Post on 14-Apr-2017
BIOMEDICAL WASTE MANAGEMENT
Dr. Sayantan Mondal
Overview : Definition Extent of Problem , Need, Present practices BMW Management Rules and application, categories of BMW segregation,Transport & storage Treatment & Disposal Authorization, Reporting of Accidents BMW management Committee Take Home Message
Points to be discussed …………
What is Biomedical Waste?
Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I;
Biologicals" means any preparation made from organisms or micro-organisms or product of metabolism and biochemical reactions intended for use in the diagnosis, immunisation or the treatment of human beings or animals or in research activities pertaining thereto;
Specific to hospitals Bio-medical waste is defined as waste that is generated during the diagnosis, treatment or immunization of human beings and are contaminated with patient’s body fluids (such as syringes, needles, ampoules ,organs and body parts, placenta, dressings, disposables plastics and microbiological wastes).
Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use
Medical waste: refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals
4
Definition
Infectious waste: are the portion of medical waste that could transmit an ‘infectious disease’.
Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.
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Definition
Government/private hospitals Nursing homes Physician/dentist office or clinic Dispensaries Primary health care centers Medical research and training centers animal./slaughter houses labs/research organizations Vaccinating centers Bio tech institutions/production units
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Sources of health care waste
What is Biomedical Waste?
Waste Sharps eg: Needles Discarded medicines
Human anatomical waste Solid waste eg: cotton swabs
Who’s at Risk ?
• Doctors and nurses
• Patients
• Hospital support staff
• Waste collection and disposal staff
• General public and
• the Environment
Non-Infec-tious
waste, 80%
Patholo-gical and Infectious
waste; 15%
Chemical and Pharmaceutical waste; 3%
Sharps; 1%Radioactive,
Cytotoxic and heavy metals, 1%
Categories of Bio-Medical Wastes
Pharmaceutical Waste
Sharp Waste 10
Cytotoxic drugs
Lab reagents
Genotoxic waste
Chemical waste
11
Waste with high content of heavy metals
Worn out batteries
Blood pressure guages 12
1. Infection
2. Genotoxicity Cytotoxicity
3. Chemical toxicity
4. Radioactivity hazards.
5. Physical injuries
6. Public sensitivity.
The exposure to hazardous health care waste can result in
Infection
The infectious agents enter in the body through
Puncture, Abrasion, Cut in the skin; Through mucous membranes; By inhalation and ingestion.
Most Common Infections
1. Gastro enteric through faeces and/or vomit
e.g. Salmonella, Vibrio Cholera, Helminthes
Hepatitis A 2. Respiratory through inhaled secretions
e.g. Mycobacterium tuberculosis; measles virus;
streptococcus pneumonae 3.Ocular infections through eye secretions
e.g. Herpes virus, 4. Skin infection through pus
e.g. Streptococcus spp , 5. Meningitis through Cerebrospinal fluid
e.g. neisseria meningitides,
Most Common Infection Cont.
6. Blood borne diseases• AIDS • Septicaemia and bacteraemia • Viral Hepatitis B & C
7. Hemorrhagic fevers through body fluids
• Lassa, Ebola and Marburg viruses
Genotoxicity and Cytotoxicity
Chemical Toxicity
• Irritant to skin and eyesE.g. alkylating agent, intercalating agent
• Carcinogenic and Mutagenice.g. Secondary neoplasia due to chemotherapy
• Many drugs are hazardous• May cause intoxication , burns, poisoning on exposure
Radioactivity Hazards
Physical InjuriesRadioactive waste exposure may cause headache, dizziness, vomiting, genotoxicity and tissue damage
May result from sharps, chemicals and explosive agents
Public sensitivityVisual impact of the anatomical waste, recognizable body parts
NEED FOR BMW MANAGMENT Nosocomial infections to patients from poor infection
control practices and poor waste management.
Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers.
Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.
Risk of infection outside hospital for waste handlers and scavengers, other peoples.
