Gestionare a deseurilor spitalicesti

Spitalul este organizare complexa cu probleme speciale, complicate si provocatoare. All activities of the hospital are closely interdependent, and these should meet with humanitarian aspect so that 'the hospital can be converted from structure of the brick and morter into living institution of service'. Toate activitatile din spital sunt in stransa interdependenta, si acestea ar trebui sa se intalneasca cu aspect umanitar, astfel incat 'la spital pot fi convertite din structura de caramida si morter in viata institutie de serviciu'. The management of the hospital waste poses a great problem for proper maintenance of the healthy environment of the hospital. Gestionare a deseurilor spitalicesti reprezinta o problema mare pentru intretinerea corespunzatoare a mediului sanatos al spitalului. The management of the hospital is responsible for correct and clear separation and disposal of waste since it is potentially hazardous to patients, staff and community at large. Conducerea spitalului este responsabil pentru separarea corecta si clara si eliminarea deseurilor, deoarece aceasta este potential periculoasa pentru pacienti, personal si comunitate in general. It covers the whole process right from the sick bed, laboratory, Operation Theater or kitchen up to its delivery to the disposal system. Acesta acopera dreptul de intregul proces de la bolnav pat, de laborator, Teatrul de operare sau bucatarie pana la livrarea catre sistemul de eliminare.

Classification Clasificare

The hospital waste can be classified as Deseurilor de la spitale pot fi clasificate ca

1. Biohazardous  waste Deseuri cu risc biologic

• Corpses and parts of human organs. Cadavre si parti de organe umane.
• Waste impregnated with blood such as from operation theatre, dressing room, laboratory, mortuary, etc. Deseuri impregnate cu sange, cum ar fi de la exploatarea teatru, dressing, laborator, mortuar, etc
• Wound dressing and caste  from plastic room Rana sos si casta de la camera de plastic
• Waste from isolation wards, laboratory animals and their excreta. Deseuri de la saloane de izolare, animalele de laborator si excretiile lor.
• Dialytic waste Dialytic deseuri
• Radio-active waste and other waste from Radiology department. deseurilor radioactive si a altor deseuri de la departamentul de radiologie.
• Chemical waste from laboratories Deseuri chimice din laboratoare
• Disposal materials like plastic tubes, plastic containers, IV sets, syringes, catheters etc. materiale de eliminare cum ar fi tuburi de plastic, recipiente din plastic, seturi IV, seringi, catetere, etc
• Waste from stores eg cartoons, plastic bags, crates, etc. Deseuri de la magazine de exemplu, desene animate, pungi de plastic, cutii, etc
• Sharp objects eg glass, canes etc. Obiectele ascutite de exemplu, sticla, bastoane etc

1. Non- hazardous waste Non-deseuri periculoase

• Dry household waste eg floor refuse like dust, paper trash, etc. Uscat podea deseuri menajere de exemplu, refuza ca praful de hartie gunoi,, etc
• Wet garbage from kitchen and pantry. Wet gunoi din bucatarie si camara.

AMOUNT OF HOSPITAL WASTE Cantitatea de deseuri SPITAL

The total amount of hospital waste depends on the standard and specialization of the hospital. Cantitatea totala de deseuri spitalicesti depinde de standard si specializare a spitalului. According to Gerig (1993) the average amount of hospital waste can be calculated as (approximately): Potrivit Gerig (1993), valoarea medie a deseurilor spitalicesti poate fi calculat ca (aproximativ):

• Psychiatric hospitals, sanatoria            1.5 - 1.7 kg/bed/day spitalele de psihiatrie, sanatorii 1.5 - 1.7 kg / pat / zi
• General hospitals                  2.0 - 3.0kg/bed/day spitale generale 2.0 - 3.0kg/bed/day
• Emergency hospitals and clinics          3.0 - 5.0kg/bed/day spitale de urgenta si clinici 3.0 - 5.0kg/bed/day

HAZARDS OF HOSPITAL WASTE Pericolelor deseurilor spitalicesti

• potential source of transmitting infection, potentiala sursa de infectie transmitere,
• Low level radioactivity. Scazut nivel de radioactivitate.
• Health hazards to Doctors, Nurses, Paramedical personnel and other personnel either working or providing supportive services to the organization. riscurilor pentru sanatate la medici, asistente medicale, personalul paramedical si alte categorii de personal, fie de lucru sau furnizarea de servicii de sustinere a organizatiei.
• There may be toxic and inflammable waste. S-ar putea fi deseuri toxice si inflamabile.
• Defective transportation and disposal may cause public health hazard. defecte de transport si de eliminare poate provoca pericol sanatatea publica.

