感染性事業廢棄物處理過程 之安全衛生問題 謝賢書 長榮大學職業安全與衛生學系 2018/11/23

前言 AIDS in 1980s An accident, children playing with vials of blood, in Marion, Indiana, 1987 Sharps in Eastern shore beach in summer, 1988 2018/11/23

前言 The expert panel held by EPA, concluded that community exposures to infectious waste were isolated incidents; the primary risk was occupational MWTA signed into law on Nov. 11, 1988 Medical waste poses no threat to public by Agency for Toxic Substance and Disease Registry, June, 1990 2018/11/23

紛歧之研究調查結果 Domestic waste contains more organisms than found routinely in clinical waste Data on infectious arising from exposure to other forms of clinical waste are lacking The risk of transmission of hepatitis B infection from sharps discarded in the community is low and the risk from HIV is even less. Journal of Hospital Infection, 1999, 41:1-6 2018/11/23

紛歧之研究調查結果 Archives of Family Medicine, 2000, 9(1):26-29 Household waste has been found to contain more microorganisms with pathogenic potential for humans on average than medical waste there is also no evidence that a member of the public or a waste industry worker has ever acquired an infection from medical waste, although injuries have been reported the only medical waste that has been associated with infectious disease transmission is contaminated sharps. Archives of Family Medicine, 2000, 9(1):26-29 2018/11/23

紛歧之研究調查結果 Studies on the bacterial content of hospital waste appear to indicate that it is not a very good culture medium for pathogens and disease transmission Journal of Hospital Infection, 2003, 55:260-268 2018/11/23

紛歧之研究調查結果 American Journal Infection Control, 2001, 29, 198-202 Studies have demonstrated that medical waste poses virtually no infectious hazard to the public American Journal Infection Control, 2001, 29, 198-202 2018/11/23

紛歧之研究調查結果 “10 to 10,000 times less microbially contaminated than household waste” Kalnowsky, 1983 Waste from surgical suites or ICU is no more contaminated than household waste 2018/11/23

紛歧之研究調查結果 The first document on transmission of tuberculosis from occupational exposure to infectious medical waste JAMA, 2000, vol 284, no 13,1683-1688 2018/11/23

紛歧之研究調查結果 Identify HBV as an occupational risk for healthcare and related occupation workers. Argue that they should be vaccinated against hepatitis B. Infection Control Hospital Epidemiology, 1999, 20: 591-2 2018/11/23

紛歧之研究調查結果 The risks have so far been only poorly investigated. Healthcare waste is a reservoir of potentially harmful microorganisms which can infect hospital patients, healthcare workers, and the general public, says the WHO. The Lancet, 2002, 359, 56 2018/11/23

US Regulations Medical Waste Tracking Act by EPA, 1989, not reauthorized. Blood-borne Pathogens Standard by OSHA, 1990, requirements for handling, storage, and labeling 2018/11/23

US Regulations Hazardous Materials Regulation by DOT, 1991, packaging, labeling and documentation Accreditation requirements for healthcare settings by JCAHO, 1995, require written plan, goals and performance standards for waste management 2018/11/23

US Regulations Biosafety in Microbiological and Biomedical Laboratories by CDC and NIH, 1999 Requirments for waste decontamination when working with human pathogens Guidelines for Research Involving Recombinant DNA Molecules by NIH, 2001 Requirments for waste decontamination when working with genetically modified organisms, including plants 2018/11/23

感染性廢棄物管理 1. 感染性廢棄物之定義 2. 感染性廢棄物之種類 3. 感染性廢棄物處理計畫 4. 血液病源菌標準 2018/11/23

感染性廢棄物之定義 名稱混淆 medical waste, regulated medical waste biohazard waste, isolated waste infectious waste, potentially infectious waste clinical waste (UK) 定義 Center for Disease Control (CDC) the American Hospital Association (AHA) EPA Congress states 2018/11/23

醫療廢棄物 一般廢棄物 可燃 不可燃 資源回收 有害廢棄物 化學性 放射性 感染性 感染性廢棄物 可分為可燃及不可燃 2018/11/23

感染性廢棄物管理 1. 感染性廢棄物之定義 2. 感染性廢棄物之種類 3. 感染性廢棄物處理計畫 4. 血液病源菌標準 2018/11/23

感染性廢棄物之種類 廢棄之感染性培養物、菌株及相關生物製品 病理學廢棄物 血液廢棄物 廢棄物之尖銳器具 受污染之動物屍體、殘肢、用具 手術或驗屍廢棄物 實驗室廢棄物 透析廢棄物 隔離廢棄物 其他經中央主管機關會同目的事業主管機關認定對人體或環境具危害性，並經公告者 2018/11/23

