Safe Management of Wastes from Health care Activities A Practical Guide 2nd Edition by World Health Organization ISBN 978-9241548564 9241548568
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ISBN 10: 9241548568
ISBN 13: 978-9241548564
Author: World Health Organization
This is the second edition of the WHO handbook on the safe, sustainable and affordable management of health-care waste―commonly known as “the Blue Book”. The original Blue Book was a comprehensive publication used widely in health-care centers and government agencies to assist in the adoption of national guidance. It also provided support to committed medical directors and managers to make improvements and presented practical information on waste-management techniques for medical staff and waste workers.
It has been more than ten years since the first edition of the Blue Book. During the intervening period, the requirements on generators of health-care wastes have evolved and new methods have become available. Consequently, WHO recognized that it was an appropriate time to update the original text. The purpose of the second edition is to expand and update the practical information in the original Blue Book.
The new Blue Book is designed to continue to be a source of impartial health-care information and guidance on safe waste-management practices. The editors’ intention has been to keep the best of the original publication and supplement it with the latest relevant information.
The audience for the Blue Book has expanded. Initially, the publication was intended for those directly involved in the creation and handling of health-care wastes: medical staff, health-care facility directors, ancillary health workers, infection-control officers and waste workers. This is no longer the situation. A wider range of people and organizations now have an active interest in the safe management of health-care wastes: regulators, policy-makers, development organizations, voluntary groups, environmental bodies, environmental health practitioners, advisers, researchers and students. They should also find the new Blue Book of benefit to their activities.
Chapters 2 and 3 explain the various types of waste produced from health-care facilities, their typical characteristics and the hazards these wastes pose to patients, staff and the general environment. Chapters 4 and 5 introduce the guiding regulatory principles for developing local or national approaches to tackling health-care waste management and transposing these into practical plans for regions and individual health-care facilities. Specific methods and technologies are described for waste minimization, segregation and treatment of health-care wastes in Chapters 6, 7 and 8. These chapters introduce the basic features of each technology and the operational and environmental characteristics required to be achieved, followed by information on the potential advantages and disadvantages of each system.
To reflect concerns about the difficulties of handling health-care wastewaters, Chapter 9 is an expanded chapter with new guidance on the various sources of wastewater and wastewater treatment options for places not connected to central sewerage systems. Further chapters address issues on economics (Chapter 10), occupational safety (Chapter 11), hygiene and infection control (Chapter 12), and staff training and public awareness (Chapter 13).
A wider range of information has been incorporated into this edition of the Blue Book, with the addition of two new chapters on health-care waste management in emergencies (Chapter 14) and an overview of the emerging issues of pandemics, drug-resistant pathogens, climate change and technology advances in medical techniques that will have to be accommodated by health-care waste systems in the future (Chapter 15).
Table of contents:
1 Introduction
2 Definition and characterization of health-care waste
2.1 General definition and classification
2.1.1 Sharps waste
2.1.2 Infectious waste.
2.2 Pathological waste
2.3 Pharmaceutical waste, including genotoxic waste.
2.4 Chemical waste
2.5 Radioactive waste.
2.6 Non-hazardous general waste.
2.7 Sources of health-care waste…..
2.8 Generation of health-care waste
2.9 Physicochemical characteristics.
2.10 Minimum approach to overall management of health-care waste..
2.11 Desirable improvements to the minimum approach.
2.12 References and further reading.
3 Risks associated with health-care waste
3.1 Overview of hazards
3.1.1 Types of hazards..
3.1.2 Persons at risk.
3.1.3 Hazards from infectious waste and sharps.
3.1.4 Hazards from chemical and pharmaceutical waste.
3.1.5 Hazards from genotoxic waste…..
3.1.6 Hazards from radioactive waste….
3.1.7 Hazards from health-care waste-treatment methods
3.2 Public sensitivity
3.3 Public health impact
3.3.1 Impacts of infectious waste and sharps.
3.3.2 Impacts of chemical and pharmaceutical waste
Impacts of genotoxic waste.
3.3.4 Impacts of radioactive waste..
3.4 Survival of pathogenic microorganisms in the environment..
3.5 The need for further research and epidemiological surveys
3.6 References and further reading
4 Legislative, regulatory and policy aspects of health-care waste.
4.1 Importance of a national policy.
4.2 Guiding principles
4.3 International agreements and conventions
4.3.1 The Basel Conventionz
4.3.2 The Bamako Convention.
4.3.3 The Stockholm Convention…..
4.3.4 The environment and sustainable development conferences.
4.3.5 United Nations Committee of Experts on the Transport of Dangerous Goods
4.3.6 United Nations Economic Commission for Europe
4.3.7 Aarhus Convention of the United Nations Economic Commission for Europe
4.4 Available guidance.
4.4.1 World Health Organization Guidance
4.4.2 The International Solid Waste Association
4.4.3 ISWA policy document on health-care waste management.
4.5 National legislation
4.6 Technical guidelines
4.7 Minimum approach to developing health-care waste-management policy
4.8 Desirable improvements to the minimum approach.
4.9 References and further reading.
Health-care waste-management planning.
