prolab.eco.brprolab.eco.br/_img/_noticias_arquivos/_noticias_arquivos_3... · volumes between the sharp and cutting waste and other waste, in which it was realized that sharp and

Agradecimentos

RESUMO

per

capita

ABSTRACT

Health home-care service has significantly grown in recent years,

and the development of this therapeutic assistance to patients is

based on the concept of joint action by families and health

professionals, which offers patients a better psycho-affective

support, as well as better life quality (within their limitations), besides

significant cost reduction, and a decrease in the risk of hospital

infections (since patients are removed from hospital microbiotics),

not to mention the rotation of occupied beds in hospitals. Although

the appropriate handling of waste is a recommended procedure,

including of those produced by patients with home-care, enterprises

and professionals offering this kind of assistance do not handle them

correctly, due to financial problems, lack of knowledge or

inappropriate training. Estimates show that the city of São Paulo

may have 7.5 tons/day of potentially infected waste being handled

together with domestic waste simply because there is no appropriate

management of this modality of health care in terms of deject

handling. It is important to evaluate the gravity of this problem of

potentially dangerous waste being added to less dangerous ones,

which consistently increases the inherent dangers in the process. In

face of these questions, in this dissertation a management tool was

discussed and defined; it was also adapted to the conditions of a

dwelling since it was believed that relevant goals both to society

and environment could be reached. As the main results, the

characterization of Solid Waste of Health Care Services RSSS

that are produced during home-care assistance, which allowed a lot

of relevant information, such as the comparison of weights and

volumes between the sharp and cutting waste and other waste, in

which it was realized that sharp and cutting waste represent less

than 0.60%, both in terms of mass and volume. This implies that

waste belonging to Groups A and B is the most significant, since it

represents over 99% of all home waste. It was possible to define a

per capita generation of 2.65kg/day, which is quite similar to what is

produced by hospitals. Waste collecting from every dwelling takes

about 47 minutes, when 18.9km are covered and an average of

109.05 liters are collected. The second significant result was the

elaboration of a Manual of Procedures for the Handling of Home-

care Waste; this manual sets up the minimal conditions for the

different stages of waste handling. It was based on Plan of the

Management of Waste Produced by Health Services PGRSS, and

proposed by (National

Agency for Sanitarian Surveillance) , but adapted to home

conditions. The Manual offers some important contributions, such as

the determination of responsibility of each component in the process

of home-care assistance, in relationship to every action proposed by

Plan for Waste Handling; it defines the minimal conditions for the

different stages of waste storing; it offers some parameters for the

identification of quality of services by third parties; it proposes the

necessary indicators for a possible efficiency management of the

Plan; it emphasizes the imperious need of a separation of medicine

and other supply delivery from the collecting of waste and other

possibly infected materials.

Keywords: Solid Waste, Home-Care, Health Solid Waste

Management Plan, Health Solid Waste, PGRSS.

LISTA DE ILUSTRAÇÕES

LISTA DE ABREVIATURAS E SIGLAS

Diagnosis Related Groups

Environmental Protection Agency

Hepatitis vírus Hepatitis vírus

United Nations Environmental Protection

World Health Organization

SUMÁRIO

13

1 INTRODUÇÃO

lix

residuum

14

15

1.1 Os resíduos sólidos

16

1.2 Os resíduos sólidos e as questões relacionadas à saúde

17

18

19

20

World Health Organization - WHO

21

1.3 Os resíduos sólidos de serviços de saúde

-

-

-

-

-

-

22

23

Salmonela Shigella spp. Vibrio cholerae Mycobacterium

tuberculosis Streptococcus pneumoniae Neisseria gonorrhoeae

Bacillus anthracis Staphylococcus spp. Staphylococcus aureus

Enterococcus Klebsiella Candida albicans

24

Staphylococcus aureus

Pseudomonas aeruginosa.

