Biomedical Waste Management

Disposal of Hospital & Bio-Medical Wastes

[Bio-Medical Waste Management]

Dr. Gunwant JoshiChief Chemist

Madhya Pradesh Pollution Control Board

What Causes wastes from Hospital premisesWhat Causes wastes from Hospital premises HAZARDOUS?HAZARDOUS?

1.1. Waste Chemical-medications, Solutions, or Waste Chemical-medications, Solutions, or

2.2. Infectious microbes,Infectious microbes,

3.3. Chemicals such as formaldehyde, Chemicals such as formaldehyde, waste anesthetic gases, etc.,waste anesthetic gases, etc.,

4.4. Used disposables, Wasted equipments and Used disposables, Wasted equipments and Chemotherapeutic agents, Chemotherapeutic agents,

5.5. Laser Smoke and aerosolized medicationsLaser Smoke and aerosolized medications

Apart from HospitalsApart from HospitalsInfectious wastes are also generated atInfectious wastes are also generated at

Dental Chambers Dental Chambers Nursing homes Nursing homes Path. LaboratoriesPath. Laboratories Blood BanksBlood Banks Veterinary institutionsVeterinary institutions Bio-Medical & Biotech Research centersBio-Medical & Biotech Research centers

The work environments similar to The work environments similar to Hospital environment.Hospital environment.

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Recurrence of Older infectious deceases & Advent of Newer infections

Prompted improvements in Medical technology and Centralized Medicare,Brought huge volumes of Toxic & Hazardous Waste

Situation forced a serious rethinking & necessited an appropriate Legislation

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Who’s at Risk ?

• Doctors and nurses

• Patients

• Hospital support staff

• Waste collection and disposal staff

• General public and

• the Environment

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The Biomedical Waste The Biomedical Waste (Management & Handling) Rules, (Management & Handling) Rules, 19981998

The Municipal Solid Waste The Municipal Solid Waste (Management & Handling) Rules, (Management & Handling) Rules, 20002000

To minimize the potential for spread of disease To minimize the potential for spread of disease from a medical settings to the general public; from a medical settings to the general public;

To reduce the overall amount of infectious To reduce the overall amount of infectious medical waste produced.medical waste produced.

Infectious agents may become toyes of terrorists, Infectious agents may become toyes of terrorists, as Bioweapons of Mass Destructionas Bioweapons of Mass Destruction

Prospective BioweaponsProspective BioweaponsBiological AgentsBiological Agents AnthraxAnthrax Smallpox Smallpox BotulismBotulism PlaguePlague TularemiaTularemia Hemorrhagic FeversHemorrhagic Fevers

Q FeverQ Fever GlandersGlanders CholeraCholera E.Coli E.Coli O157:H7 O157:H7

Chemical AgentsChemical Agents Nerve AgentsNerve Agents Vesicants or Blister AgentsVesicants or Blister Agents

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Never mix Infectious Bio waste in to Never mix Infectious Bio waste in to Municipal wastes Municipal wastes

[The entire waste lot shall become infectious][The entire waste lot shall become infectious]

Segregation and safe containment Segregation and safe containment (packing) of waste at health facility level (packing) of waste at health facility level

Processing and storage for Processing and storage for

terminal disposalterminal disposal

Basic Concepts of Basic Concepts of Hospital waste managementHospital waste management

Hospital Wastes are dangerous and Hospital Wastes are dangerous and require more careful attentionrequire more careful attention

These are heterogeneous waste, These are heterogeneous waste, both solid & liquid, primarily both solid & liquid, primarily from Health Care Facilitiesfrom Health Care Facilities

The available techno-economic The available techno-economic options for the disposal are options for the disposal are largely determined by Nature largely determined by Nature of activity of HCF and volume of activity of HCF and volume of the various waste of the various waste componentscomponents

Liquid wastesLiquid wastes

Approx. Quantity : 4 to 250 liters / bed / dayApprox. Quantity : 4 to 250 liters / bed / day

1. Domestic Effluents and sewage1. Domestic Effluents and sewage

2. 2. Sewage from isolation wards, ICU’s Sewage from isolation wards, ICU’s toilets & urinals, Bed-bath, bathrooms toilets & urinals, Bed-bath, bathrooms

and hospital’s laundryand hospital’s laundry

3.3. Wash waters from laboratories,OPD, Wash waters from laboratories,OPD, Dressing rooms & Operation theaters.Dressing rooms & Operation theaters.

