BIO-MEDICAL

WASTE

MANAGEMENT

BIO-MEDICAL WASTE

MANAGEMENT

What is Bio medical waste

Waste generated in the diagnosis, treatment or immunization of human beings or animals, in research or in the production or testing of biological products.

BIOMEDICAL WASTE RULES APPLY TO:-

4

All who generate, collect, receive, store, transport, treat, dispose, or handle

bio medical waste :-

Hospitals,

Nursing homes

Clinics

Dispensaries,

Veterinary institutions

Animal houses

,

Pathological laboratories

(irrespective of the size)

Blood banks,

Clinical establishments

Research or educational institution

Health camps,

Medical or surgical camps,

Vaccination camps,

Blood donation camps,

First aid rooms of schools,

Forensic and research labs.

Ayush hospitals,

• First time the rules were framed in 1998.

• Later amendments were made in 2000, 2003

and 2011.

• Latest guidelines came into existence from 28th

March 2016.

• Amendments were further made in March

2018

WHY BMW

Rules

?

Hospital or Lab/

Infectious waste is not

dumped in open

ground …. potentially

hazardous to the

environment and

human beings

6

• What are the hazards of the improper management of the biomedical waste generated in a hospital?

Needle prick injury

Mechanical vector transmitted diseases

Outbreak of other infectious diseases

Attract rag pickers and lead to reuse of contaminated items.

PROCESS FLOW OF BMW

13

Generation Segregation

Storage Collection

Transportation Treatment &

Disposal

WASTE CATEGORISATION

14

WASTE

Non Infectious 75-85%

Infectious 10- 15%

Hazardous 5- 15%

How to segregate waste .... in Non

Chlorinated Bags

15

WASTE

PLASTIC Non

Plastic

GLASS

GENERAL SHARP M ETAL

Infectious Waste

BIO-MEDICAL WASTE

MANAGEMENT

BLACK BAG

Non-infectious waste (85%) generated in hospital can be collected.

• Paper, plastics

• Wrappers, Cardboards, Outer packaging

• Kitchen waste

• Unsoiled plaster cast

• Expired filling materials

• Tooth paste/ powder

• Cements temporary/ permanent

General waste

What goes in RED BAG

21

Infectious Plastic and rubber waste such as

• Gloves

• I.V. tubing and I. V sets

• Catheters

• Urine bags

• Syringes (without needles and fixed needle syringes)

• Suction tips

• Vaccutainers with their needles cut and gloves.

• Disposable plastic glasses

• Used alginate impressions

• Rubber base impression materials

WHAT GOES IN

YELLOW BAG

23

• Human/Animal tissue organs or body parts

• Animal carcasses

• Any non plastic soiled waste( contaminated with blood/ body fluids )

• Cotton dressings, bandages

• Linen beddings

• Soiled plaster casts, Soiled paper

• Periodontal packs

• Extracted teeth

Antibiotics and other drugs

Microbiology waste • Culture devices, stocks

or specimen of microorganisms

• Blood bags

WHAT GOES IN BLUE BAG?

25

•Glassware – broken ,

Contaminated glass Medicine

Vials, ampoules etc

•(Glass sharps such as broken ampoules,injection vials

•Glass slides, coverslips

•Injection vials

•Broken test tubes/ Broken pipettes)

WHAT GOES IN WHITE PUNCTURE PROOF AND LEAK PROOF

CONTAINER

26

White (Translucent) – Waste sharps

including metals – packed in puncture

proof containers

Needles, syringes with fixed needles

Scalpels, Blades, lancet

Suture needle, aluminum foil Intravenous canula LP needle Bone screws ( sharps)

Any contaminated sharp object causing

puncture/cuts

Handed over to Waste Agency… when

2/3

full.

• Destroy needle

Cut syringe tip

Decontaminate in bucket having 10%

bleach

CHEMICAL/LIQUID WASTE

28

liquid waste: To be treated

with 1 to 2 % Hypochlorite

or to have an ETP.

Floor washing etc should be

pre-treated onsite using

10% Sodium Hypochlorite

or connected to ETP

AT SOURCE PRE TREATMENT

Pre-treatment By

Autoclave

Disinfection By

Hypochlorite

29

STANDARDS FOR AUTOCLAVING OF BIO- MEDICAL WASTE (Pre-treatment..at source)

Chemical indicator strip….is to be

used with each batch of waste and

note change in color as an indication

of temperature and pressure achieved.

Frequency: To use more than one

strip with every batch and bag,record

the same.