SEGREGATION OF WASTE Separarii deseurilor

Segregation of waste at the point of generation is the most important activity for an effective hospital waste management; it is the responsibility of waste procedure and should be done at the source of waste generation. Segregarea a deseurilor la punctul de generatie este cea mai importanta activitate pentru o gestionare eficienta a deseurilor spitalicesti, este responsabilitatea procedurii de deseuri si ar trebui sa fie facut la sursa de generare a deseurilor.

Segregation various from hospital to hospital depending on treatment system and the policies practiced within the hospital. diverse, de la spital la spital in functie de sistemul de tratare, precum si politicile practicate in cadrul spitalului de segregare. Most of the hospital segregate their waste into three categorize ie hazardous, non hazardous and sharps. Cele mai multe dintre spital separa deseurile acestora in trei categorii si anume periculoase, nepericuloase si obiecte ascutite. Suitable containers or bags are placed in all location where the waste are generated. containere potrivite sau pungi sunt plasate in toate locul unde deseurile sunt generate.

According to WHO, 1999 following guidelines are given to segregate the hospital waste. Potrivit OMS, 1999 indica urmatoarele orientari de separare a deseurilor spitalicesti.

• Yellow colored containers           Infectious waste Galben containere colorate de deseuri infectioase
• Black colored containers              Non infectious waste, non hazardous waste and De culoare neagra Containere de deseuri infectioase, deseuri nepericuloase si

o       

• Communal waste Comunale de deseuri
• Green colored containers             Sharp Verde containere colorate Sharp

COLLECTION AND TRANSPORTATION OF HOSPITAL WASTE Colectare si transport a deseurilor spitalicesti

The hospital waste should preferably be collected in a standard disposable polyethylene bag fitted with a fastener. Deseuri spital trebuie sa fie colectate de preferinta intr-un sac din polietilena de unica folosinta standard echipate cu un dispozitiv de fixare. Covered plastic bucket or some strong receptacle should be used for collection of pointed articles like syringe etc. Acoperite galeata de plastic sau unele recipient puternic ar trebui sa fie utilizate pentru colectarea de articole subliniat ca seringa etc

The hospital waste should be transported by manually operated  trolleys and stored at controlled temperature by in-house incineration in a separate storage room. Deseuri spital trebuie sa fie transportate de catre carucioare actionate manual si depozitate la temperatura controlata prin incinerare in-house intr-o camera de depozitare separate. If such facility is not available, the hospital waste should be transported either by manually operated trolley or trailer to the site of outside incinerator. In cazul in care astfel de facilitate nu este disponibil, deseurile spital trebuie sa fie transportate fie de catre carucior actionate manual sau remorca, pentru site-ul de incinerator afara.

DISPOSAL OF HOSPITAL WASTE Eliminare a deseurilor spitalicesti

An effective and efficient management is of vital importance in any health care delivery system. Un management eficient si eficace este de o importanta vitala in orice sistem de livrare de sanatate. Until recently, opinions available for disposable of hospital waste were limited to incineration and in some countries autoclaving. Pana de curand, disponibile pentru avize de unica folosinta a deseurilor spitalicesti au fost limitate la incinerare si in unele tari autoclavare. Both technologies have some limitations in the management of current volumes and composition of hospital waste stream in an environmentally sound matter. Ambele tehnologii au unele limitari in gestionarea volumelor curente si compozitia de flux de deseuri spital intr-o chestiune ecologic. The basic approach to waste management is to reduce the quantity of waste at source as far as practicable. Abordarea de baza pentru gestionarea deseurilor este de a reduce cantitatea de deseuri la sursa, pe cat posibil. Waste should be recycled whenever feasible with due regards to environmental considerations to reduce the quantity of material entering the waste system. Deseurile ar trebui sa fie reciclate ori de cate ori este posibil, cu privire la cauza consideratiilor de mediu pentru a reduce cantitatea de material care intra in sistemul de deseuri.

