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
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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
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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
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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 : nhz@doe.gov.my
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