a log of all accidents 13

14 Waste Segregation Infectious Waste Symbol Red Bag Infectious Waste Black Bag General Waste Sharps Containers Infectious Waste 14

15 Swaziland Color Coding Scheme for Health Care Waste Type of Waste Infectious Waste Pretreated Waste Sharps Chemicals & Pharmaceutical Waste Radioactive Waste Cytotoxic Food Waste Colors of container & marking Red Yellow Red marked Clinical Waste Sharps Brown Maroon labeled with Radioactive Symbol Orange, marked with a Cytotoxic Symbol Green Type of Container Heavy Duty, Leak Proof Plastic Bag Heavy Duty, Leak Proof Plastic Bag Puncture Proof Container Heavy Duty Plastic Bag Lead Box Heavy Duty Plastic Bag Heavy Duty Plastic Bag with a strong seam General Waste Black Heavy Duty Plastic Bag 15

16 Handling and Transportation of Waste Handle bags with care to prevent tearing Close and lock sharps container Put bagged waste and sharps containers in a rigid, leak-proof container and secure lid Do NOT compact infectious waste Containers must be sealed before transport Transport in lockable trucks designated for medical waste 16

17 Handling and Transportation of Waste Labeling Affixed to Waste Containers: Type of health care waste Form of waste and waste category Date of collection Volume/quantity of waste Chain of Custody Precautions to be taken while handling Emergency procedures in the event of accident or spillage Producer and destination of the waste 17

18 Chain of Custody Form 18

19 Chain of Custody Procedure 1. Clinic staff completes form and gives to transporter 2. Clinic retains a copy 3. Transporter places waste in a secure temporary location at Receiving Unit. 4. Transporter gives form to receiving Unit to sign for Proof of Delivery 5. Transporter keeps a copy for records 6. Bio-Med Dept. keeps original form 19

20 Disinfection and Cleaning What needs to be disinfected and cleaned? Equipment (bins, containers, trucks) Working and environmental surfaces Reusable PPE When should it be disinfected and cleaned? As soon as feasible and; At end of a work shift 20

21 Disinfection and Cleaning How should it be disinfected and cleaned? Rinse with water Apply a diluted sodium hypochlorite solution (via sponge or submersion) Allow solution to stand 5 minutes Rinse thoroughly and air dry Fresh sodium hypochlorite solution batch every 24 hours Disposal of sodium hypochlorite solution? Dilute by running water to the top of bucket Pour contents down the drain 21

22 Disinfection and Cleaning How to make sodium hypochlorite solution? Determine from the list of active ingredients the concentration of sodium hypochlorite (Range from 1% to 10%) Fill a bucket of water with at least 7.5 L of water Add the appropriate amount of sodium hypochlorite solution from table (next slide) Mix well with a clean utensil. WARNING: Avoid skin and eye contact. Solution may sensitize and may cause skin irritation. This solution is extremely corrosive and harmful to swallow. 22

23 Disinfection and Cleaning Used Sodium Hypochlorite Concentration Amount of Water in Bucket Amount of Sodium Hypochlorite Solution to add 0.5% - 1.0% 7.5 L 3.5 L 1.0% - 3.0% 7.5 L 1.05 L 3.0% - 5.0% 7.5 L 0.7 L 5.0% % 7.5 L 0.35 L 23

24 Disinfection and Cleaning Contact with skin and eyes Skin contact with the solution: flush thoroughly with water for 3 minutes Eye contact with the solution: flush eyes with water immediately and get medical attention Cleaning broken sharps and glassware Do not pick up by hand Use a brush and dust pan, tongs or forceps 24

25 Spillage of Medical Waste General Spillage Procedure: Evacuate the contaminated area Determine the nature of the spill Evacuate anyone not involved in clean-up Put on appropriate PPE Limit spread of spill Neutralize or disinfect material Collect all spilled and contaminated materials (Do NOT pick up by hand) Wipe with absorbent cloth Do not flip cloth Rinse area and wipe dry Disinfect any tools used Remove PPE and disinfect if necessary 25

26 Spillage of Medical Waste Spillage of Dry Clinical Waste Use heavy duty gloves Use dust pan/shovel and brush Place spillage materials in a new RED bag Label contents Dispose or disinfect gloves Clean and disinfect dust pan/shovel and brush 26

27 Spillage of Medical Waste Spillage of sharps Never pick up sharps by hand Use a fresh container, heavy duty gloves, and apron Use a dust pan/shovel and brush Or use disposable forceps for small quantities of sharps Clean and disinfect equipment or items that have come in contact with contaminated material 27

28 Spillage of Medical Waste Spillage of blood: Wear appropriate PPE Cover with paper towels and freshly prepared hypochlorite solution After 10 minutes, collect the towels up and put carefully into a RED clinical waste bag. Wash exposed surfaces with warm detergent solution and dry 28

29 Spillage of Medical Waste Spillage of other bodily fluids: Wear appropriate PPE Spillage of bodily fluids other than blood can be cleaned using hot water and detergent. Normal low risk/low volume body fluids that are not contaminated by blood can be disposed of by putting into a RED bag. 29

30 Do s and Don ts DO always wear appropriate protective clothing when dealing with hazardous waste DO wash your hands thoroughly and often (according to SOPs) DO alert your supervisor when in doubt DO NOT take lifters DO NOT open bags/sharps containers to resort waste DO NOT use the vehicle for other purposes 30

31 References US Occupational Safety & Health Administration Standards 29 CFR NIOSH Publication No : Guidelines for Protecting the Safety and Health of Health Care Workers Hepatitis B Foundation - PATH: Personal Protective Equipment for Waste Handlers. July Kingdom of Swaziland, Ministry of Health. National Healthcare Waste Management Guidelines. March Kingdom of Swaziland, Swaziland Environmental Authority. The Waste Regulations SCMS Training Manual on Standard Operating Procedures for Health Care Waste Management S. Ackerson, Feb Picture References: Science Photo Laboratory WHO Healthcare Waste Management 31

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