pengurusan buangan terjadual di malaysia: sisa klinikal
Transcription
pengurusan buangan terjadual di malaysia: sisa klinikal
PENGURUSAN BUANGAN TERJADUAL DI MALAYSIA: SISA KLINIKAL SKOP PEMBENTANGAN 1 2 4 5 • PERUNDANGAN BERKAITAN PENGURUSAN BUANGAN TERJADUAL • POLISI PENGURUSAN BUANGAN TERJADUAL • PENGURUSAN SISA KLINIKAL • HALA TUJU PENGURUSAN BUANGAN TERJADUAL 2 PERUNDANGAN BERKAITAN PENGURUSAN BUANGAN TERJADUAL 3 Peraturan-Peraturan Kualiti Alam Sekeliling (Buangan Terjadual) 2005 PERATURAN-PERATURAN KUALITI ALAM SEKELILING (BUANGAN TERJADUAL) 2005 -77 Kategori BT (Kod SW ) -Merangkumi 17 Peraturan -Mengambilkira : a) Pemerolehan kembali BT b) Pengurusan Khas Buangan Terjadual – cradle to cradle c) Penstoran BT tidak lebih 20 MT atau 180 hari d) Keperluan Latihan 4 Peraturan-Peraturan Kualiti Alam Sekeliling (Buangan Terjadual) 2005 APAKAH BUANGAN TERJADUAL? Semua buangan yang dimasukkan dan disenaraikan dalam Jadual Pertama, Peraturan-Peraturan Kualiti Alam Sekeliling (Buangan Terjadual) 2005 5 Elemen Utama dalam PPKAS (BT) 2005 1 2 • Mengawal dan memantau penghasilan buangan melalui sistem notifikasi (E-SWISS); • Melesenkan kemudahan buangan terjadual 3 • Rawatan dan pelupusan buangan terjadual hanya di premis yang ditetapkan sahaja; dan 4 • Manifest system untuk memantau pergerakan buangan terjadual dari mula hingga ke pelupusan 6 Peraturan-Peraturan Kualiti Alam Sekeliling (Buangan Terjadual) 2005 1 • Pemberitahuan kepada JAS mengenai jenis dan kuantiti buangan yang dihasilkan 2 • Menggunapakai “Best Environmental Practices” dan “BestAvailable Techniques” 3 • Mengemaskini inventori buangan terjadual 7 Peraturan-Peraturan Kualiti Alam Sekeliling (Buangan Terjadual) 2005 4 • Bertanggungjawab memastikan buangan terjadual yang dihasilkan dihantar ke PYDT atau untuk pelupusan 5 • Buangan terjadual boleh digunasemula, dikitarsemula atau dilakukan pemerolehan kembali 6 • Buangan hendaklah dilabel dan disimpan dengan baik di tempat yang bersesuaian 8 Peraturan-Peraturan Kualiti Alam Sekeliling (Buangan Terjadual) 2005 7 8 • Memberi latihan kepada pekerja yang terlibat dalam pengurusan buangan terjadual • Mengemukakan notifikasi dan pelupusan buangan terjadual • Consignment Note • e-Consignment (on-line) SIXTH SCHEDULE CONSIGNMEN T NOTE 9 Peraturan-Peraturan lain yang berkaitan; Aktiviti 18: Perintah Kualiti Alam Sekeliling (Premis Yang Ditetapkan)(Kemudahan Pengolahan Dan pelupusan Buangan Terjadual) 1989; Peraturan-Peraturan Kualiti Alam Sekeliling (Premis Yang Ditetapkan) (Kemudahan Pengolahan dan Pelupusan Buangan Terjadual) 1989; Perintah Kualiti Alam Sekeliling (Premis Yang Ditetapkan) (Kemudahan Pengolahan dan Pelupusan Buangan Terjadual) 1989; dan Perintah Kualiti Alam Sekeliling (Pembawa Yang Ditetapkan) (Buangan Terjadual) 2005 10 Legal Procedures – Setting up a Clinical Wastes Treatment and Disposal Facilities • • • • EIA Study Written Permission License to Operate Compliance to All Approval Conditions 11 POLISI PENGURUSAN BUANGAN TERJADUAL Bekas untuk kitarsemula atau gunasemula oleh pembekal atau pengilang, atau untuk di isi semula dengan bahan kimia yang sama adalah tidak dikategorikan sebagai buangan terjadual Lesen pengangkut buangan terjadual hanya dikeluarkan kepada pihak/pemilik kilang fasiliti kitar semula atau pemerolahkembali atau pelupusan buangan terjadual Import/Eksport/Transit buangan terjadual perlu mematuhi keperluan dan obligasi Konvensyen Basel 12 POLISI PENGURUSAN BUANGAN TERJADUAL Malaysia tidak membenarkan pengimportan buangan terjadual ke dalam negara Selain itu, memandangkan fasiliti/kemudahan buangan tejadual telah dibina dalam negara, maka pengeksportan buangan terjadual ke luar negara juga tidak dibenarkan Bagaimanapun, Malaysia hanya membenarkan pengeksportan buangan terjadual sekiranya fasiliti/kemudahan tempatan tidak mempunyai capacity untuk merawat atau melupuskan buangan 13 CLINICAL WASTES HANDLING PROCEDURES 14 Garispanduan Pengurusan Sisa Klinikal 12/9/2015 15 IDENTIFICATION AND DEFINITION Category of waste from hospital and health care establishment: 1) Clinical waste 2) Radioactive waste 3) Chemical waste 4) Pressurized container 5) General waste 16 IDENTIFICATION AND DEFINITION Clinical waste are waste containing: – Human or animal tissue – Blood or body fluid – Excretions – Drugs – Pharmaceutical products – Soiled swabs