廢棄之感染性培養物、菌株及相關生物製品 2018/11/23

血液廢棄物 廢棄之人體血液或血液製品，包括血清、血漿及其他血液組成分 2018/11/23

病理學廢棄物 指手術或驗屍取出之組織、器官、 殘肢等 2018/11/23

廢棄物之尖銳器具 指於醫學、研究或工業等實驗室中，或用於醫護行為曾與感染物質接觸而廢棄之尖端器具，包括注射針頭、注射筒、輸液導管、手術刀或曾與感染性物質接觸之破裂玻璃器皿等 2018/11/23

受污染之動物屍體、殘肢、用具 指於研究生物製品製造、藥品實驗等過程接觸感染性物質，包括經檢疫後廢棄或因病死亡之動物屍體、殘肢或用具等 2018/11/23

手術或驗屍廢棄物 指使用於醫療、驗屍或實驗行為而廢棄 之具有感染性之衣物、紗布、覆蓋物、導尿管、排泄用具、褥墊、手術用手套 指使用於醫療、驗屍或實驗行為而廢棄 之具有感染性之衣物、紗布、覆蓋物、導尿管、排泄用具、褥墊、手術用手套 2018/11/23

實驗室廢棄物 指於醫學、病理學、藥學、商業、工業、農業、檢疫或其他研究實驗室中與感染性物質接觸之廢棄物，包括抹布、蓋玻片、手套、實驗衣、口罩等 2018/11/23

透析廢棄物 指進行血液透析時與具感染性病人血液接觸之廢棄物，包括導管、濾器、手巾、床單、手套、口罩、實驗衣等 2018/11/23

隔離廢棄物 指罹患傳染性疾病須隔離之病人或動物之血液、排泄物、分泌物或其污染之廢棄物 2018/11/23

感染性廢棄物定義之比較 1.Microbiological (e.g., stocks and cultures) Type of Watse AHA CDC IOWA EPA MWTA 1.Microbiological (e.g., stocks and cultures) Yes 2.Blood and Blood Products 3.Pathological(e.g., tissues) 4.Sharps(used) 5.Communicable Disease Isolation (CDC Class 4) No 6.Contaminated Animal Carcasses 7.Other Isolation 8.Contaminated Lab Waste Optional(1) Yes(2) 9.Surgery and Autopsy Waste 10.Dialysis Waste 11.Contaminated Equipment 12.Sharps(Unused) 2018/11/23

感染途徑之五項因素 病原菌存在(pathogen) 足夠之病毒(virulence) 病菌之致病劑量(dose) 侵入口(a portal of entry) 宿主之體質(resistance of the host 2018/11/23

感染性廢棄物管理 感染性廢棄物管理 1. 感染性廢棄物之定義 2. 感染性廢棄物之種類 3. 感染性廢棄物處理計畫 4. 血液病源菌標準 1. 感染性廢棄物之定義 2. 感染性廢棄物之種類 3. 感染性廢棄物處理計畫 4. 血液病源菌標準 2018/11/23

感染性廢棄物管理處理計畫 目的 提供醫療人員、實習生與訪客安全的環境 依據法規妥善管理感染性廢棄物 2018/11/23

感染性廢棄物管理處理計畫 感染性廢棄物之處理(包裝、滅菌、儲存及移除) 感染性廢棄物之運送 意外應變計畫 教育訓練 稽核計畫 書面作業程序及相關記錄 管理計畫 (含管理階層之承諾) 2018/11/23

包裝處理感染性廢棄物 正確分類及適當分離 不正確分類 減少廢棄物處理過程產生危害 推廣減廢運動中最有效的手段危害最大 將非感染性廢棄物丟置於感染性收集容器 將尖銳廢棄物置於非感染性廢棄物收集容器 將不可燃廢棄物丟置於可燃廢棄物收集容器 廢棄玻璃瓶若仍有殘餘液體 2018/11/23

包裝處理感染性廢棄物 處理感染性廢棄物時必須以紅色塑膠袋包裝 所有經滅菌程序之紅色塑膠袋須雙層塑膠袋包裝 廢棄物勿裝超過塑膠袋容量之三分之二 所有紅色塑膠袋須標示名稱、產出地點、聯絡電話及內容物 勿擠壓內容物 2018/11/23

包裝處理特別規定 實驗室須有分別承裝污染及非污染破裂玻璃器皿之容器 易碎或破裂之玻璃器具須放至於實驗室中承裝廢棄玻璃容器 受污染之血清試管須用容器承裝以免穿透塑膠袋，並經高壓滅菌處理 2018/11/23

感染性廢棄物之運送儲存 收集使用之推車應有頂蓋密閉 感染性及非感染性廢棄物應由不同推車分別收集 推車則應定期清洗、消毒 收集廢棄物之推車應行經事先規劃之清運路線 清運之路線及指定之電梯則應定期消毒。 2018/11/23