Spore testing at least once in every

week

Medical waste shall not be

properly treated considered

unless the

as

time, temperature and

pressure indicators indicate that the

time, temperature and

were reached during the

process - AUTOCLAVE

required

pressure

autoclave

AGAIN

PROCEDURE : The

autoclave should be

dedicated for the purposes of

disinfecting and treating bio-

medical waste.

When operating a gravity

flow autoclave, medical

waste shall be subjected to: A

temperature of not less than

121° C and pressure of 15

pounds per square inch (psi)

for an autoclave residence

time of at least 20 minutes. 30

% of hypochlorite solution to be used

• Calcium hypochlorite ( 70% available chlorine) - 140 gram/ 20 liters of water

• Sodium hypochlorite ( 5 % available chlorines)– 2 liters/ 20 liters of water

• 10% solution is prepared by adding 100gm of bleaching powder in 1 liter of water

TRANSPORTATION

• Within hospital:- By designated wheeled containers and trolleys

• Outside the hospital:- By the authorized vehicle as specified by the Govt.

• Bags for transportation must be labelled ( date, weight, ward number, department and duty in charge signature)

Transport

Transport by wheeled trolleys/containers /carts only in vehicles authorized for the purpose

They should be

Easy to load and unload

No sharp edges

Easy to clean

Disinfect daily

PERSONNEL PROTECTIVE EQUIPMENTS

• Gloves

• Masks and Goggles

• Boots

VACCINATION

• HEPATITIS B VACCINE

• TETANUS TOXOID

MANAGEMENT OF SPILLS

• COVER THE SPILLS WITH PAPER TOWEL/ BLOTTING PAPER/ NEWSPAPER.

• ADD 10% SODIUM HYPOCHLORITE SOLUTION ON AND AROUND THE SPILL FROM PERIPHERY TO CENTER.

• COVER IT FOR AROUND 30 MINUTES.

• REMOVE PAPER WITH GLOVED HANDS AND DISCARD IT IN YELLOW BAG.

• FINALLY THE FLOOR IS CLEANED WITH DETERGENT AND WATER IN A USUAL WAY.

ACCIDENTAL EXPOSURE

• CONTACT CMO

• Use of Hand sanitizers/ Tap water with soap/ Disinfectants

HIV : 3 infections per 1,000 sticks with a HIV +ve Needle

• 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000

Hepatitis C: 18 persons per 1,000 needle-sticks

• 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 0000000000000000000

HEPATITIS B IS most infectious (30%)

• 0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000a000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000

BIO-MEDICAL WASTE

MANAGEMENT

42

DISINFECTION OF MATTRESSES , BLANKETS AND PILLOWS

• COVER THE MATTRESSES WITH WATERPROOF MATERIAL- PLASTIC/ REXENE.

• WASHING CAN BE DONE MANUALLY.

• NATURAL DISINFECTION CAN ALSO BE DONE (SUNLIGHT- UV RAYS).

• SYNTHETIC BLANKETS ARE PREFERRED. • WOOLEN BLANKETS ARE DECONTAMINATED BY EXPOSING TO

FORMALDEHYDE VAPOURS OR AUTOCLAVING.

PERSONAL PROTECTION

1. Dressing-

Waterproof apron-to protect against splashes

2. Gloves

3. Masks

4. Protective glasses , eye shields

5. Foot wear- washable footwear , knee length (gum boots)

6. Immunization : Hepatitis B , Tetanus injection

THE SEQUENCE OF DONNING Personnel Protective Equipment (PPE)

• Wear shoes covers with trousers tucked • Hand hygiene • Gown • Cap • Face mask ( fit for size) • Goggles or face shield • Gloves • After use discard in appropriate waste disposal bags–

to be autoclaved / chemically disinfected before final disposal

The sequence of removing PPE

• Remove gloves and discard in disposable bags

• Remove goggles and discard as above

• Remove gown and discard in waste disposal bags

• Use alcohol based hand rub/ or wash hands with soap and water

• Remove face mask by grasping elastic or tie strips behind ears (don’t touch front of mask)

cont…

• Remove cap ( head cover) and discard

• Remove shoe covers

• Do hand washing again

• Leave the room

• Once outside the room do hand washing again with soap and water

Health hazards of BMW Type of waste Health hazard

Human / Animal waste/ Soiled waste

HIV,HBV,HCV, Haemorrhagic fevers, cholera, salmonellosis, shigellosis, rabies, leptospirosis, anthrax,TB, pneumonia, septicemia

Sharps HIV, HBV, HCV, Injuries

Cytotoxic/ radioactive waste

Cancer, genetic mutation, birth defect

Chemical waste Poisonings, dermatitis, conjunctivitis, bronchitis