World

Health Organization

habitat

ORGANISMOS TEMPO DE SOBREVIVÊNCIA

Leptospira interrogans

Mycobacterium tuberculosis

Salmonella Thyphi

Salmonella Parathyphi

Salmonella

Shigella

World Health Organization

25

26

-

-

-

27

-

-

-

-

-

28

29

-

-

-

-

30

-

-

-

31

32

-

-

-

-

-

-

-

33

United

Nations Environmental Protection -

-

-

-

1.4 Aspectos legais e normativos

34

35

36

37

38

39

40

Norma ABNT (no)

Objetivo da Norma

41

-

-

-

-

42

43

44

-

-

-

-

45

-

1.5 A assistência domiciliar no Brasil e no Mundo

46

home-care

47

home- care

48

49

50

Medicare

Medicaid Diagnosis

Related Groups

51

-

-

52

-

-

-

53

Home-

Home-Care

54

55

56

-

-

-

-

57

58

59

2 OBJETIVOS

2.1 Objetivo geral

2.2 Objetivos específicos

60

61

3 MÉTODOS E PROCEDIMENTOS METODOLÓGICOS

62

63

4 GERENCIAMENTO DOS RSSS NO AMBIENTE DOMICILIAR

Environmental Protection Agency

64

Disposal Tips for

Home Health Care

4.1 A geração dos RSSS no domicílio

(home-care)?

65

Home-Care

66

67

68

69

4.2 A periculosidade associada aos RSSS

70

-

-

-

-

71

4.2.1 Indicadores de contaminação ambiental relacionados aos RSSS

72


73

ESCALA DE PESOS CONDIÇÃO ATRIBUÍDA

74

Grupo de microrganismos Etiopatogenia Doenças

Escherichia coli

Pseudomonas aeruginosa

Clostridium



75

Microrganismos patogênicos

Forma ou estágio de resistência ambiental

Dose infectante1

Escherichia coli

Clostridium perfringens



76

Indicador de Contaminação

Ambiental Critério

Descrição do critério Importância

(peso)

Mycobacterium

Tuberculosis

Staphylococcus

Aureus

Clostridium

Botulinum

77

Indicador deContaminação

Ambiental

Critério (importância) Descrição do critério

Importância(peso)

Escherichia coli

Clostridium

Perfringens Habitat

78

Indicador deContaminação

AmbientalCritério Descrição do critério

Importância(peso)

Escherichia coli

79

Staphylococcus

Aureus

Pseudomonas

Aeruginosa Habitat

80

Mycobacterium tuberculosis:

-

-

-

-

-

-

E. coli

-

81

-

Clostridium perfringens

-

-

-

-

-

-

-

82

-

4.3 O Plano de Gerenciamento de Resíduos de Serviços de Saúde

83

84

85

86

87

88

5 RESULTADOS E DISCUSSÃO

89

5.1 A caracterização dos RSSS na assistência domiciliar

90

91

92

93

(*)

(= 2

.326

) (=

1.9

92)

(= 7

82.2

12)

(= 1

.944

.296

) (=

41.

233)

(=

5.3

57)

(= 6

95)

(= 8

9.42

5)

(= 4

.496

.356

) (=

363

.093

)

782.

212)

1.94

4.29

6)

41.2

33)

5.35

7)

695)

89.4

25)

4.49

6.35

6)

363.

093)

(*

) Obs

erva

ções

:

94

95

96

-

-

5.2 Manual de procedimentos para o manejo de resíduos na assistência domiciliar

97

98

99

100

101

102

103

6 CONCLUSÕES E RECOMENDAÇÕES

104

105

106

REFERÊNCIAS

Vigilância sanitária e meio ambiente harmonizam ações

NBR10004:

NBR 12807

NBR 12808

NBR 12809

NBR 12810

NBR 7500

Espaço para Saúde

Saúde em Debate

Resíduos sólidos provenientes de coletas especiais:

Conceitos básicos de resíduos sólidos.

107

Emission of viable bacteria in the exhaust flue gases from a hospital incinerator Journal Hops Infect.

Constituição da República Federativa do Brasil

Home-Care

Diário Oficial da União

108

Diário Oficial da República Federativa do Brasil

Gerenciamento de resíduos de serviços de saúde.

Saúde ambiental e gestão de resíduos de serviços de saúde.