A) Autoclave (High temperature, High Pressure Steam Vessels) A Autoclava) (temperatura inalta, de inalta presiune de aburi nave)

Do not work as efficiently in transferring heat to waste loads. Nu lucra la fel de eficient in transferul de caldura la deseuri sarcini. Moreover, sharp waste material cannot be autoclaved. Mai mult decat atat, deseurile ascutite nu pot fi introduse in autoclave.

B) Incinerator B) incinerator

Advantages Avantaje

• Preferred method of disposing pathological and infectious waste. Metoda preferata de eliminare a deseurilor patologice si infectioase.
• The volume and weight of the organic waste are reduced to a great extent. Volumul si greutatea deseurilor organice sunt reduse in mare masura.
• Humidity up to 35 per unit is no problem for the process. Umiditatea de pana la 35 per unitate este nici o problema pentru proces.
• Protection of environment if fixing of emission limit couls be provided for incinerators. Protectia mediului in cazul in care fixarea a couls limita de emisie sa fie prevazute pentru incineratoare.
• The ash or inorganic material is sterile due to temperature in the burning chamber and can be handled as household waste. Materialul de cenusa sau anorganic este steril din cauza temperaturii in camera de ardere si pot fi tratate ca deseuri menajere.
• Waste like cartoon and polyethylene can be incinerated. Deseuri cum ar fi desene animate si polietilena pot fi incinerate.

Disadvantages Dezavantaje

• Cannot process the large pathological waste in an environmentally sound manner. Nu poate procesa deseurile mare patologice intr-un mod ecologic.
• Not suitable for today's broader hospital waste stream that consists of almost 15 per cent plastics and 20 per cent non combustibles. Nu sunt potrivite pentru fluxul de astazi mai larg deseurilor de la spitale, care consta din aproape 15 la suta materiale plastice si 20 la suta combustibililor non.
• Air emission is a major public concern. de emisie Air este o preocupare majora public.

C) New system C) Noul sistem de

In 1986, ABB Sanitec division of Swiss-based ABB Asea Brown Bovert Group developed and placed in the commercial market the microwave disinfection system as safe procedure to medical community, environmentally sound and cost effective alternative. In 1986, divizia ABB Sanitec de sediul in Elvetia, ABB Asea Brown Bovert Group a dezvoltat si introdus pe piata comerciala a sistemului de dezinfectie cu microunde ca procedura in conditii de siguranta a comunitatii medicale, ecologice si de cost alternative eficiente.

The ABB Sanitec system, as reported, is simple in its design, installation and operation, and widely accepted in foreign countries to treat hospital waste the application of moist heat by conventional microwaves. Sistemul ABB Sanitec, astfel cum sunt raportate, este simplu sa in proiectarea, instalarea si exploatarea, si larg acceptate in tari straine pentru a trata deseurile spitalicesti aplicarea de caldura umeda de microunde conventionale. The entire process takes place inside a compact unit that is fully self-contained, and requires only appropriate electrical connections and a water line for installation. Intregul proces are loc intr-o unitate compacta care este pe deplin de sine statator, si necesita doar conexiunile electrice corespunzatoare si o linie de apa pentru instalare.