Solid wastesSolid wastes

Approximate Quantity : 0.3 to 3.5 kg/bed/dayApproximate Quantity : 0.3 to 3.5 kg/bed/day

1.Garbage1.Garbage 5555%% ((Bulk Density :330 kg/mBulk Density :330 kg/m33,Cal.Value:1000 K.cal / kg, Moisture :40%,Cal.Value:1000 K.cal / kg, Moisture :40%))

2.Bio-medical waste 2.Bio-medical waste (sensu stricto)(sensu stricto) 1313%% A. Wasted body remains A. Wasted body remains 05% 05%

(Blood,Cultures,Anotomicals)(Blood,Cultures,Anotomicals) B. Pharmaceutical & Chemical Wastes. 02%B. Pharmaceutical & Chemical Wastes. 02% C. Pathological wastes C. Pathological wastes (may be infectious). (may be infectious). 06% 06%

3.Sharp Objects3.Sharp Objects 2020%%

4.4.Pressurized Containers & Discarded InstrumentsPressurized Containers & Discarded Instruments 0202%%

5.Radioactive Wastes5.Radioactive Wastes 0.30.3%%

Key to proper Bio - Medical Waste Key to proper Bio - Medical Waste

Management is the segregationManagement is the segregation

as individual categories of waste as individual categories of waste are to be treated & disposed off are to be treated & disposed off in different specific waysin different specific ways

1.1. Out rightly send Domestic Effluents Out rightly send Domestic Effluents to to ....the municipal sewersthe municipal sewers

2. Isolate & Collect the infectious liquid 2. Isolate & Collect the infectious liquid wasteswastes((streams 2 & 3streams 2 & 3),), Disinfect completely Disinfect completely and then send to municipal sewersand then send to municipal sewers

3. 3. Pack the Segregated Solid Waste Pack the Segregated Solid Waste according according to prescribed modeto prescribed mode

andand

May be May be

Where,Where,

The BMW shall be treated usingThe BMW shall be treated using Standard methods such as Incineration, Standard methods such as Incineration, Autoclaving, Micro- waving, and Chemical Autoclaving, Micro- waving, and Chemical & Mechanical techniques& Mechanical techniques

and the treated waste residue shall be and the treated waste residue shall be finally disposed off in a secured finally disposed off in a secured LandfillLandfill

Hospital Waste classificationHospital Waste classification

Hazardous waste:Hazardous waste:Only 10-25% of Hospital waste is actually hazardous and can be injurious to humans or animals and deleterious to environment.

This may be either

A. Infectious Bio-hazard Infectious in nature

B. Sharps that may lead to secondary infections

C. Toxic Bio-hazard Cytotoxic in nature

D. Radiation Bio-hazard Radioactive in nature

Other Potentially Infectious MaterialOther Potentially Infectious Material Any body fluid with visible bloodAny body fluid with visible blood Amniotic fluidAmniotic fluid Cerebrospinal fluidCerebrospinal fluid Pericardial fluidPericardial fluid Peritoneal fluidPeritoneal fluid Pleural fluidPleural fluid Saliva in dental proceduresSaliva in dental procedures Semen/vaginal secretionsSemen/vaginal secretions Synovial fluidSynovial fluid Anywhere body fluids that are indistinguishableAnywhere body fluids that are indistinguishable

Blood and Fluid Borne Pathogen Blood and Fluid Borne Pathogen Exposures may typically occurExposures may typically occurby one of the following ways:by one of the following ways:

Puncture from contaminated needles, broken glass, Puncture from contaminated needles, broken glass,

or other sharpsor other sharps Contact between non-intact (cut, abraded, acne, or Contact between non-intact (cut, abraded, acne, or

sunburned) skin and infectious body fluidssunburned) skin and infectious body fluids Direct contact between mucous membranes and Direct contact between mucous membranes and

infectious body fluidsinfectious body fluids

Example: A splash in the eyes, nose, or mouthExample: A splash in the eyes, nose, or mouth

Under Environment Protection Act,1998Under Environment Protection Act,1998

BIO-MEDICAL WASTE (Management & handling) RULES 1998BIO-MEDICAL WASTE (Management & handling) RULES 1998

11stst Amendment Rules vide S.O.201(E) Dated 06/03/2000 Amendment Rules vide S.O.201(E) Dated 06/03/2000

22ndndAmendment Rules vide S.O.1069(E) Dated 17/09/2003 Amendment Rules vide S.O.1069(E) Dated 17/09/2003

The Authorization is required forThe Authorization is required for Generation/Collection/Reception/StorageGeneration/Collection/Reception/Storage TransportationTransportation Treatment/DisposalTreatment/Disposal or any other form of handling.or any other form of handling.