In the late 1980’s◦ Items such as used syringes washed up on
several East Coast beaches USA ◦ HIV and HPV virus infection ◦ Lead to development of Biomedical Waste
Management Law in USA. However in India the seriousness about the
management came into lime light only after 1990’s.
History
GLOBALLY- Developed countries generate 1 to 5 kg/bed/day
Developing countries: meager data, but figures are lower. 1-2kg/pt./day
WHO Report: 85% non hazardous waste : 10% infective waste
: 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive)
INDIA:-No national level study - local or regional level study shows hospitals
generate roughly 1-2 kg/bed/day 21
MAGNITUDE OF THE PROBLEM
in 2000 injections with contaminated syringes
caused: • 21 million hepatitis B virus (HBV) infections (32% of all new infections); • Two million hepatitis C virus (HCV) infections (40% of all new infections); • 260 000 HIV infections (5% of all
new)
WHO has estimated that
>95,000 hospitals and healthcare facilities in India .4.2 lakh kg of biomedical waste is generated on a daily basis.Three million tonnes of medical wastes generated every year. Expected to grow 8% annually.2,91,983 kg/day BMW is disposed. which means that almost 28% of the wastes is left untreated and not disposed finding its way in dumps or water bodies and re-enters our system.Karnataka tops the chart with 62,241 kg/day of BMW. Only 179 CTF to treat the BMW in the country.No. of HCF/CBWTF violated BMW rules 5472No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 3585
India :Extent of the problemCPCB,April,2011 data
•Around 40% of the hospitals in the country are dumping the BMW with Municipal garbage
•Waste is not segregated at the site
• 3585 hospitals have been served notice for acting as defaulters of these rules.
•No proper treatment options
•No regulated disposal plan/sites
Present practice within many of the Hospitals
1. Survey of waste generated.2. Segregation of hospital waste.3. Collection & Categorization of
waste.4. Storage of waste.( Not beyond 48
hrs. )5. Transportation of waste.6. Treatment of waste.
STEPS IN THE MANAGEMENT OF BIOMEDICAL WASTE
BIOMEDICAL RULES 1998The Government of India as contemplated under Section 6,8 and 25 of the Environment (Protection) Act,1986, has made the Biomedical Wastes (Management & Handling) Rules, 1998.
The rules are applicable to every institution generating biomedical waste which includes hospitals, nursing homes, clinic, dispensary, veterinary institutions, animal houses, laboratory, blood bank. The rules are applicable to all persons who generate, collect, store, transport, treat, dispose, handle bio medical waste in receive, any form.
Approx. Quantity : 4 to 250 liters / bed / day
Sewage from isolation wards, ICU’s
toilets & urinals, Bed-bath, bathrooms
and hospital’s laundry Wash waters from laboratories,OPD, Dressing rooms & Operation theaters.
