Waste Miniimization

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recycle and reuse
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  Safe management of wastes from health-care activities  58 Waste minimization, recycling,and reuse   6 6.1Waste minimization Significant reduction of the waste generated in health-care establish-ments and research facilities may be encouraged by the implementationof certain policies and practices, including the following: ã Source reduction : measures such as purchasing restrictions to en-sure the selection of methods or supplies that are less wasteful orgenerate less hazardous waste. ã Recyclable products : use of materials that may be recycled, eitheron-site or off-site. ã Good management and control practices : apply particularly tothe purchase and use of chemicals and pharmaceuticals. ã  Waste segregation : careful segregation (separation) of waste matterinto different categories (see section 7.1) helps to minimize the quan-tities of hazardous waste. A number of examples of policies and practices that tend to minimizequantities of waste are summarized in Box 6.1.Careful management of stores will prevent the accumulation of largequantities of outdated chemicals or pharmaceuticals and limit the wasteto the packaging (boxes, bottles, etc.) plus residues of the products re-maining in the containers. These small amounts of chemical or pharma-ceutical waste can be disposed of easily and relatively cheaply, whereasdisposing of larger amounts requires costly and specialized treatment,which underlines the importance of waste minimization.Waste minimization usually benefits the waste producer: costs for boththe purchase of goods and for waste treatment and disposal are reducedand the liabilities associated with the disposal of hazardous waste arelessened. All health-service employees have a role to play in this process andshould therefore be trained in waste minimization and the managementof hazardous materials. This is particularly important for the staff of departments that generate large quantities of hazardous waste.Suppliers of chemicals and pharmaceuticals can also become responsiblepartners in waste minimization programmes. The health service canencourage this by ordering only from suppliers who provide rapid deliv-ery of small orders, who accept the return of unopened stock, and whooffer off-site waste management facilities for hazardous wastes.Reducing the toxicity of waste is also beneficial, by reducing the problemsassociated with its treatment or disposal. For example, the SupplyOfficer could investigate the possibilities of purchasing PVC-free  Waste minimization, recycling, and reuse  59 plastics that may be recycled or of goods supplied without unnecessarypackaging. 6.2Safe reuse and recycling Medical and other equipment used in a health-care establishment maybe reused provided that it is designed for the purpose and will withstandthe sterilization process. Reusable items may include certain sharps,such as scalpels and hypodermic needles, syringes, glass bottles andcontainers, etc. After use, these should be collected separately from non-reusable items, carefully washed (particularly in the case of hypodermicneedles, in which infectious droplets could be trapped), and may then besterilized by one of the processes listed in Box 6.2. Although reuse of hypodermic needles is not recommended, it may be necessary in estab-lishments that cannot afford disposable syringes and needles. Plasticsyringes and catheters should not be thermally or chemically sterilized;they should be discarded.Long-term radionuclides conditioned as pins, needles, or seeds and usedfor radiotherapy may be reused after sterilization.Special measures must be applied in the case of potential or provencontamination with the causative agents of transmissible spongiformencephalopathies (also known as prion diseases). These measures, which Box 6.1Examples of policies and practices thatencourage waste minimization Source reduction ãPurchasing reductions: selection of supplies that are less wasteful or lesshazardous.ãUse of physical rather than chemical cleaning methods (e.g. steam disinfectioninstead of chemical disinfection).ãPrevention of wastage of products, e.g. in nursing and cleaning activities. Management and control measures at hospital level ãCentralized purchasing of hazardous chemicals.ãMonitoring of chemical flows within the health facility from receipt as raw ma-terials to disposal as hazardous wastes. Stock management of chemical and pharmaceutical products ãFrequent ordering of relatively small quantities rather than large amounts at onetime (applicable in particular to unstable products).ãUse of the oldest batch of a product first.ãUse of all  the   contents of each container.ãChecking of the expiry date of all products at the time of delivery.  Safe management of wastes from health-care activities  60 Box 6.2Examples of sterilization methods for reusableitems Thermal sterilization ã Dry sterilization Exposure to 160 ° C for 120 minutes or 170 ° C for 60 minutes in a “Poupinel” oven.ã Wet sterilization Exposure to saturated steam at 121 ° C for 30 minutes in an autoclave. Chemical sterilization ã Ethylene oxide  Exposure to an atmosphere saturated with ethylene oxide for 3–8 hours, at 50–60 ° C, in a reactor tank; the so-called “gas-sterilizer” tank should be dry beforeinjection of the ethylene oxide. Ethylene oxide is a very hazardous chemical; thisprocess should therefore be undertaken only by highly trained and adequatelyprotected technical personnel (see section 8.2 for protective measures).ã Glutaraldehyde  Exposure to a glutaraldehyde solution for 30 minutes. This process is safer forthe operators than the use of ethylene oxide but is microbiologically less efficient. 1 Report of a WHO consultation on public health issues related to animal and humanencephalopathies  . Geneva, World Health Organization, 1992 (unpublished documentWHO/CDS/VPH/92.104, available on request from Department of CommunicableDisease Surveillance and Response, World Health Organization, 1211 Geneva 27,Switzerland). This document was undergoing revision at the time of publication of this handbook. are capable of reducing or eliminating infectivity, are described in detailin a WHO document. 1 The effectiveness of thermal sterilization may be checked, for example,by the  Bacillus stearothermophilus  test and of chemical sterilization bythe  Bacillus subtilis  test (see Box 8.13, page 102, for description).Certain types of container may be reused provided that they are carefullywashed and disinfected. Containers of pressurized gas, however, shouldgenerally be sent to specialized centres to be refilled. Containers that onceheld detergent or other liquids may be reused as containers for sharpswaste (if purpose-made containers are not affordable) provided that theyare puncture-proof and correctly and clearly marked on all sides.Recycling is usually not practised by health-care facilities, apart, per-haps, from the recovery of silver from fixing-baths used in processingX-ray films. However, recycling of materials such as metals, paper, glass,and plastics can result in savings for the health-care facility—eitherthrough reduced disposal costs or through payments made by the recy-cling company.In temperate climates, the heat generated by on-site incinerators may bean attractive and cost-effective option for heating hospital premises.In determining the economic viability of recycling, it is important to takeaccount of the costs of alternative disposal methods and not just the costof the recycling process and the value of the reclaimed material.
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