Disposal of Waste from Injection Room

Park's Textbook of PSM - Bio-Medical Waste Management Rules 2016

Background

Definition (BMW Rules 1998/2016): "Any waste generated during diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production or testing of biologicals."

Waste Generated from an Injection Room

DIAGRAM 1 - Colour-Coded Categories for Injection Room Waste

Colour-Coded Classification (BMW Rules 2016 - TABLE 3, Schedule 1)

*Deep burial only in rural or remote areas where incineration/plasma pyrolysis not available.

DIAGRAM 2 - Step-by-Step Disposal Process

Step-by-Step Disposal Process

• Done at the point of generation - right at the injection tray
• Place each waste in the correct colour-coded bag/container immediately
• Never mix categories

• Bags/containers should never be filled beyond ¾ capacity
• Must be tied and labelled with the biohazard symbol (☣)
• Waste should be transported off-site within 48 hours

• Each bag/container must carry: biohazard symbol, category of waste, date of generation, name of health facility

• Closed wheeled trolleys/carts - not by hand
• Not mixed with general hospital waste during transport

Key Points for Needles (Sharps) - HIGH YIELD

Hazards from Sharps/Injection Waste (Health Hazards)

1. Needle-stick injuries - causing transmission of HIV, HBV, HCV
2. Scavenging-related injuries - to waste-pickers/sanitation workers
3. Re-use of syringes - if not properly destroyed, risk of disease transmission (hepatitis, HIV)
4. Environmental contamination - if improperly disposed

"Sharps, such as needles and lancets, account for approximately 1% of health-care waste but represent the greatest risk because of their capacity to cause injury and transmit infection." - Park's SPM

Summary Mnemonics

• Yellow = anatomical/soiled/chemical (burn/bury)
• Red = recyclable plastic/soft items (autoclave + recycle)
• White = sharp items (autoclave + mutilate)
• Black = general, non-hazardous (municipal)

1. Reduce waste generation
2. Reuse (only where safe)
3. Treat by safe, environmentally sound methods
4. Dispose residue by landfill in confined, carefully designed sites

Rapid Sand Filtration

Park's Textbook of Preventive and Social Medicine

Introduction

• Gravity type - e.g., Paterson's filter
• Pressure type - e.g., Candy's filter

DIAGRAM 1 - Flow Diagram of a Rapid Sand Filtration Plant (Park's Fig. 6)

Steps in Purification (5 Steps - HIGH YIELD)

Step 1 - COAGULATION

• Raw water is treated with alum (aluminium sulphate)
• Dose: 5 to 40 mg/litre (depends on turbidity, colour, temperature, pH)
• Alum dissociates to form aluminium hydroxide Al(OH)₃

Step 2 - RAPID MIXING

• Treated water undergoes violent agitation in a mixing chamber for a few minutes
• Ensures quick and thorough dissemination of alum throughout the water

Step 3 - FLOCCULATION

• Slow, gentle stirring in a flocculation chamber for ~30 minutes
• Mechanical flocculator with paddles rotating at 2-4 rpm
• Forms a thick, white flocculant precipitate of aluminium hydroxide
• Larger floc diameter = greater settling velocity

Step 4 - SEDIMENTATION

• Coagulated water flows into sedimentation tanks
• Detained for 2 to 6 hours
• Flocculent precipitate + impurities + bacteria settle at the bottom
• At least 95% of flocculant precipitate must be removed before entering rapid sand filter
• Sludge at bottom is removed periodically

Step 5 - FILTRATION (through rapid sand filter)

• Partly clarified water passes through the rapid sand filter bed
• The remaining alum-floc (not removed by sedimentation) is held back on the sand bed
• This forms a slimy layer comparable to zoogleal layer in slow sand filter
• Adsorbs bacteria; oxidation of ammonia also occurs
• When "loss of head" reaches 7-8 feet → filter stops, backwashing begins

DIAGRAM 2 - View of Rapid Sand Filter Unit (Park's Fig. 7)

DIAGRAM 3 - Cross-section of Filter Bed (Park's Fig. 5)