Liquid wastes
Approximate Quantity : 0.3 to 3.5 kg/bed/day 1.Garbage 55% (Bulk Density :330 kg/m3,Cal.Value:1000 K.cal / kg, Moisture :40%)2.Bio-medical waste (sensu stricto)13% A. Wasted
body remains 05% (Blood,Cultures,Anotomicals) B. Pharmaceutical & Chemical Wastes 02% C. Pathological wastes (may be infectious) 06%3.Sharp Objects 20%4.Pressurized Containers & Discarded Instruments 02%5.Radioactive Wastes 0.3%
Solid wastes
WASTE CATEGORY TYPE OF WASTE
Category No. 1 Human Anatomical Waste
Category No. 2 Animal Waste
Category No. 3 Microbiology & Biotechnology Waste
Category No. 4 Waste Sharps
Category No. 5Discarded Medicine and Cytotoxic drugs
Category No. 6 Soiled Waste
Category No. 7 Solid Waste
Category No. 8 Liquid Waste
Category No. 9 Incineration Ash
Category No.10 Chemical Waste
TYPES OF BIOMEDICAL WASTES
BIOMEDICAL WASTE(MANAGEMENT & HANDLING) RULES by Govt. of India, 1998Revised in 2011Now known as BMW Rules, 2011
2011 1998Every occupier generating BMW, irrespective of the quantum of wastes comes under the BMW Rules and requires to obtain authorisation
Occupiers with more than 1000 beds required to obtain authorisnatio
Duties of the operator listed Operator duties absentTreatment and disposal of BMW made mandatory for all the HCEs
Rules restricted to HCEs with more than 1000 beds
A format for annual report appended with the Rules
No format for Annual Report
Form VI i.e. the report of the operator on HCEs not handing over the BMW added to the Rules
Form VI absent
WASTECATEGO
RY
WASTE TYPE TREATMENT & DISPOSAL
Category 1
Human Anatomical waste (human tissues, organs, body parts
Incineration/deep burial
Category 2
Animal Waste: Animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses
Incineration/deep burial
Category 3
Microbiology & Biotechnology Wastes: Wastes from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live or attenuated vaccines human and animal cell culture used in research and infectious agent from research and industrial laboratories, waste from production of biologicals, toxins, dishes and devices used for transfer of cultures
Disinfection at source by chemical treatment or by Autoclaving / Microwaving / followed by Mutilation / shredding and after treatment final disposal in secured landfills or disposal of recyclable waste (plastic or glass ) through registered or authorized recycler
SCHEDULE I: CATEGORIES OF BIO-MEDICAL WASTE
WASTE CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
Category No. 4
Waste Sharps (needles, glass syringes or syringes with fixed needles, scalpels ,blades, glass etc.) that may cause puncture and cuts(Includes both used and unused sharps).
Disinfection (chemical treatment / destruction by needle & tip cutter, autoclaving/microwave and mutilation/shredding and final disposal through CBWTF / landfills
Category No. 5
Discarded Medicines & Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines)
Disposal in secured landfills or Incineration
Category No. 6
Soiled Waste (Items contaminated with blood, & body fluids including cotton, dressings, soiled plaster casts, linens, beddings, other material contaminated with blood)
Incineration
WASTE CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
Category No.7
Infectious Solid Waste (waste generated from disposable items other than the waste sharps such as tubing's, hand gloves, saline bottles with IV tubes, catheters, glass, intravenous sets etc.
Disinfection by chemical Treatment / autoclaving /Microwaving followed by mutilation / shredding & final disposal through registered recycler
Category No.8
Chemical Waste ( Chemicals used in production ofbiologicals, chemicals used in disinfection as insecticides etc.)
Chemical treatment and discharge into drains for liquids and secured landfill for solids
NOTE 1. Chemicals treatment using at least 1% hypochlorite solution or
any other equivalent chemical reagent.
2. Mutilation/shredding must be such so as to prevent unauthorized reuse.
3. There will be no chemical pretreatment before incineration. Chlorinated plastics should not be incinerated.
Schedule-IIColour coding and Type of Containers forDifferent Biomedical Wastes Colour
coding
Type of containe
r
Waste catego
ryTreatment /
Disposal
Non chlorinated Plastic Bags
Incineration/Deep Burrial
Non chlorinated plastic bag / puncture proofContainer for sharps
Chemical Treatment /
Autoclaving / Microwaving and
followed by Mutilation &
shredding and disposal in landfills
or disposal of recyclable waste
Non chlorinated Plastic Bags /Containers
Chemical Treatment
and discharge into drains for liquids
and secured landfill for solids
Non chlorinated Plastic Bags
Municipal waste
Disposed as per the Municipal Solid
Waste
BIOHAZARD SYMBOL
CYTOTOXIC HAZARD SYMBOL
BIOHAZARD
CYTOTOXIC
HANDLE WITH CARE Note : Lable shall be non-washable and prominently visible.
