State sanitary and anti-epidemic rules and norms of medical waste management

Abstract

Background. Hands are a favorable environment for bacterial colonization. The microflora of skin is divided into resident and transient. The latter gets to the hands of healthcare workers (HCW) by the contact during professional activities during various diagnostic and treatment procedures, as well as by the contact with contaminated objects. General requirements for hand hygiene include short nails, absence of false nails, absence of infected skin injuries (or covered injuries) on the hands and forearms, absence of jewelry or watch. If there is visible dirt, the hands should be washed with usual soap. As for disinfection, it is divided into focal (current and final) and preventive (planned and according to the epidemic indications). Not only the hands of the HCW, medical devices, surfaces and furniture, but also medical waste (MW) should be disinfected. Objective. To describe the features of disinfection and MW management. Materials and methods. Analysis of the literature on this issue. Results and discussion. After use, the syringes are disinfected together with the needles without caps and collected in waterproof and puncture-proof containers. When using containers for sharp objects, it is allowed to fill them for 3 days. Medical devices should be immersed in a disinfectant solution immediately after use; the solution should cover the tools at least 1 cm above their surface. Containers with disinfectant solutions must be marked with the name of the solution, its concentration, purpose, exposure time, date of preparation and expiration date. Disinfectants are divided into halide-containing, alcohol-containing, aldehyde-containing, oxidizing, detergent and composite. Decamethoxine – an antiseptic and antifungal drug for topical use – is widely used for disinfection. The mechanism of action of this solution is to disrupt the permeability of the cytoplasmic membrane of bacteria and fungi by binding to phosphatide groups of membrane lipids. The problem of MW is a major problem in the domestic health care system. Ukraine annually produces about 400 thousand tons of MW, 100-120 thousand of which are dangerous. The risks caused by MW are divided into infectious, chemical and radiation-associated. Categories of MW include category A – epidemically safe MW, B – epidemically dangerous MW, C – toxicologically dangerous MW, D – radiologically dangerous MW. The waste management system includes its collection and sorting; marking; disinfection; transportation within the institution; utilization or disposal (category A only). For each type of waste there are special types of containers and markings regulated by normative documents. Category A waste include household waste of all departments of the hospital, except infectious; waste that have not had contact with biological fluids of the body; food waste of all departments of the hospital, except infectious. Food waste is collected separately from other waste. When collecting MW of B category (used medical instruments; items contaminated with blood or other biological fluids; organic MW of patients; food waste of infectious departments), it is forbidden to cut or destroy this waste, to remove needles from syringes, to spill or compact MW, to install containers for waste collection at a distance of less than 1 m from heating appliances. Category C waste includes drugs, substances for diagnostics, and disinfectants; batteries; items containing mercury and heavy metals; wastes generate as a result of operation of transport, lighting systems, etc. Collection and temporary storage of waste, associated with cytostatics and genotoxic drugs, as well as all MW produced as a result of their preparation (category C), is not allowed without decontamination. It is also needed to decontaminate the workplace. Any work with such waste should be carried out with the use of personal protective equipment in the special ventilated rooms. Category D waste management is implemented in accordance with the requirements of the legislation of Ukraine on radioactive waste management and radiation safety standards. Conclusions. 1. The problem of MW is a significant problem of the domestic health care system. 2. Categories of MW include category A – epidemically safe MW, B – epidemically dangerous MW, C – toxicologically dangerous MW, D – radiologically dangerous MW. 3. The waste management system includes their collection and sorting; marking; disinfection; transportation within the institution; utilization or disposal (category A only).