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"Infection
Control for Viral Haemorrhagic Fevers In the African Health Care Setting"
Section 6. Dispose of Waste
Safely
This
section describes how to:
- Dispose of liquid
waste and patient excreta in an isolated latrine or toilet.
- Use an incinerator
to burn contaminated waste.
- Use a pit to burn
contaminated waste.
- Maintain security
of the disposal site.
Direct,
unprotected contact during disposal of infectious waste can result in
accidental transmission of VHF. For this reason, all contaminated waste
produced in the care of the VHF patient must be disposed of safely. All
non-reusable items should be destroyed so they cannot be used again. Burning
should be carried out at least daily.
6.1
What Needs Disposal |
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When
VHF is suspected, disinfect and dispose of:
- Infectious blood
and other body fluids such as urine, faeces, and vomitus
- Disposable needles
and syringes and disposable or non-reusable protective clothing
- Treatment materials
and dressings
- Non-reusable gloves
- Laboratory supplies
and biological samples
- Used disinfectants.
Recommended
Disposal Methods:
Liquid
waste, including patient excreta, can be disposed of in an isolated latrine
or toilet set aside for VHF cases. Burning is the recommended method for
disposal of other VHF-contaminated waste. A safe and inexpensive disposal
system can be made by using an incinerator or a pit for burning.
- A latrine or toilet
that joins the patient's isolation room can be used to receive the disinfected
bedpan contents from the VHF patient. The latrine or toilet should be
isolated. Access should be restricted to health facility staff trained
to work in the VHF isolation area. Isolating the patient area is described
in Section 3.5.
- Incinerators are
containers with holes for ventilation to allow air to enter and exit
the container. This allows the fire to reach temperatures high enough
to completely destroy all biological materials. Use flammable fuel (such
as diesel fuel) to speed the burning process and keep the temperatures
high.
Incineration is
recommended for disposal of:
- Needles and
syringes
- Used treatment
materials and dressings
- Non-reusable
protective clothing
- Laboratory supplies.
- When an incinerator
is not available, burn waste in a pit. Use fuel to accelerate the burning
and ensure that all waste is completely destroyed. Use a pit to dispose
of:
- Disinfected
body fluids such as urine, faeces, and vomitus when no designated
latrine or toilet is available.
- Used disinfectants.
If it is not possible to dispose of used disinfectants in a latrine
or toilet, burn the used disinfectant together with flammable items
(disposable gowns or masks, for example). Burning with the flammable
items will help keep the temperature of the fire hot enough to boil
off the liquids.
Note: All
staff who are likely to handle infectious material should know and use
VHF Isolation Precautions. Reinforce with all health facility staff the
importance of handling infectious waste safely.
6.2
Select Staff to Supervise Waste Disposal and Burning |
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Select
a person with authority who will:
- Oversee all the
disposal procedures, including preparation of the incinerator and pit.
- Train and supervise
the staff who carry out waste disposal.
- Make a schedule
for collecting and burning disposable waste.
- Supervise the
collection and burning to make sure it is carried out safely
6.3
Train and Supervise Staff to Carry Out Waste Disposal |
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The
cleaning staff who do the disposal tasks should understand the purpose
of safe disposal, know how to wear protective clothing, and know clearly
how to carry out waste disposal safely.
After the cleaning staff is selected:
- Describe the risks
of VHF transmission. Explain that health facility staff who carry out
waste disposal should wear protective clothing including a plastic apron
and at least two pairs of gloves. Wear thick gloves as the outer pair
of gloves.
- Describe the disposal
procedures that cleaning staff will carry out:
- Bring the containers
of infectious waste from the isolation and cleaning areas to the disposal
site. Discard the items in the incinerator or burning pit.
- Pour fuel on the
waste in the incinerator or over the pit. Light the fire.
- Watch the burning
carefully.
- Move waste
frequently as it burns to be sure all items burn completely.
- If any items
remain, repeat the burning procedures.
- When burning ends,
remove ashes from incinerator and bury them in a pit.
- When the pit is
nearly full of ash, cover it with soil. Waste should not be near the
surface. It should take about half a meter of soil to close the pit.
- Build a new pit
when the old pit is full.
- Show the cleaning
staff how to:
- Wear protective
clothing with one pair of thick or kitchen gloves over an inner pair
of thin gloves.
- Collect and carry
the buckets of infectious waste from the isolation area to the disposal
area.
- Collect and dispose
of liquid waste in an isolated latrine or toilet. If no latrine or toilet
can be isolated, burn the liquid waste in the pit.
- Place the infectious
waste in the incinerator or pit for burning.
- Dowse the infectious
waste with fuel (such as diesel fuel) and burn it.
- Watch the burning
from beginning to end to make sure all the waste items are burned before
letting the fire go out.