Schedule-IIILABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS
Bio-medical waste shall not be mixed with other wastes
Bio-medical waste shall be segregated into containers/bags at the point of generation in accordance with Schedule II
The containers shall be labeled according to Schedule III.
Segregation, Packing,
Black Dustbin & BagsPaper waste, food waste and other non infectious wastes generated from the hospitals should be stored in black coloured bags / containers & Disposed as per MSW management rules, 2000
MANAGEMENT OF HOSPITAL WASTE
KITCHEN WASTE/FOOD
PAPER/plastic
WASTE DISPOSAL
WRAPPERS
Outer packing/ Cardboard
General/Kitchen waste
BLACK BINFor Noninfectious Solid waste
Bandages
Hum
an
anat
omica
l was
te-
plac
enta
Swab stick-decontaminated
WASTE DISPOSAL
SWABS
Dressing
soiled linen, contaminated gowns, drapes
Animal waste
Discarded medicine/cytotoxic drugs
YELLOW BINCategory 1,2, 5,6
RED BINDrains
Plastic culture plates & tubes
I/V sets
Urine bag
WASTE DISPOSAL
All infectious waste sharp, non sharp & sharps plastic waste
Category 3, 4, 7
Pathology waste
In Blue Nonchlorinated bags
Chemical waste
Chemical Treatment and discharge into drains for liquids and secured landfill for solids
Segregated incinerable wastes kept in Yellow bag
Sharps in sharp container
Personnel safety devicesThe use of protective gears should be made mandatory for all the personnel handling waste.
In an area away from general traffic and accessible only to authorized personnel
DO NOT store for more than 48 hours If for any reason it becomes necessary to store
the waste beyond such period take measures to ensure that the waste does not adversely affect human health and environment
Storage
Transportation and Storage If a container is
transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV.
Waste category No. Day -------- Month -------- Waste class Year -------- Waste description Date of generation-----------Sender's Name & Address Receiver's Name & Address Phone No. ........................... Phone
No. ........................... Telex No. ............................ Telex
No. ............................ Fax No. ............................... Fax
No. ............................... Contact Person ................... Contact
Person ...................In Case of Emergency, Please Contact:
Name & Address Phone No.
Schedule-IVLabel for Transportation of Bio-Medical Waste Containers / Bags
1.Incineration 2.Chemical Disinfection 3.Wet and dry thermal treatment 4.Microwave irradiation 5.Land disposal 6.Inertization
Treatment & Disposal Technologies
Incineration Combustion efficiency (CE) shall be
at least 99.00%. The Combustion efficiency is
computed as follows: %C02 C.E. = ------------ X 100 %C02 + % CO The temperature of the primary
chamber shall be 800 +/-500 C The secondary chamber gas
residence time shall be at least 1 (one) second at 1050 +/- 500 C
Drawbacktoxic products like furanes and dioxins - can cause air pollution
Bio Medical Wastes Destruction by Double Chambered Incinerator
Details of Double Chambered Incinerator
Incinerator Ash Disposal
Emission StandardsParameters Concentration mg/Nm3 at (12%CO2 correction)
Particulate matters 150Nitrogen Oxide 450HCl 50
Minimum stack height shall be 30 metres above ground
Volatile organic compounds in ash shall not be more than 0.01%
Schedule -VDEEP BURIAL PIT for BMW
AutoclaveA temperature of not less than 121 0C and pressure of 15 pounds per square inch (psi)for an autoclave residence time of not less than 60 minutesValidation test : Spot testing by Bacillus stearo-thermophilus spores on a spores strip with at least 1 x 104 Spores/ml.
Routine test : Chemical indicator strip/tape
STANDARD FOR MICROWAVINGSHOULD KILL BACTERIA AND OTHER PATHOGENIC ORGANISM
BIOLOGICAL INDICATOR Bacillus Subtilis
CHEMICAL PROCESSES
Dissolved chlorine dioxide, bleach (sodium hypochlorite), peracetic acid, or dry inorganic chemicals.