5.1 The need for planning
5.2 National plans
5.2.1 Purpose of a national health-care waste-management plan
5.2.2 Action plan for developing a national programme
5.3 Waste-management plan for a health-care facility.
5.3.1 Assignment of responsibilities.
5.3.2 Management structure, liaison arrangements and duties..
5.3.3 Assessment of waste generation.
5.3.4 Development of a hospital waste-management plan…
5.3.5 Implementation of the waste-management plan……..
5.4 Minimum approach to planning
5.5 Desirable improvements to the minimum approach.
5.6 References and further reading.
Health-care waste minimization, reuse and recycling..
6.1 The waste-management hierarchy
6.2 Waste minimization
6.3 Environmentally preferable purchasing
6.4 Green procurement…
6.4.1 Recycling symbols for plastics
6.5 Safe reuse.
6.6 Recycling and recovery……….
6.7 Environmental management systems.
6.8 Minimum approach to waste minimization….
6.9 Desirable improvements to the minimum approach.
6.10 References and further reading
7 Segregation, storage and transport of health-care waste….
7.1 Guiding principles
7.2 Segregation systems……
7.2.1 Waste containers, colour codes and labels.
7.2.2 Beyond basic segregation.
7.2.3 Waste containers: specifications and siting.
7.2.4 Setting and maintaining segregation standards..
7.3 Collection within the health-care facility.
7.4 Interim storage in medical departments
7.5 Onsite transport of waste
7.5.1 General requirements
7.5.2 Transport trolleys…….
7.5.3 Routing.
7.6 Central storage inside health-care facilities.
7.6.1 General requirements.
7.6.2 Hazardous waste storage.
7.6.3 Layout of waste-storage areas.
7.6.4 Documentation of the operation of storage places
7.7 Offsite transport of waste.
7.7.1 Logistic staff.
7.7.2 Vehicle requirements….
7.7.3 Labelling of the transport vehicle.
7.7.4 Cleaning of container and vehicle
7.7.5 Transport documentation.
7.8 Minimum approach to segregation, storage and transport
7.9 Desirable improvements to the minimal approach.
7.10 References and further reading.
8 Treatment and disposal methods
8.1 Selection of treatment methods
8.2 Overview of waste-treatment technologies.
8.2.1 Thermal processes
8.2.2 Chemical processes
8.2.3 Irradiation technologies
8.2.4 Biological processes
8.2.5 Mechanical processes.
8.3 Suitability of treatment methods for infectious waste…
8.4 Steam treatment technologies.
8.4.1 Autoclaves….
8.4.2 Integrated steam-based treatment systems
8.5 Microwave treatment technologies
8.6 Dry-heat treatment technologies.
8.7 Chemical treatment technologies.
8.7.1 Internal shredding of waste
8.7.2 Chemical disinfectants.
8.7.3 Microbial resistance.
8.7.4 Alkaline hydrolysis
8.8 Incineration.
8.8.1 Combustion
8.8.2 Pyrolysis and gasification
8.8.3 Required waste characteristics.
8.8.4 Energy recovery
8.8.5 Types of incinerators for health-care waste.
8.8.6 Environmental control of incinerators..
8.8.7 Dust removal.
8.9 Encapsulation and inertization.
8.10 Emerging technologies..
8.11 Applications of treatment and disposal methods to specific waste categories.
8.11.1 Sharps.
8.11.2 Anatomical waste, pathological waste, placenta waste and contaminated animal carcasses
8.11.3 Pharmaceutical waste.
8.11.4 Cytotoxic waste.
8.11.5 Chemical waste.
8.11.6 Waste containing heavy metals.
8.12 Land disposal
8.12.1 Municipal and other external disposal sites.
8.13 Minimum approach to treatment and disposal..
8.14 Desirable improvements to the minimum approach.
8.15 References and further reading.
9 Collection and disposal of wastewater
9.1 Characteristics of health-care wastewater
9.2 Hazards of wastewater from health-care facilities.
9.2.1 Wastewater-related diseases..
9.2.2 Hazards from liquid chemicals in wastewater.
9.2.3 Hazards from pharmaceuticals in wastewater….
9.2.4 Hazards from radioactive substances…
9.2.5 Quantity of wastewater.
9.2.6 Quality of wastewater by hospital department…
9.3 Collection and pretreatment of liquid health-care waste.
9.3.1 Sewerage systems for health-care facilities.
9.3.2 Pretreatment of hazardous liquids…
9.4 Discharge into municipal sewage systems….
9.5 Onsite wastewater treatment