Classification and managementClassification and management

CategoryCategory Waste Type Waste Type Treatment and Disposal Method Treatment and Disposal Method

Category 1 Category 1 Human Wastes Human Wastes (Tissues, organs, body (Tissues, organs, body parts parts

Incineration / deep burial Incineration / deep burial

Category 2 Category 2 Animal WasteAnimal Waste Incineration / deep burial Incineration / deep burial

Category 3 Category 3 Microbiology and Microbiology and Biotechnology waste Biotechnology waste Autoclave/microwave/incinerationAutoclave/microwave/incineration

Category 4 Category 4 SharpsSharpsDisinfection (chemical treatment)Disinfection (chemical treatment)+/autoclaving/microwaving and +/autoclaving/microwaving and mutilation shreddingmutilation shredding

Category 5 Category 5 Discarded Medicines Discarded Medicines and Cytotoxic Drugs and Cytotoxic Drugs

Incineration/ destruction and drugs Incineration/ destruction and drugs disposal in secured landfills disposal in secured landfills

Schedule-ISchedule-I

CategoryCategory Waste Type Waste Type Treatment and Disposal Method Treatment and Disposal Method

Category 6 Category 6 Contaminated solid Contaminated solid waste waste

Incineration/autoclaving / Incineration/autoclaving / microwaving microwaving

Category 7 Category 7 Solid waste (disposable Solid waste (disposable items other than items other than sharps) sharps)

Disinfection by chemical treatment+ Disinfection by chemical treatment+ microwaving/autoclaving & microwaving/autoclaving & mutilation shreddingmutilation shredding

Category 8 Category 8

Liquid waste Liquid waste (generated from (generated from laboratory washing, laboratory washing, cleaning, housekeeping cleaning, housekeeping and disinfecting and disinfecting activity)activity)

Disinfection by chemical treatment+ Disinfection by chemical treatment+ and discharge into the drains and discharge into the drains

Category 9 Category 9 Incineration ash Incineration ash Disposal in municipal landfillDisposal in municipal landfill

Category10Category10 Chemical Wastes Chemical Wastes Chemical Treatment + and Chemical Treatment + and discharge in to drain for liquids and discharge in to drain for liquids and secured landfill for solids secured landfill for solids

Classification and managementClassification and management

Schedule-I. contd…Schedule-I. contd…

Schedule-IISchedule-II

Colour coding and Type of Containers forColour coding and Type of Containers forDifferent Biomedical WastesDifferent Biomedical Wastes

Colour Colour codingcoding

Type of Type of containercontainer

Waste Waste categorycategory

Treatment /Treatment /Disposal Disposal

Plastic Plastic BagsBags

Incineration/Incineration/Deep BurrialDeep Burrial

DisinfectedDisinfectedContainer /Container /Plastic Plastic BagsBags

Autoclaving, Autoclaving, Microwaving andMicrowaving and Chemical TreatmentChemical Treatment

Plastic Plastic Bags Bags /Puncture /Puncture ProofProofContainersContainers

Autoclaving, Autoclaving, Microwaving and Microwaving and Chemical TreatmentChemical Treatment

Destruction/ shreddingDestruction/ shredding

Plastic Plastic BagsBags

Disposal in the Disposal in the Secure LandfillSecure Landfill

Yellow Dustbin & BagsYellow Dustbin & Bags

From OT: Amputated Limbs, Placenta, Intestine, Uterus Ovary etc.From Labs: Live or Attenuated vaccines, Infected Samplesand cultures, Culture Plates, Wastes from production of Biologicals,Toxins.

MANAGEMENT OF HOSPITAL WASTE

Red Dustbin & BagsRed Dustbin & Bags

Cotton pads, Swabs, Gauge Pieces, Dressings, Bandages, Cloths, Bedsheets and Plaster castes Soiled with blood, Pus, Vomits, Sputum and other Body Fluids.


Wastes comprising of out dated, Wastes comprising of out dated, contaminated and discarded contaminated and discarded medicines, solid chemicals used medicines, solid chemicals used for disinfection in Lab & for disinfection in Lab & Hospitals as insecticidesHospitals as insecticides

Black Dustbin & Bags


Blue Dustbins & BagsBlue Dustbins & Bags

Needles, Scalples, Blades, Glass ampoules and Syringes etc. that may cause puncture and cuts. This includes both used and unused sharps


May also be put forMay also be put for

All disposable items like I.V.Sets, S.V.Sets, Venflon, Catheter, I.V.Fluid Bottles Uro-bags, Ryles tube, Drainage Tube and Bags, Empty blood bags and Dialysis and other plastic disposable.