Diário Oficial da República Federativa do Brasil

Diário Oficial da República Federativa do Brasil,

Diário Oficial da República Federativa do Brasil,

109

Home-Care

110


home- careRevista Home Care

Ecologia aplicada ao saneamento ambiental

Anais...

Guia para o manejo interno de resíduos sólidos em estabelecimentos de saúde

Metodologia científica

ENVIRONMENTAL PROTECTION AGENCY Disposal tips for home health care December

______ Medical waste management in the United States: second interim report to congress executive summary.

Infecção hospitalar e suas interfaces na área da saúde.

111

Caderno de Saúde Pública,

Helminthological and microbiological analyses of municipal waste of the city of Ladz as the criteria for evaluation of the rate of environmental pollution. Wiad Parazytol.

Como elaborar projetos de pesquisa

Anais

112

Pesquisa de informações básicas municipais

home-careRevista Medicis, Cultura, Ciência e Saúde

Proposals on the management of the wastes from the home health care. The Japanese Journal of Clinical Pathology. Supplement May

Revista de Saúde Pública

Preservação e conservação de recursos hídricos.

Las aguas subterráneas: un valioso recurso que requiere protección.

Revista de Administração em Saúde

.

Observatório de Recursos Humanos em Saúde no Brasil

O trabalho da enfermeira no serviço de assistência domiciliar:

113

Saneamento ambiental

Revista Brasileira de Home-Care

Gerenciamento de resíduos de serviços de saúde

Lixo:

Uma história da saúde pública.

Caracterização gravimétrica e físico-química dos resíduos sólidos domiciliares do Município de São Paulo - 2003

114

Informações sobre coleta, transporte e tratamento de RSSS e sobre home-care no Município de São Paulo

Produção e características do chorume em processo de decomposição de lixo urbano

Manual de gerenciamento de resíduos sólidos de serviços de saúde.

Caderno de Saúde Pública,

Estatísticas Totallix.

Estatísticas Totallix.

Fármacos & Medicamentos

Decomposition of deciduous leaf letter in a Woodland Stream: a seanning electron microscopic stud. Microbiol. Ecol

Saneamento, saúde e

115

ambiente

Trabalhadores de saúde e meio ambiente

Revista Brasileira de Saúde Ocupacional,

Home Health CareRevista de Administração em Saúde

Meio ambiente

Folha de São Paulo

WORLD HEALTH ORGANIZATION. Management waste from hospital Report Bergin Euro Reports and Studies

______. Water, sanitation and hygiene links to health. Facts and figures

116

APÊNDICE

Manual de Procedimentos para o Manejo de Resíduos na Assistência Domiciliar

117

RESUMO

118

119

ABSTRACT

Health home-care service has significantly grown in recent years,

and the development of this therapeutic assistance to patients is

based on the concept of joint action by families and health

professionals, which offers patients a better psycho-affective

support, as well as better life quality (within their limitations), besides

significant cost reduction, and a decrease in the risk of hospital

infections (since patients are removed from hospital microbiotics),

besides the rotation of occupied beds in hospitals. Although the

appropriate handling of waste is a recommended procedure,

including of those produced by patients with home-care, enterprises

and professionals offering this kind of assistance do not handle them

correctly, due to financial problems, lack of knowledge or

inappropriate training. Estimates show that the city of São Paulo

may have 7.5 tons/day of potentially infected waste being handled

together with domestic waste simply because there is no appropriate

management of this modality of health care in terms of waste

handling. It is important to evaluate the gravity of this problem of

potentially dangerous waste being added to less dangerous ones,

which consistently increases the inherent dangers in the process. In

face of these questions, the elaboration of a Manual of Procedures

for the Handling of Home-care Waste was advisable; this manual

sets up a series of procedures for the safe handling of waste, and is

based on the Plan for the Management of Health Care Waste

PGRSS, issued by the National Agency of Sanitarian Surveillance

, but adapted to home-care. The Manual offers some

120

important contributions, such as: the determination of responsibility

for each component of the home-care process in terms of every

action proposed by the Plan for Waste Handling; it sets up the

minimal conditions for the different stages of waste handling; it

proposes some parameters for the identification of quality of

services by third parties; it proposes indicators for the possibility of

efficiency management of the Plan; it indicates the imperious need

of a separation of medicine and other supply delivery from waste

collecting and other possibly infected materials.

