Download 2 - GD MAROC

WHO Regional Office for Europe
Healthcare Waste Management
Training
Module 2
Risks From Healthcare Wastes
Content
Introduction
Risks from healthcare wastes
Human health
Environment
Chain of infection & personal
hygiene
Routes of exposure
Emergency procedures
Summary
Healthcare Waste Management Training
Introduction
The WHO has estimated that unsafe waste
practices (including unsafe transport
practices) caused:
• 21 million hepatitis B virus (HBV)
infections (32% of all new infections);
• 2 million hepatitis C virus (HCV)
infections (40% of all new infections);
• 260 000 HIV infections (5% of all new
infections).
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Types of risks
The main risks associated with healthcare wastes are:
• Physical risks
• Chemical risks
• Microbiological risks
• Radiological risks
• Environmental risks
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Physical risks
• Physical risks occur mostly due to sharp items like
broken glass, syringes, disposable scalpels and
blades, etc.
• The problem with physical risks are not the injury itself,
but the break in the protective shield of the human
body.
• Cuts, stitches, etc. can be a port of entry for different
kinds of pathogenic agents. Additionally, ionising
radiation, lasers, noise and electricity can also be
physical hazards.
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Chemical risks
Reactivity:
It may be unstable, or
explode or produce toxic
fumes, gases and vapours
when mixed with water, e.g.
certain cyanides or sulphide
bearing wastes.
Flammability:
Waste which can catch fire
under certain conditions,
e.g. paints and certain
degreasers and solvents.
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Chemical risks II
Toxicity:
It may be harmful or fatal when
ingested or absorbed, or may
leach toxic chemicals into the
soil or ground water.
Irritant:
A chemical, which is not
corrosive, but which causes a
reversible inflammatory effect
on living tissue or an allergy.
Ecotoxic:
Substances which can harm
the environment if disposed of
incorrectly.
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Chemical risks III
Oxidiser:
Substances which supply O2
increasing the flammability of
other substances.
Corrosive:
May have a very high or low
pH, causing possible
destruction, or irreversible
damage to living tissue at the
site of contact.
Harmful:
Chemicals that may cause
damage to health.
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Chemical risks IV
“+”:
The sign “+” (plus or cross)
indicates that a substances has
a higher hazard, e.g. toxic and
very toxic, highly flammable and
extremely flammable.
Mutagenic:
Substances capable of causing a
change, or mutation, in genetic
material (DNA) or in living cells.
Carcinogenic:
Substances causing cancer or
contributing to the causation of
cancer.
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Chemical risks V
• Since December 2008 new hazard symbols
(Goal: Worldwide standardization)
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Microbiological risks
• Microbiological risks from waste can come from
materials, contaminated with pathogenic agents.
• Typical samples are:
–
–
–
–
–
–
Cultures and stocks of infectious agents,
Waste from infected patients,
Waste contaminated with blood and body fluids,
Discarded diagnostic samples,
Infected animals from laboratories,
Contaminated materials like swabs, bandages or
contaminated equipment.
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Radiological risks
• Radiological risks are created by radioactive waste
from radioactive diagnostic or radiotherapy. The halflife time of the used radioactive materials is normally
low.
• The type of diseases caused by radioactive waste is
determined by the type and extent of exposure. It can
range from headache, dizziness, and vomiting to much
more serious problems. Radioactive waste can also
be genotoxic.
Radionuclide
Emission
Half-life
Application
³H
β
12.3 y
Research
14C
β
5730 y
Research
57Co
β
271 d
Diagnostic
67Ga
γ
78 h
Diagnostic
131I
β
8d
Therapy
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Environmental risks
EXAMPLE: MERCURY WASTE
Mercury is found in
thermometers, dental
amalgam, fluorescent light
bulbs & medical batteries
Healthcare waste activities
redistribute the mercury &
release it into the
environment (via the
disposal of equipment
containing it)
Mercury is a toxic metal
which, on contact with water
or soil, is converted by micro
organisms into a more toxic
form known as methyl
mercury
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Environmental risks II
EXAMPLE: MYTHYL MERCURY
Methyl mercury is transported via
natural cycles into Rivers, lakes &
oceans.
The contamination is
persistent and builds up in
the silt.
The methyl mercury then
accumulates in their bodies
Fish will take in methyl
mercury via their diet &
from passing water over
their gills.
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Environmental risks III
EXAMPLE: MYTHYL MERCURY
The concentration of methyl mercury builds up
as it passes up the food chain in a process
called bio-accumulation.
Large predatory fish will have high levels
methyl mercury in their bodies.
These fish may be caught and consumed
by humans.
Mercury is toxic for humans – it can
damage the nervous system,
kidneys & other organs
Mercury can also be passed on to unborn
children via their mothers blood
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Environmental risks IV
Remember:
environmental
contamination
will often affect
US!!
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Who is at risk?