感染性廢棄物之運送儲存 無須高壓滅菌之感染性廢棄物應存放於儲存櫃 將標示清楚之紅色塑膠袋置於儲存櫃 儲存櫃須上鎖 2018/11/23

重複使用廢棄物之運送儲存 將遭污染之可重複使用器具如燒杯、試管等置於特定位置之小推車內 為確保遭污染器具之安全，下午4時後勿再拿出 2018/11/23

洩漏之處理應變 立即通知相關人員(如標示於儲存櫃之處理人員) 洩漏處理箱應放置於一固定地方以利及時處理 處理人員須受過相關訓練，須配帶相關防護設施 2018/11/23

感染性廢棄物冷藏設施 部分醫療院所之冷藏設施設在地下室 儲存設施應定期清洗，排水之管道應接至院內廢水處裡系統 良好通風為安全衛生之基本要求 其緊急應變措施需考慮停電、淹水之可能性 可行替代方案 儲存設施應定期清洗，排水之管道應接至院內廢水處裡系統 良好通風為安全衛生之基本要求 有些醫療院所將滅菌設備及冷藏設施共置一處，須注意電器安全 考量消防設施是否足以應付意外事故。 2018/11/23

醫療廢棄物之運送 過程應有嚴謹之規劃及書面文件 清運車子應有定期保養計畫 運送過程若發生意外事故 包括於固定時間抵達業主處載運 行走固定路線，避免行經交通擁擠，人煙稠密，或交通意外事故頻繁之路段 清運車子應有定期保養計畫 避免清運車拋錨，引起公眾注意 運送過程若發生意外事故 駕駛員或隨車人員知悉判斷情節輕重，即時通知業主，啟動緊急應變措施。 2018/11/23

減廢之定義 產源減量：減量的方法 分類：清楚分類感染性廢棄物與非感染性廢棄物 減量：減少廢棄物產生 工程控制：使用減廢方法(如使用小容器承裝) 2018/11/23

減廢實例 Disposal of regulated medical waste is a major expense of hospitals A major obstacle in cutting costs is the lack of a universally accepted definition of infectious waste All hospitals can reduce their infectious waste stream through better waste segregation. 2018/11/23

減廢實例 DHC produced 1163 kg/day of infectious waste in 1991, 31% was plastic and nearly 41% was paper. As waste segregation program was fully implemented by December 1992, the infectious waste was reduced to 407 kg/day － a reduction of 65% from 1991. Incinerator operation was reduced from daily to 3 days a week. 2018/11/23

減廢實例 Several sharps turned up in the infectious waste bags. A large number of disposable laparoscopic forceps, scissors, staplers, and clips were discarded. Unserviceable stainless steel instruments were discarded. Pressurized aerosol cans containing flammable materials were found in infectious bags. Disposable suction canisters full of blood and body fluids were found in plastic bags. 2018/11/23

減廢實例 Plastic IV bottles and IV lines are not normally infectious and can be disposed of as ordinary waste. Some of the paper（33%）was blue wrapping material for sterilized instrument sets. This can be discarded as ordinary waste. Glass bottles and aluminum cans should be discarded as ordinary waste. 2018/11/23

減廢實例 A expected trend was the increasing percentage of plastic material while the paper was decreasing. A shortage of trained and technically competent personnel for reprocessing. A reduction of 70% infectious waste between 1991 and 1999 from 2.8 kg patient/day to 0.85 kg patient/day 2018/11/23

非感染性廢棄物 擦手紙 小刀片外套包裝 針頭外套包裝 手套 紙箱 紙類 試管 food wrappers 擦手紙  小刀片外套包裝  針頭外套包裝 手套 紙箱 紙類 試管 food wrappers pop cans (can be recycled in the blue bins) 2018/11/23

感染性廢棄物管理 1. 感染性廢棄物之定義 2. 感染性廢棄物之種類 3. 感染性廢棄物處理計畫 4. 血液病源菌標準 2018/11/23

血液病原菌標準 Blood-borne Pathogens Standard, by OSHA, 1990 血液性病原菌是指帶有具致病之病菌的人體血液，包括細菌與病毒，如B型肝炎病毒和AIDS病毒 美國職業安全衛生協會之暴露控制計畫 2018/11/23

血液病原菌標準 防護措施:所有人類血液及血液製品均視為污染物 2018/11/23

血液病原菌標準 實驗室中嚴禁進食、抽煙、化妝及配戴隱形眼鏡 No mouth pipetting; use pipetting device 廢棄物妥善處理 依危害程度著適合之防護裝備並使用屏障防止暴露 2018/11/23

安全衛生管理 風險認知 態度行為 系統 制度 2018/11/23

謝謝大家、敬請指教 2018/11/23