A separate Blue Dustbins & Bags

Containers Colour Containers Colour Tells other staff what is in the containerTells other staff what is in the container Tells the contractor what to do with the wasteTells the contractor what to do with the waste Can apply to both sacks and rigid containersCan apply to both sacks and rigid containers

Safe for Disposal to General Waste

Carcass, anatomical

Sharps

Cytotoxic

Colour-Coded Bins for Segregation Colour-Coded Bins for Segregation of Bio Medical Wasteof Bio Medical Waste

Schedule-IIISchedule-III

Label for Containers of Bio-Medical WasteLabel for Containers of Bio-Medical Waste

Bio HazardBio Hazard Cyto-Toxic SubstanceCyto-Toxic Substance

Schedule-IVSchedule-IV

Label for Transportation of Label for Transportation of Bio-Medical Waste Containers / BagsBio-Medical Waste Containers / Bags

Waste category No.Waste category No. Day -------- Month -------- Day -------- Month -------- Waste classWaste class Year -------- Year -------- Waste description Waste description Date of generation----------- Date of generation-----------Sender's Name & Address Sender's Name & Address Receiver's Name & AddressReceiver's Name & Address Phone No. ...........................Phone No. ........................... Phone No. ........................... Phone No. ........................... Telex No. ............................Telex No. ............................ Telex No. ............................ Telex No. ............................ Fax No. ...............................Fax No. ............................... Fax No. ............................... Fax No. ............................... Contact Person ...................Contact Person ................... Contact Person ................... Contact Person ...................

In Case of Emergency, Please Contact:In Case of Emergency, Please Contact: Name & AddressName & Address Phone No.Phone No.

Schedule -VSchedule -V

a - a - STANDARD FOR LIQUID WASTESTANDARD FOR LIQUID WASTE

pH pH 6.5 to 9.06.5 to 9.0

Suspended SolidsSuspended Solids 100 mg/l. 100 mg/l.

Oil & greaseOil & grease 10 mg/l.10 mg/l.

BODBOD 30 mg/l.30 mg/l.

CODCOD 250 mg/l.250 mg/l.Bio assayBio assay 90 % Survival of fish after 90 % Survival of fish after

96 hours in 100% effluent96 hours in 100% effluent

Send Domestic Effluents to municipal sewersSend Domestic Effluents to municipal sewers

Disinfect the infectious liquid waste and then Disinfect the infectious liquid waste and then send it to municipal sewerssend it to municipal sewers

Bio Medical Liquid Wastes DisinfectionBio Medical Liquid Wastes Disinfection by Sodium Hypochloriteby Sodium Hypochlorite

Bio Medical Liquid Wastes TreatmentBio Medical Liquid Wastes Treatment by by an Effluent Treatment Plantan Effluent Treatment Plant

Garbage Wastes Collection &TransportGarbage Wastes Collection &Transport

Sharp ManagementSharp Management

AlwaysRemember

Not to recap the Needle and cut it

Immediately after the use

Sharp Sign

Unauthorised Use/Reuse

Unsafe collection

Unsafe disposal

Sharps IssuesSharps Issues Must be collected at the point of generation, in a

leak-proof and puncture-resistant container Containers must bear the international biohazard

symbol and appropriate wording Containers should never be completely filled, nor

filled above the full line indicated on box.

Sharp EncapsulationSharp Encapsulation : Sharp Pit : Sharp Pit

• MUTILATE & DISTROY

•DISINFECT:- Chemically/Autoclave/Microwave

•DISPOSE IN SHARP PIT

•SEAL PIT WHEN 2/3 FULL

•START DISPOSAL IN NEW PIT.

•Alternatively, after Destruction/ Mutilation and Disinfection the Stored Sharps can be sold as

Scrap

Waste Sharp & Syringe DestructionWaste Sharp & Syringe Destruction The Shredded Needles, The Shredded Needles,

Sharps and Plastics may Sharps and Plastics may be kept in the secured be kept in the secured containers and containers and could be sent to could be sent to Plastic / MetalPlastic / Metal Recycling PlantsRecycling Plants

Bio Medical Wastes:Bio Medical Wastes:

Segregate and Segregate and Pack it right at thePack it right at the

point of Generation point of Generation

Bio Medical Wastes Collection &TransportBio Medical Wastes Collection &Transport

BMW BMW CTDF CTDF

at Bhopalat Bhopal

Govindpura Industrial AreaGovindpura Industrial Area

Bio Medical Wastes Bio Medical Wastes Collection &TransportCollection &Transport

by by

Common Common Treatment Treatment & Disposal & Disposal

Facil ityFacil ity

Inspection & Re-Segregation Inspection & Re-Segregation

It requires to segregate again to ensure the final It requires to segregate again to ensure the final disposal of BMW as per BMW Rules 1998 (M & H)disposal of BMW as per BMW Rules 1998 (M & H)