6.4
Select Site for Burning VHF-Contaminated Waste |
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Select a burning
site on the health facility grounds. It should be located away from the
normal traffic flow. To help maintain security and prevent unauthorized
access, the site should not be in public view or in an area where it will
attract a crowd. The ash from the burning is not infectious, and it can
be placed in a pit and buried.
6.5
Use Incinerator to Burn VHF-Contaminated Waste |
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If an
incinerator is available on the health facility's grounds, and it can
be set aside for VHF-contaminated waste, use diesel fuel during burning
to make sure all the waste is completely destroyed.
If no incinerator is available, make one from an empty 220-litre (55-gallon)
oil or fuel drum.
1. |
Gather the
following supplies:
- 220-litre
(55-gallon) drum
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Fig.
54. A
220-litre drum |
- Chisel or
other sharp instrument (an awl, for example to cut metal
- Hammer
- 0.5 mm or
1.0 mm metal wire
- The piece
cut out from the top of the drum or a wire screen or grill about
1 cm thick
- Metal rods
or bars 4 cm or 5 cm x 2 cm.
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2.
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Cut
open the drum by removing the top in one piece. Save the top cutaway
piece. |
3. |
Hammer
the edges of the drum so they are not sharp. |
4. |
Cut
three half-moon openings just below the open end of the drum. |
5. |
Turn the drum
and put the open end on the ground. The bottom of the drum is now
the top.
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Fig.
55. Turn the drum and put the open end on the ground
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6. |
Cut four holes
on the sides of the drum. These holes are for threading the two metal
rods through the drum so that they form an X or cross inside the drum.
The crossed rods will support a platform used for holding the infectious
material to be burned.
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Fig. 56.
Place the rods across the drum |
To cut the holes for the rods: Just above the half moon openings (about
one-third of the height of the drum), cut a hole the same size as
the diameter of the metal rod. Directly across from the hole, on the
other side of the drum, cut a second hole so that a rod can be threaded
through the two holes. Repeat the steps and make two more holes on
opposite sides of the drum. Thread each rod through the holes to make
an X or cross. |
7. |
Use
the top piece of the drum that was cut away in step 2 to make the
platform. It will rest on the crossed rods and hold the infectious
material to be burned. The platform also lets air come in from the
bottom of the drum so that the temperatures at the bottom are high
enough to completely burn the material. To make the platform: Punch
holes in the cutaway top piece of the drum. Make enough holes so it
looks like a sieve. Save the platform to use in Step 10. |
8. |
Pierce
a series of holes (about 0.5 cm in diameter) on the sides of the drum
and above the crossed rods to improve the draw of the fire. |
9. |
Cut
away half of the bottom of the drum (which is now the top of the incinerator
and is facing up). Attach the wire loops to the cutaway half. Attach
another loop for a handle to open the trap door. Items to be burned
will be put in the incinerator through this door. |
10. |
Place
the platform you made in Step 7 inside the drum on top of the rods.
Replace the incinerator if, as a result of the heat, large holes appear
in the sides. |
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Fig.
57. A complete incinerator |
To burn waste
in the incinerator:
- Place the infectious
waste inside the top of the drum. Soak the waste in one litre of fuel.
- Light the fire
carefully.
- Watch the fire
and frequently mix the waste with the metal bars to be sure all of the
waste is burned.
- When the fire
has gone out, empty the ashes into a pit.
6.6
Use a Pit to Burn VHF-Contaminated Waste |
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If an incinerator
is not available, make a pit for burning infectious waste.
- Locate the pit
far from the normal traffic flow of the health facility.
- Dig a pit that
is 2 meters deep. It should be wide enough to hold all contaminated
waste material, including discarded liquids
To burn waste
in the pit:
- Place the disinfected
waste in the pit, including disinfected liquid waste that was not discarded
in an isolated latrine or toilet.
- Pour fuel (such
as diesel fuel) on the waste. Carefully start the fire.
- Watch the burning
to make sure all the waste is completely destroyed.
- When the fire
has gone out, if any waste remains, repeat the steps for burning.
- When no waste
remains and the fire goes out, cover the ashes with soil.
- Before the pit
becomes completely full, cover it with soil so that no pieces of waste
are visible or are too close to the surface. The pit should be closed
when it can be covered by one-half meter of soil.
- Dig a new pit
6.7
Take Steps to Ensure Security of Burning Site |
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Maintain the security
of the burning site to limit access to contaminated items. This is important
since children could be tempted to pick up the interesting waste materials
and use them for toys. Dogs, cats, and other animals may carry items beyond
the health facility boundaries.
Tie a rope around
the disposal area. Hang warning signs from the rope that tell people this
is a dangerous area. Also station a guard to prevent unauthorized access
to the disposal area.
Never leave unburned
waste in the incinerator or the pit.
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Infection
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