or dressings – Syringes, needles, sharps etc 17 IDENTIFICATION AND DEFINITION Environmental Quality (Scheduled Wastes) Regulations, 2005: – – – – SW 403 –Discarded drugs containing psychotropic substances or containing substances that are toxic, harmful, carcinogenic, mutagenic or teratogenic SW 404 – Pathogenic and clinical waste and quarantined materials SW 421 – A mixture of scheduled wastes SW 422 – A mixture of scheduled and nonscheduled wastes 18 WASTE CLASSIFICATION & HANDLING DESCRIPTION GUIDANCE 1. Blood and body fluid waste a) Soiled surgical dressings etc. which have come into contact with blood or wounds, cloths and wiping materials used to clear up body fluids and spills of blood. b) Material other than reusable linen, from cases of infectious diseases c) Pathological waste Special requirement on the management from the viewpoint of infection prevention. These category of waste must always be incinerated completely in an appropriate incinerators. 19 WASTE CLASSIFICATION & HANDLING DESCRIPTION GUIDANCE 2. Waste posing the risk of injury (“sharps”). All objects and materials which are closely linked with healthcare activities and pose a potential risk of injury and/infection, e.g. needles, scalpel blades, blades and saw, any other instruments that could cause a cut or puncture. Collected and managed separately from other waste. The collection containers must be puncture-resistant and leaktight. This category of waste has to be disposed/ destroyed completely as to prevent potential risk of injury/ infection. 20 WASTE CLASSIFICATION & HANDLING DESCRIPTION GUIDANCE 3. Infectious wastes Clinical waste arising from laboratories (e.g. pathology, haematology, blood transfusion, microbiology, histology) and post mortem rooms, other than waste included in category 1 waste. Special requirement on the management from the viewpoint of infection prevention. This category of waste must always be incinerated completely in an appropriate incinerator. 21 WASTE CLASSIFICATION & HANDLING DESCRIPTION GUIDANCE 4. Pharmaceutical and Cytotoxic Pharmaceutical Wastes • Unusable pharmaceuticals: • Expiry date exceeded; • Expiry date exceeded after the packaging has been opened or the ready-to-use preparation prepared by the user; or • Use is not possible for other reasons (e.g. call-back campaign) Class I – pharmaceuticals such as camomile tea, cough syrup, which pose no hazard during collection, intermediate storage and waste management : managed jointly with municipal wastes. Class II – pharmaceuticals which pose a potential hazard when used improperly by unauthorised persons : managed in an appropriate waste disposal facility. 22 WASTE CLASSIFICATION & HANDLING DESCRIPTION GUIDANCE Class III – Heavy metal-containing unidentifiable pharmaceuticals : managed in an appropriate waste Wastes arising in the use, disposal facility. manufacture and preparation of, Intermediate storage - under and in the oncological treatment of controlled and locked conditions. patients with, pharmaceuticals with Cytotoxic wastes must be a cytotoxic effect (mutagenic, collected separately from carcinogenic and teratogenic pharmaceutical waste and properties). disposed of in a hazardous waste incinerator 4. Pharmaceutical and Cytotoxic Pharmaceutical Wastes 23 WASTE CLASSIFICATION & HANDLING DESCRIPTION GUIDANCE 5. Other infectious wastes Disposed of in a hazardous waste incineration plant All healthcare waste known or clinically assessed by a medical practitioner or veterinary/ surgeon to have the potential of transmitting infectious agents to humans or animals. Used disposable bed-pan liners, urine containers, incontinence pads and stoma bags. 24 RESPONSIBILITY OF WASTE GENERATOR • Notify DOE on scheduled waste generated • Waste treated/disposed of at prescribe premises only • Waste rendered harmless before disposal • Reduced waste best practicable means • Ensure waste properly stored, treated, delivered and received 25 RESPONSIBILITY OF WASTE GENERATOR • Use durable and clearly labeled containers • Keep inventory of scheduled waste • Conform with consignment note system • Provide information to transporter on the nature of waste and action to be taken in case of accidents 26 Overview of Clinical Waste Management Services 6 Disposal of final residue 1 Segregation of waste 2 Collection of waste to central