Extensive testing in France and USA concluded that it is possible to achieve total disinfection with respect to the control micro-organism like streptococcus foecalis, pseudomonas aeroginosa, candida albicans, aspergillus niger, entrococcus, girdia, strain of hepatitis, etc. Testarea extinsa in Franta si Statele Unite ale Americii a concluzionat ca este posibil sa se realizeze dezinfectie totala in ceea ce priveste controlul micro-organisme cum ar fi foecalis streptococ, aeroginosa Pseudomonas, Candida albicans, Aspergillus niger,, girdia entrococcus, tulpina de hepatita, etc

Advantages Avantaje

• The unit is said to be 78 per cent cost savings. Unitatea este declarat a fi 78 la suta de economii de cost.
• No liquid discharge. Nr lichid de descarcare de gestiune.
• No requirement for a sewer connection. Nici o cerinta pentru o conexiune de canalizare.
• All wastes, including vials, hypodermic needles, syringes, plastic tubing are thoroughly shredded into tiny bits unrecognizable as hospital waste. Toate deseurile, inclusiv flacoane, ace hipodermice, seringi, tuburi din plastic sunt complet distruse in bucatele mici de nerecunoscut ca deseurilor spitalicesti.
• Achieves an extra-ordinarily high level of disinfection. Atinge un nivel foarte ridicat de obicei de dezinfectie.
• No requirement of building since unit is enclosed. Nici o cerinta de a construi, deoarece aparatul este inclus.
• The technology is positive, alternative to incinerator as it benefits community's environment. Tehnologia este pozitiv, alternativa la incinerator, deoarece beneficiile de mediu ale comunitatii.

D) Chemical treatment D) tratare chimica

Chemical disinfection are the preferred ttreatment for liquid infectious wastes, but it can also be use in treating solid in infectious waste. dezinfectie chimice sunt preferate t tratament pentru deseuri lichide infectioase, dar poate fi, de asemenea, utilizate in tratarea deseurilor solide in infectioase. Chemical treatment is used according to the type of microorganism degree of contamination, type of disinfectant, contact time and other relevant factor such as temperature, the biology of the microorganism etc. Tratamente chimice este utilizat in functie de tipul de microorganism gradul de contaminare, tip de timp dezinfectant, contact si alt factor relevant, cum ar fi temperatura, biologia de microorganisme, etc

E) Hydroclave E) Hydroclave

It supplies steam (which is stored in a double wall/jacket) as an indirect heat source allowing total dehydration of the waste at 132d c and 36psi, the waste is also internally agitated & fragmented to attain a high sterilization level  of all components & particles- sharps, pathological waste etc. Acesta furnizeaza abur (care este depozitat intr-un perete dublu / sacou) ca o sursa de caldura indirect permite deshidratarea totala a deseurilor la 132d c si 36psi, deseurile sunt, de asemenea, pe plan intern agitat & fragmentate sa atinga un nivel ridicat de sterilizare a tuturor componentelor si particulele - sparturi, deseuri patologice etc

F) Microwave F) cu microunde

Microwave uses electromagnetic wave that enters into or penetrates materials. Cuptor cu microunde foloseste undelor electromagnetice, care intra in sau patrunde materiale. Most microorganisms are destroyed by the action of microwaves of a frequency of about 2450 MHz and a wavelength of 12.24 cm. Cele mai multe microorganisme sunt distruse prin actiunea de microunde de o frecventa de aproximativ 2450 MHz si o lungime de unda de 12.24 cm. the microwave rapidly heat the water contained within the waste and the infectious components are destroy by heat conduction. microunde caldura rapid de apa continuta in deseuri si componentele infectioase sunt distrug prin conductie de caldura. The efficiency of microwave disinfection should be checked routinely through bacteriological and virological testes. Eficienta de dezinfectie cu microunde ar trebui sa fie verificata de rutina prin testicule bacteriologice si virusologice.

G) Burial Pit G) Pit Ingroparea

A special type small pit (1-2m depth) could be prepared to receive medical waste only and filled to a depth of 1-1.5 cm. O groapa de tip special mici (adancime 1-2m) ar putea fi pregatit pentru a primi deseurilor medicale si a umplut doar la o adancime de 1-1,5 cm. After each waste load, the waste should be covered with soil layer 10-15 cm deep. Dupa fiecare incarcatura de deseuri, deseurile ar trebui sa fie acoperite cu un strat de pamant de 10-15 cm adancime. If soil is not available, line may be deposited over the waste can be buried in a special pit. Daca solul nu este disponibil, linia poate fi depus peste deseurilor poate fi ingropat intr-o groapa special.