9.5.1 Wastewater-treatment systems
9.5.2 Disinfection of wastewater
9.5.3 Disposal of sludge
9.5.4 Emerging technologies…
9.5.5 Reuse of wastewater and sludge
9.5.6 Offsite treatment and disposal in specialized facilities.
9.6 Operation and monitoring of sewerage systems……..
9.6.1 Operation and maintenance of wastewater systems.
9.6.2 Monitoring of wastewater systems.
9.7 Minimum approach to wastewater management.
9.7.1 Sanitation system……..
9.7.2 Minimal liquid hazardous waste-management system
9.7.3 Basic wastewater-treatment systems.
9.8 Desirable improvements to the minimum approach.
9.9 References and further reading.
10 Economics of health-care waste management.
10.1 Guiding principles
10.2 Cost elements.
10.2.1 Costs at a health-care facility level.
10.22 Costs at a central treatment facility level.
10.23 Costs at a national level.
10.3 Cost estimation..
10.4 Cost and financing.
10.4.1 Methods of financing.
10.4.2 Costing tools.
10.4.3 Pricing models for a treatment provider.
10.5 Recommendations for cost reductions…
10.6 Minimum approach to health-care waste management costing.
10.7 Desirable improvements to the minimum approach.
10.8 References and further reading.
11 Health and safety practices for health-care personnel and waste workers……..
11.1 Guiding principles
11.2 Occupational health risks
11.2.1 Health hazards
11.22 Cytotoxic safety.
11.3 Exposure prevention and control
11.3.1 Hierarchy of controls (applied to bloodborne pathogens)
11.3.2 Dealing with spillages
11.3.3 Reporting accidents and incidents…
11.3.4 Protective equipment
11.3.5 Occupational post-exposure prophylaxis
11.4 Training……
11.5 Minimum approaches to health and safety practices.
11.6 Desirable improvements to the minimum approach.
11.7 References and further reading.
Hospital hygiene and infection control.
12.1 Guiding principles
12.2 Chain of infection
12.3 Epidemiology of nosocomial infections.
12.3.1 Transition from exposure to infection..
12.3.2 Sources of infection…..
12.33 Routes of transmission..
12.4 Prevention of nosocomial infections
12.4.1 Standard precautions
12.4.2 Isolation of infected patients and standard precautions
12.4.3 Cleaning…
12.4.4 Sterilization and disinfection…
12.4.5 Hand hygiene.
12.5 Measures for improving infection control
12.6 Minimum approach to hygiene and infection control.
12.7 Desirable improvements to the minimum approach.
12.8 References and further reading.
13 Training, education and public awareness
13.1 Importance of training and education
13.2 Education and training of health-care personnel.
13.2.1 Planning and implementation.
13.22 Employees to be trained.
13.23 Content of education programmes.
13.24 Follow-up and refresher courses.
13.25 Training responsibility…..
13.3 Implementation of a training course.
13.3.1 The training package.
13.3.2 Selection of participants.
13.4 Training health-care waste handlers.
13.4.1 Health-care personnel
13.4.2 Cleaning staff…
13.4.3 Staff who transport waste
13.4.4 Treatment plant operators.
13.4.5 Landfill operators.
13.5 Integrating training with public education on risks of health-care waste.
13.6 Minimum approach to training, education and public awareness.
13.7 Desirable improvements to the minimum approach.
13.7.1 Improvements to the minimum approach.
13.7.2 Improvements to more advanced approaches
13.8 References and further reading.
14 Health-care waste management in emergencies.
14.1 Guiding principles
14.2 Phases for the safe management of health-care waste in emergencies.
14.2.1 Phase one: rapid initial assessment.
14.22 Phase two: emergency response
14.23 Phase three: recovery phase
14.3 Contingency planning and emergency preparedness
14.4 References and further reading.
15 Future issues
15.1 Changing patterns of disease…….
15.1.1 Emerging diseases and multidrug-resistant organisms..
15.1.2 Pandemics.
15.2 Environmental issues.
15.2.1 Climate change.
15.22 Other environmental issues
15.3 Waste technology.
15.4 Social, cultural and regulatory changes
15.5 References and further reading
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Tags: World Health Organization, Safe Management, Wastes from Health, A Practical Guide