store 3 Central storage area 5 Clinical waste incinerator 4 Transported in dedicated trucks 27 RESPONSIBILITY TO SEGREGATE WASTE • Nursing and clinical staff • To ensure segregation at source 28 SEGREGATION • • • • Only clinical waste in yellow bags Seal when three quarters full Do not remove any waste deposited in yellow bags Segregation starts at point of production and continue to disposal • Carried out at source • Do not mix clinical waste and general waste 29 SEALING • Seal must be intact after movement completed • Seal with self-locking tag for bags • Seal when reached intended capacity • Snap-locking flap for sharp boxes • Do not staple 30 LABELLING • all bags/drums/bins must be able to identify its source • labels attached • pre-printed self-adhesive labels • fill in date generated, company name, address & contact number 31 TRANSPORTATION & COLLECTION 32 COLLECTION WITHIN HOSPITAL 33 INSIDE THE HOSPITAL • Minimize the passage through patients areas and clean area • Use waste routes as designated • Use of dedicated vehicle • Cleaning and disinfection 34 COLLECTION OF CLINCAL WASTE • Clinical waste should be removed daily or as needed by unit/department • No bags/containers will be removed unless properly identified, and secure to prevent spillages 35 SMALL FREEZER UNIT If collection of waste from hospital is less frequent than once daily, small freezers will be installed in wards generating large quantities of easily biodegradable clinical waste, such as placenta from labor room 36 REPLACING BAGS • Under no circumstances should yellow bags be replaced by black bags • Bag holders should be clearly identified as either clinical or non-clinical waste • Duty of hospital attendants to immediately replace full sealed bags 37 CENTRAL STORAGE AREA • • • • Clearly identified Locked when access not needed Keys kept by appointed personnel Sited separately from general waste 38 LOCATION • Away from public access • Easily accessible to internal and off-site transport • Away from food preparation and storage area • Well lit, well ventilated • Secure from entry of animals and free from infestation by rodents and insects • Covered area 39 FACILITIES • • • • Washing Equipment and materials to deal with spillages Disinfection of storage areas All waste from cleaning process should drain into the foul sewer 40 STORAGE CAPACITY • • • • Sufficient Minimum of 2 days storage This is for contingency purposes Wherever possible is should be removed daily 41 SPILL OR ACCIDENTAL DISCHARGE • Waste management plan to be followed • Contaminated areas to be cleared and disinfected • Exposure of workers to be limited during operations • Impact on the environment should be limited best possible • Staff are trained and prepared for ERP • Dangerous spill carried out by designated and specially trained personnel 42 METHODS OF DISPOSAL • Landfills • Autoclaving • Microwave • Chemical Disinfecting • Incineration 43 WHY INCINERATION? • Incineration ensures total destruction of organic materials and pathogen present within clinical waste • 95% reduction in weight and volume of clinical waste • Alternatives to Clinical Waste present difficulties in verification of : – Decontamination – Operator hazards – Odorous discharge – Environmental Hazards 44 e-CN Notifikasi Inventori BT Nota Konsainan Electronic Scheduled Waste Information Systems eSWIS Waste Management Process Flow Baseline: DOE establish baseline for reporting of Scheduled Waste SW1: Metal & metal bearing wastes required submit % of residue per waste code % Not Comply inform supported range of waste code & accommodated ranges report waste composition with CN for eligible WR SW2: Wastes containing principally inorganic constituents which may contain metals & organic materials Recovery: Acceptance: WR to Characteristic: WG to SW3: Wastes containing principally organic constituents which may contain metals & inorganic materials Off-site Treatment/ Special management SW4: Wastes which may contain either organic or inorganic constituents Recovery SW5: Other Wastes Repository: all traceable transactions in one source Disposal Eligible: all % Comply % Product % Waste disposal waste to eligible receiver with range(SW5*) HALA TUJU BUANGAN TERJADUAL DI MALAYSIA 48 Hirarki Pengurusan Buangan Terjadual Prevention/Reduction Re-use Disposal Recovery Recycling