Structure of Filter Bed

Backwashing (KEY FEATURE of Rapid Sand Filter)

• Filters become clogged as filtration proceeds
• When loss of head = 7-8 feet → filtration stopped
• Backwashing: Flow of water is reversed through the sand bed
• Dislodges impurities and cleans the sand bed
• Washing stopped when clear sand is visible and wash water is sufficiently clear
• Duration: ~15 minutes
• Frequency: daily or weekly (depending on loss of head)
• Some filters use compressed air as part of backwashing

Comparison: Rapid Sand Filter vs. Slow Sand Filter (TABLE 3, Park's)

Note: Slow sand filter removes bacteria better, but rapid sand filter is faster and occupies less space.

Advantages of Rapid Sand Filter (over Slow Sand Filter)

1. Can deal with raw water directly - no preliminary storage needed
2. Filter beds occupy less space
3. Filtration is rapid - 40-50 times faster than slow sand filter
4. Easy washing (backwashing)
5. More flexibility in operation

Key Numbers to Remember (HIGH YIELD)

PART 1: National Mental Health Programme (NMHP) & Mental Healthcare Act 2017

Park's Textbook of PSM - 6 Marks

National Mental Health Programme (NMHP)

AIMS of NMHP (3 Aims)

OBJECTIVES of NMHP (3 Objectives)

1. To ensure availability and accessibility of minimum mental health care for all, particularly for the most vulnerable and underprivileged sections of population
2. To encourage application of mental health knowledge in general health care and in social development
3. To promote community participation in mental health services development and to stimulate efforts towards self-help in the community

PROGRAMME STRATEGIES

1. Integration of mental health with primary health care through NMHP
2. Provision of tertiary care institutions for treatment of mental disorders
3. Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority and State Mental Health Authority

DISTRICT MENTAL HEALTH PROGRAMME (DMHP) - Components

DMHP - Promotive & Preventive Activities (Added in Recent Years)

THRUST AREAS of NMHP

1. District mental health programme in enlarged and more effective form covering entire country
2. Streamlining/modernization of mental hospitals - modify their present custodial role
3. Upgrading departments of psychiatry in medical colleges; enhancing psychiatric content of curriculum at UG and PG level
4. Strengthening Central and State Mental Health Authorities with permanent secretariat
5. Research and training in community mental health, substance abuse, and child-adolescent psychiatric clinics

The MENTAL HEALTHCARE ACT, 2017 (HIGH YIELD)

• India ratified the UN Convention on Rights of Persons with Disabilities - making it obligatory to align laws with the convention
• Mental Healthcare Bill 2013 introduced in Parliament to protect and promote rights of persons with mental illness
• Received assent of President of India on 07.04.2017

Key Provisions:

• Protect and promote rights of persons with mental illness during delivery of health care
• Ensure treatment and rehabilitation in the least restrictive environment possible
• Regulate public and private mental health sectors within a rights framework
• Suicide has been DECRIMINALIZED under the Act (most high-yield point)
• Achieve greatest public health good - principles of equity, efficiency, active participation

PART 2: Community Mental Health Problems

Park's Textbook of PSM - 6 Marks

Magnitude of the Problem (National Mental Health Survey 2015-16)

Key Findings:

DIAGRAM - Prevalence of Mental Disorders in India (Park's Fig. 1)

Types/Classification of Community Mental Health Problems

ICD-10 Classification of Mental & Behavioural Disorders:

Simply - Major vs Minor Mental Illness:

1. Schizophrenia - split personality, lives in a dream world
2. Manic Depressive Psychosis - heights of excitement to depths of depression
3. Paranoia - extreme suspicion, progressive delusions

• (a) Neurosis/Psychoneurosis - patient NOT insane but unable to react normally; morbid fears, compulsions, obsessions
• (b) Personality & Character Disorders - legacy of unfortunate childhood experiences

Causes of Mental Ill-Health (Agent-Host-Environment Model)

• Toxic substances (mercury, lead, manganese)
• Psychotropic drugs (barbiturates, alcohol)
• Nutritional deficiencies (thiamine, pyridoxine, iodine)
• Infective agents during prenatal/perinatal period (measles, rubella)
• Traumatic factors (road accidents)
• Radiation