To enhance exposure of the waste to the chemical agent, chemical processes often involve shredding, grinding, or mixing.
Every occupier of an institution generating, collecting, receiving, storing, transporting, treating and /or handling Biomedical Waste shall apply on Form 1 for Authorization to the Board.
The State Pollution Control Board are declared as prescribed Authority for grant of Authorization. The Board grants authorizations after satisfying itself.
Authorization
APPLICATION FOR AUTHORISATION(To be submitted in duplicate.)
ToThe Prescribed Authority(Name of the State Govt/UT Administration)Address.1. Particulars of Applicant(i) Name of the Applicant(In block letters & in full)(ii) Name of the Institution:Address:Tele No., Fax No. Telex No.2. Activity for which authorisation is sought:(i) Generation(ii) Collection(iii) Reception(iv) Storage(v) Transportation(vi) Treatment(vii) Disposal(viii) Any other form of handling3. Please state whether applying for resh authorisation or for renewal:(In case of renewal previous authorisation-number and date)
Form 1- Continued4.
(i) Address of the institution handling bio-medical wastes:(ii) Address of the place of the treatment facility:(iii) Address of the place of disposal of the waste:5.(i) Mode of transportation (in any) of bio-medical waste:(ii) Mode(s) of treatment:6. Brief description of method of treatment and disposal (attach details):7.(i) Category (see Schedule 1) of waste to be handled(ii) Quantity of waste (category-wise) to be handled per month8. DeclarationI do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information.I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority.Date : Signature of the Applicant Place : Designation of the Applicant
Every occupier/operator submit an annual report
to the prescribed authority in Form II by 31 January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. The prescribed authority shall send this information in a compiled form to the Central Pollution Control Board by 31 March every year.
Annual Report
a. Every authorized person shall maintain records related to BMW.
b. All records shall be subjected to inspection and verification by the prescribed authority at any time.
c. In any accidents, the authorized person shall report the accident in Form III along with the remedial action taken to the prescribed authority forth with
Maintenance of Records & Accident Reporting
Setting up a CELL or UNIT for BMW management.
The BMW 2011, Rules have also made mandatory for all the HCEs with 30 or more beds to set up a cell or unit to deal with the BMW management. The cell has to meet every six months and minutes of the meeting have to be submitted along with the Annual Report to the prescribed authority
Head of the hospital : chairman Waste Mx officer (dev. and implementation
plan)Members: HOD’s of all department Nursing superintendent, Head nurse, Sanitary inspector Chief pharmacist, Radiation officer Supply officer, financial officer
BMW management committee
Day to day control of segregation, transport & disposal of BMW Co-ordinate with the store officer for continuous supply of basic
items for BMWM Prepare guidelines for BMWM & distribute to all department Prepare BMW posters to raise awareness Arrange training programmes on BMWM & safety measures for
all categories of HCW Co-ordinate with HOD/In-charge of Deptt. where deficiencies
are pointed out Co-ordinate with Chhattisgarh Environment Conservation Board
)
Responsibility of WMC
Dos and Don’ts
Do’s The used product should be
segregated The used product should be mutilated.
The used product is treated prior to disposal.
Use protective gear when handling waste
Collect waste when the bin is 3/4 the full
Clean spills with disinfectant Use trolleys & do not drag waste bagsDo not Reuse plastic equipment. Mix plastic equipment with other
wastes. Burn plastic waste. Avoid needle stick injuries Avoid using common lift to move waste Avoid spillage
Waste minimization & recycling of waste Identification of points of generation of waste Waste segregation at source Compiling the inventory of waste Waste treatment (disinfection etc.) at the site Waste collection and transportation, on-site and off-
site Waste treatment , on-site & off the site Final disposal of waste Occupational safety Continuous monitoring of the system Training of the staff.
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in conclusion
Conclusion Bio-medical waste programme cannot be
successfully implemented without the willingness, self-motivation, and co-operation from all sections of employees of any health care setting.
If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community.