Recovery SPECIAL WASTE MANAGEMENT Pre Treatment: Incineration/PCT/Solidification Landfilling 49 Hirarki Pengurusan Buangan Terjadual 50 Hirarki Pengurusan Buangan Terjadual 51 Pengurusan Khas Buangan Terjadual 52 Pengurusan Khas Buangan Terjadual 53 PELAN STRATEGIK PASCA 2015 54 Mengandungi 8 strategi utama sebagai bidang keberhasilan utama (KRA) dan menjadi tonggak utama bagi pengurusan Buangan Terjadual negara ke arah kecemerlangan. STRATEGI PENGURUSAN BUANGAN TERJADUAL PASCA 2015 Penekanan kepada 25 teras di dalam memacu kecemerlangan pengurusan buangan terjadual dan bahan berbahaya. STRATEGI PENGURUSAN BUANGAN TERJADUAL PASCA 2015 JAS telah meletakkan lapan strategi utama sebagai bidang keberhasilan utama (KRA) dan menjadi tonggak utama bagi pengurusan Buangan Terjadual negara ke arah kecemerlangan. Dua puluh lima teras dipertanggungjawabkan bagi diberi penekanan di dalam memacu kecemerlangan pengurusan buangan terjadual dan bahan berbahaya. STRATEGI 1: MEMPERKASA DASAR DAN PERUNDANGAN PENGURUSAN BUANGAN TERJADUAL NEGARA 1 2 3 • Teras 1 : Memperkemaskan Dasar Pengurusan Buangan Terjadual • Teras 2 : Memperkasakan Perundangan Pengurusan Buangan Terjadual • Teras 3 : Membangun Dan Membentuk Garispanduan Pengurusan Buangan Terjadual Tujuan: Memperkemaskan dasar pengurusan buangan terjadual, memperkasakan perundangan dan garispanduan pengurusan buangan terjadual ke arah memastikan pengurusan buangan terjadual yang lebih berkesan dan mantap STRATEGI 1: MEMPERKASA DASAR DAN PERUNDANGAN PENGURUSAN BUANGAN TERJADUAL NEGARA TERAS 1: MEMPERKEMASKAN DASAR PENGURUSAN BUANGAN TERJADUAL SKOP: Mempertingkatkan program penguatkuasaan pengurusan buangan terjadual Program Aktiviti Program pembentukkan Kajian keperluan pelan pengurusan buangan Engagement pihak terjadual berkepentingan Sasaran/Pelaksana 2015/JAS/Pengeluar buangan/ pengangkut/ premis penerima Output Outcome Pelan Pengurusan Pengurusan buangan Buangan Terjadual Pasca terjadual yang holistik 2015; Aplikasi prinsip-prinsip Pelan pengurusan pengurusan BT iatu: buangan klinikal; “polluter pay principle, Pelan tindakan precautionary kebangsaan pengurusan principle, extended bahan kimia producer resposibility, Pelan pengurusan E-waste shared responsibility dan environmentally sound management”. Norhazni Mat Sari Hazardous Substances Division Department of Environment Email : [email protected] WHEELED BINS • • • • • • Yellow 240 litres Marked Lockable Contents not man handled after collection Washed and sanitised after each single delivery 60 COLOUR CODE • YELLOW - CLINICAL WASTE FOR INCINERATION • LIGHT BLUE - FOR AUTO CLAVING OR TREATMENT PRIOR TO DISPOSAL • BLACK - GENERAL WASTE 61 62 63 64 65 66 YELLOW CONTAINER • Potentially Infectious Waste Bags (waste materials contaminated or possibly contaminated with body fluids) • Gloves, gowns, masks • Gauze, dressing, swabs • Spatulas • Urine, blood bags • Sump tubes • Suction canisters • Disposable bowls and containers used for medical purposes • Haemodialysis tubing • Intravenous (IV) lines • Foley catheters • Sanitary napkins • Incontinence underpads • Pre-treated highly infections waste, medical laboratories, isolation patients • Nappies, diapers • Human and animal tissued, placentae • Body parts (where permitted by local laws and customs) 67 USED SHARP CONTAINER • • • • • • • Needles Needles and syringe assemblies Lancets Scalpels, blades Scissors, sutures Specimen tables Broken glass, ampoules 68 GENERAL WASTE CONTAINER • • • • • • • Packages, boxes, wrappings Newspapers, magazines Disposable plates, cups, utensils Food, food packaging, drinks containers Tissue, paper towels Flowers Intravenous bottles, packs 69 WHEELED BIN BAG HOLDER 70 SHARPS CONTAINER & PLASTIC BAGS 71 YELLOW BAGS • CLEARLY MARKED “CLINICAL WASTE FOR INCINERATION ONLY” • INTERNATIONAL BIOLOGICAL SIGN 72 INTERNATIONAL BIOHAZARD SIGN 73 LIGHT BLUE BAGS • Bags of waste derived for autoclaving ( or other disinfection treatment) • Should carry an indicator to show whether they have been subjected to this treatment • International symbol for “biological hazard” 74 SHARP CONTAINERS • • • • • • Made of plastic or fibreboard Puncture and resistant proof Handle Aperture Sealing device Capable of being securely closed and remain closed during transportation • Signs “danger sharps only” • “Biological hazard” symbol 75