Burden of Mental Illness

• Mental illness accounts for 11% of all years lived with disability globally
• Economic impact: Global lost output estimated at US$ 16.3 trillion (2011-2030)
• Mental disorders frequently lead to poverty, homelessness, inappropriate incarceration
• Stigmatization and discrimination lead to violation of human rights
• Economic impact in India: median monthly expenditure INR 1000-2500

Community Mental Health Services (Components)

1. Early diagnosis and treatment
2. Rehabilitation
3. Group and individual psychotherapy
4. Mental health education
5. Use of modern psychoactive drugs
6. After-care services

Comprehensive Community Mental Health Programme

"Since 95% of psychiatric cases can be treated with or without hospitalization close to their homes, the current trend is full integration of psychiatric services with other health services." - Park's SPM

Essential Elements:

PART 1: National Mental Health Programme (NMHP) & Mental Healthcare Act 2017

Park's Textbook of PSM - 6 Marks

National Mental Health Programme (NMHP)

AIMS of NMHP

OBJECTIVES of NMHP

PROGRAMME STRATEGIES

DISTRICT MENTAL HEALTH PROGRAMME (DMHP) - Components

DMHP - Promotive & Preventive Activities (Added in Recent Years)

• School mental health services: Life skills education in schools, counselling services
• College counselling services: Through trained teachers/counsellors
• Workplace stress management: Formal & informal sectors, including farmers, women etc.
• Suicide prevention services: Counselling centre at district level, sensitization workshops, IEC, help lines etc.

THRUST AREAS of NMHP

The Mental Healthcare Act, 2017 (HIGH YIELD)

• Protect and promote the rights of persons with mental illness during delivery of health care
• Ensure treatment and rehabilitation of persons with mental illness in the least restrictive environment possible
• Regulate the public and private mental health sectors within a rights framework
• Achieve the greatest public health good and promote principles of equity, efficiency and active participation of all stakeholders in decision making

KEY HIGH-YIELD POINT: Suicide has been DECRIMINALIZED under the Act.

PART 2: Community Mental Health Problems

Park's Textbook of PSM - 6 Marks

Magnitude - National Mental Health Survey (NMHS) 2015

Key findings of the survey:

DIAGRAM - Prevalence of Mental Disorders in India (Park's Fig. 1)

Types of Mental Illness

ICD-10 Classification of Mental & Behavioural Disorders

• Organic, including symptomatic, mental disorders - e.g., dementia in Alzheimer's disease, delirium
• Mental and behavioural disorders due to psychoactive substance use - e.g., harmful use of alcohol, opioid dependence syndrome
• Schizophrenia, schizotypal and delusional disorders - e.g., paranoid schizophrenia, delusional disorders, acute and transient psychotic disorders
• Mood (affective) disorders - e.g., bipolar affective disorder, depressive episode
• Neurotic, stress-related and somatoform disorders - e.g., generalized anxiety disorders, obsessive-compulsive disorders
• Behavioural syndromes associated with physiological disturbances - e.g., eating disorders, non-organic sleep disorders
• Disorders of adult personality and behaviour - e.g., paranoid personality disorder, trans-sexualism
• Mental retardation
• Disorders of psychological development
• Behavioural and emotional disorders with onset usually occurring in childhood - hyperkinetic disorders, conduct disorders, tic disorders

Causes of Mental Ill-Health

• (1) Toxic substances - carbon disulfide, mercury, manganese, tin, lead compounds
• (2) Psychotropic drugs - barbiturates, alcohol, griseofulvin
• (3) Nutritional factors - deficiency of thiamine, pyridoxine
• (4) Minerals - deficiency of iodine
• (5) Infective agents - infectious disease (e.g., measles, rubella) during the prenatal, perinatal and post-natal periods
• (6) Traumatic factors - road and occupational accidents
• (7) Radiation - nervous system is most sensitive to radiation during the period of neural development

Burden of Mental Illness

Community Mental Health Services

Comprehensive Community Mental Health Programme