Hospital waste can be managed by following: Spitalul de deseuri pot fi gestionate de catre urmatorul text:

• Create awareness amongst the hospital staff members and population. Crearea de constientizare in randul membrilor personalului spitalului si a populatiei.
• Assign the specific  responsibility to the hospital staff Atribui responsabilitatea specifice pentru personalul spitalului
• Training to the hospital staff. Training pentru personalul spitalului.
• Waste segregation, classification and assess waste management segregarea deseurilor, clasificarea si evaluarea de gestionare a deseurilor
• Ensure safe storage Asigura depozitarea in conditii de siguranta
• Identify reuse option Identificarea reutilizarea optiune
• Ensure safe transportation of wastes, ensure staff and workers safety Asigurarea de transport in siguranta a deseurilor, a asigura securitatea personalului si a lucratorilor
• Return outdated drugs or chemicals to the supplier Return droguri depasite sau substante chimice pentru a furnizorului
• Adequate treatment and disposal of waste water and other wastes Adecvate de tratare si eliminare a apelor uzate si alte deseuri
• Improve stock management of chemical and pharmaceutical Imbunatati gestiunea stocurilor de produse chimice si farmaceutice
• General waste treatment General de tratare a deseurilor

Waste management policy Politica de gestionare a deseurilor

Each health care institution should develop a waste management policy, outlining the accountabilities and responsibilities of managers, employees and staff. Fiecare institutie de ingrijire a sanatatii ar trebui sa dezvolte o politica de gestionare a deseurilor, care sa evidentieze responsabilitatile si responsabilitati ale managerilor, angajatilor si de personal. It is the responsibility of health care institution to comply with guidelines, to ensure proper classification, segregation, containment, treatment and disposal of waste. Este responsabilitatea de institutia medicala pentru a se conforma cu orientarile, pentru a asigura clasificarea adecvata,, izolare segregare, tratarea si eliminarea deseurilor.

Each health care institution establishes "waste management committee", which will have function of implementing waste management policy. Fiecare institutie de ingrijire a sanatatii stabileste 'comitet de gestionare a deseurilor', care va avea functia de punere in aplicare a politicii de gestionare a deseurilor.

Policy of waste management Politica de gestionare a deseurilor

• Waste minimization Minimizare a deseurilor
• Segregation of source Segregarea de sursa
• Identification(color coding) De identificare (coduri de culori)
• Collection Colectare
• Storage De depozitare
• Transportation Transport
• Measurement Masurare
• Treatment Tratamentul
• Disposal Eliminare
• Worker training Lucrator de formare
• Worker health and safety Lucrator de sanatate si siguranta

Waste management committee includes: comitet de gestionare a deseurilor include:

• The hospital superintendent, chairman Chestorul spital, presedintele
• The head of all hospital departments/units Seful de toate departamentele spitalului / unitati de
• The chief pharmacist Seful farmacistul
• The radiology officer Radiologie ofiter
• The matron Matroana
• The head of administration Seful administratiei
• Hospital engineer Spitalul de inginer
• The housekeeper Menajera
• Representation from support staff Reprezentare din partea personalului de sprijin

All health care establishments should have comprehensive waste disposal plans and evolve technique to collect, transport, store, and reuse and dispose hospital waste safely and gainfully. Toate unitatile medicale ar trebui sa aiba planuri cuprinzatoare de eliminare a deseurilor si sa evolueze tehnica de colectare, transport, magazin, si refolosirea deseurilor spitalicesti si aruncati in conditii de siguranta si a unei activitati.

New installation of incinerator has to fulfill air emission limit with pollution free incineration system for hospital waste. instalarea de noi incineratorului trebuie sa indeplineasca limita de emisie de aer cu sistem de incinerare poluare gratuit pentru deseurile spitalicesti.

Many experts in foreign counties believe that ABB sanitec system is the wave of the future for management of hospital waste because of its: Multi experti in judetele straina considera ca sistemul Sanitec ABB este val de viitor pentru gestionarea deseurilor spital din cauza sale:

• Thoroughness of treatment it attains Rigoare de tratament sa atinga
• Environmental friendless, and De mediu prieteni, si
• Significant cost saving Importante economii de costuri