Keywords: Solid Waste, Home-Care, Health Solid Waste Management Plan, Health Solid Waste, PGRSS.

121

LISTA DE ILUSTRAÇÕES

per capta

122

SUMÁRIO

123

APRESENTAÇÃO

124

125

126

1 RESÍDUOS SÓLIDOS DE SERVIÇOS DE SAÚDE

1.1 Definição

1.2 Geradores de RSSS

inclusive os serviços de assistência domiciliar

127

1.3 Classificação dos RSSS

128

129

130

131

2 GERENCIAMENTO DOS RESÍDUOS SÓLIDOS DE SERVIÇOS DE SAÚDE

-

-

-

132

-

-

133

-

-

-

-

134

-

-

-

-

-

-

-

-

-

2.1 Planejamento

135

-

136

-

-

2.2 Responsabilidades

-

-

137

-

-

-

-

-

138

ETAPAS RESPONSÁVEIS(*)

* (1) (2) (3) (4)(5) (6) (7)

Processose

Procedimentos

Minimizaçãoe

Redução

Geraçãodos

RSSS

Acondicionamento e

Identificação

Coleta internae

Transporte interno

Tratamentoe

Disposição final

Coleta externae

Transporte externo

(2) e/ou (3)

(1) + (6) + (7)

(1) + (5)

(2) e/ou (3)

(2) e/ou (3)

(2) e/ou (3)

(1) + (2) + (3) + (4)

Classificaçãoe

Segregação

Armazenagem

139

3 PLANO DE MANEJO

3.1 Segregação de resíduos

140

141

3.2 Acondicionamento

-

-

-

142

-

-

-

-

-

-

-

-

143

-

-

144

145

3.3 Identificação

-

-

-

-

-

146

3.4 Coleta e Transporte interno

-

-

-

147

-

-

-

-

-

-

3.5 Armazenamento temporário e Tratamento interno

148

3.6 Armazenamento

-

-

-

-

-

149

150

3.7 Coleta e Transporte externo

-

-

-

-

151

-

-

-

-

-

-

-

-

-

152

3.8 Tratamento externo e Disposição final

-

-

-

153

-

154

4 CONSIDERAÇÕES FINAIS

4.1 Educação, capacitação e sensibilização

-

-

-

-

155

-

-

-

-

-

-

-

-

-

-

-

4.2 Prestadores de serviços externos

156

157

158

-

-

-

-

-

-

-

4.3 Melhoria contínua do Plano de Manejo

159

-

-

-

-

-

-

-

-

-

160

-

-

-

-

-

161

per capta

162

per capta

163

5 PRINCIPAIS LEGISLAÇÕES APLICÁVEIS

-

-

-

-

-

-

-

164

-

-

-

-

-

-

-

-

-

-

165

-

-

-

-

-

-

-

-

166

-

-

-

-

-

-

-

167

REFERÊNCIAS

NBR 10004

NBR 12809

NBR 12810

NBR 7500

Resíduos sólidos provenientes de coletas especiais:

Conceitos básicos de resíduos sólidos.


Saúde ambiental e gestão de resíduos de serviços de saúde.

168

Plano de gerenciamento de resíduos de serviço de saúde

Manual de resíduos hospitalares.

Gerenciamento de resíduos de serviços de saúde

Engenharia Sanitária e Ambiental

169

Diário Oficial do Estado de São Paulo

Diário Oficial do Estado de São Paulo

Resíduos sólidos de serviços de saúde gerados durante a internação domiciliar: da classificação à disposição final.

Manual de gerenciamento de resíduos sólidos de serviços de saúde.

Trabalhadores de saúde e meio ambiente

Saneamento, saúde e ambiente

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prolab.eco.brprolab.eco.br/_img/_noticias_arquivos/_noticias_arquivos_3... · volumes between the sharp and cutting waste and other waste, in which it was realized that sharp and