People within a healthcare facility:
•
•
•
•
•
•
Nurses,
Physicians,
Hospital maintenance staff,
Patients,
Visitors,
Workers in support services
– Laundries,
– Waste handling,
– Transportation
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Who is at risk? II
People outside healthcare facilities:
• Local population,
• Waste carrier,
• Workers in waste disposal facilities, e.g. landfills or
incinerators
• Waste pickers
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Nosocomial infections
Definition nosocomial infections:
“Nosocomial infections, or hospital acquired
infections, are infections that are not present in a
human at the time of entry into a hospital but
develop during the work or stay in a hospital or can
be linked later with the stay or work in a hospital.”
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Nosocomial infections II
Potential points of exposure to nosocomial infections
Point of production
Segregation
Internal collection
& transport
Storage
External collection
& transport
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Infectious waste: Routes of transmission
Reservoir = Patient infected with
Blood borne virus (HIV etc)
Means of Transmission
Airborne
Direct contact or
Vehicle
Vectors (Animals,
insects etc)
Portal of exit = Waste contaminated
with blood or bodily fluids
Susceptible
host = You!
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The infectious chain: Transmission
Airborne transmission:
• The severity of disease caused by aerosols of bacteria
depends on several factors:
– The virulence of the particular organism;
– The size of the inoculums, or the level of bacteria
present;
– The underlying disease or health status of the patient;
and
– The ventilation and movement of air in the patient’s
environment
• Outbreaks of airborne viral disease transmission in
healthcare settings have been well documented.
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The infectious chain: Transmission II
Direct contact:
• Direct physical contact is a more seldom form of
transmission. It can happen during surgical activities
(splashes of blood and body fluid) and first aid or by
accidents with discarded, untreated cultures.
• Also it can happen if the healthcare worker is suffering
from an infectious disease and transmits this to a
patient.
• Another typical route is caused by failure to follow
safety procedures, e.g. pipetting with the mouth.
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The infectious chain: Transmission III
Vehicle-borne transmission:
• The most well known way is by sharps.
– USA: Over 1 million injuries with sharps every year among
healthcare workers.
• Transmission can also happen via clothing splashed
with blood or bodily fluids.
• Vermin, rodents etc can also be carriers if they have
free access to places with a high concentration of
infectious agents.
• Hands are the most common form of vehicle born
transmission!!!
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Vehicle-born transmission
1: Pathogens (bacteria & viruses) reside
in the intestinal tract.
2: Pathogens are deposited in large
quantities in and on toilet fixtures
every time they are used.
3: Pathogens are transferred from toilet
fixtures to sink via human hands.
4: The Human hand acts as a vehicle
and transports Pathogens to
5
subsequent persons who touch sink
etc.
5: Pathogens enter the body causing
infections and the transmission cycle
starts again
Do you know the correct method for
hand washing?
2
1
3
4
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Breaking the chain: Hand washing
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Breaking the chain: Hand washing II
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Routes of exposure
The route of exposure is how a toxin/substance enters or
comes into contact with the body.
There are 4 major routes of exposure and 1 minor route.
• Breathing (Inhalation)
• Direct contact (Absorption through the skin or
instillation through the eyes)
• Swallowing (Ingestion)
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Routes of exposure II
The last one is a major problem in the healthcare
sector.
• It usually comes about due to a “Needlestick”
injury
• Injection (Parenteral)
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Absorption
• The skin is the largest organ of the the body & is a
common exposure site for liquid and airborne
chemicals.
• It is a multi-layered organ with good protective
qualities.
• Contact with the skin can
cause local or systemic
damage, or both.
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Inhalation
• The respiratory
system is the major
route of exposure
for airborne
chemicals & dusts.
• It has a variety of defensive mechanisms.
• Contaminants entering the respiratory system can
cause local or systemic damage, or both.
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Ingestion
• The oral route may be taken when
toxic materials are swallowed and
enter the body via the gastrointestinal
tract.
• Opportunities for ingestion of
hazardous substances in the
workplace are common especially
through eating & smoking.
• Personal hygiene is of the
utmost importance.
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Effects of hazardous substances
Acute
• Resulting, usually immediately, from a short-term
exposure (e.g. corrosive burns, inhaling a toxic gas,
eye-irritation)
Chronic
•
•
•
•
Resulting from long-term, often low-level, exposure,
Might not appear for many years,
Is hard to predict,
If can be hard to work out what caused them?
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Handling healthcare waste
• Healthcare waste must be
handled correctly and safely
• Handling should follow written
procedures which the staff
have been trained on
• The correct protective
equipment should be used at
all times
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Emergency procedures
• Emergency
procedures must be
developed for each
risk waste based on
the hazards associated
with the waste type
• Staff should be trained
on these procedures
and have the
necessary equipment
to carry the procedures
out
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Summary
• Healthcare wastes pose many types of risk.
• Many people are at risk from healthcare waste if it is
not handled correctly.
• Nosocomial infections cause death, illness and misery
on a worldwide scale.
• Nosocomial infections are transmitted via an
“infectious chain” which we need to break to keep safe.
• Remember the routes of exposure and protect yourself
& staff at all times.
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