AutoclaveAutoclave

Validation 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

Sharp Storage & DisposalSharp Storage & Disposal

Bio Medical Plastic Wastes DisinfectionBio Medical Plastic Wastes Disinfection by Sodium Hypochloriteby Sodium Hypochlorite

Bio Medical Wastes Destruction byBio Medical Wastes Destruction by Double Chambered Incinerator Double Chambered Incinerator

Details of Double Chambered IncineratorDetails of Double Chambered Incinerator

Incinerator Ash DisposalIncinerator Ash Disposal


DEEP BURIAL PIT for BMWDEEP BURIAL PIT for BMW


D - D - STANDARD FOR DEEP BURIALSTANDARD FOR DEEP BURIAL Entry of scavengers to the burial site be Entry of scavengers to the burial site be prevented may be by using covers of prevented may be by using covers of galvanized iron/wire mash. galvanized iron/wire mash.

After every burial in the same secured After every burial in the same secured pit a layer of 10 cm. soil be added . pit a layer of 10 cm. soil be added .

Burial must be performed under close and dedicated supervision.Burial must be performed under close and dedicated supervision.

Deep burial site should be relatively impermeable and Deep burial site should be relatively impermeable and distant from habitat.distant from habitat.

There should be no well, lake, river etc. close to the site to There should be no well, lake, river etc. close to the site to avoid contamination of surface water or ground water. avoid contamination of surface water or ground water.

Location of the deep burial site to be authorized by the Location of the deep burial site to be authorized by the Prescribed Authority. Prescribed Authority.

The occupier shall maintain record for all the pitsThe occupier shall maintain record for all the pits

Land Disposal Facility for Cities & TownsLand Disposal Facility for Cities & Towns with population less than 5 lacswith population less than 5 lacs

Other Bio Medical Wastes Treatment OptionsOther Bio Medical Wastes Treatment Options

Other Bio Medical Wastes Treatment OptionsOther Bio Medical Wastes Treatment Options

Microwaveing

Other Bio Medical Wastes Treatment OptionsOther Bio Medical Wastes Treatment Options Plasma Pyrolysis Plasma Pyrolysis

Duties of the OccupierDuties of the Occupier Occupier / institution generating, collecting, Occupier / institution generating, collecting,

receiving, storing, transporting, treating, receiving, storing, transporting, treating, disposing and/or handling Bio-medical waste disposing and/or handling Bio-medical waste To apply for Grant of Authorization in form –I To apply for Grant of Authorization in form –I to MPPCB which is the Prescribed Authority.to MPPCB which is the Prescribed Authority.

Operator of the Bio - medical Waste Treatment Operator of the Bio - medical Waste Treatment Facility to apply for Grant of Authorization in Facility to apply for Grant of Authorization in form –I to MPPCB (The Prescribed Authority).form –I to MPPCB (The Prescribed Authority).

Duties of the OccupierDuties of the OccupierBio-medical Waste shall be treated and disposed Bio-medical Waste shall be treated and disposed

of in accordance with the Schedule -I and in of in accordance with the Schedule -I and in compliance with the standards prescribed in compliance with the standards prescribed in Schedule –V.Schedule –V.

Every Occupier, shall set- up the requisite Bio-medical Every Occupier, shall set- up the requisite Bio-medical Waste Treatment Facilities like incinerator, Autoclave, Waste Treatment Facilities like incinerator, Autoclave, Microwave system for treatment of waste, Microwave system for treatment of waste,

or, ensure requisite treatment of waste at common or any or, ensure requisite treatment of waste at common or any other waste treatment facilityother waste treatment facility

Duties of the OccupierDuties of the Occupier

To submit an annual report to in form –I I by 31To submit an annual report to in form –I I by 31 stst June Every year about the categories and June Every year about the categories and quantities of Bio-medical Waste handling quantities of Bio-medical Waste handling during the preceding yearduring the preceding year

To maintain records related to Generation, To maintain records related to Generation, collection,reception, storage, transportation, collection,reception, storage, transportation, treatment,disposal and/or handling of Bio-treatment,disposal and/or handling of Bio-medical waste according the rules & guidelines.medical waste according the rules & guidelines.

Duties of the OccupierDuties of the Occupier

All records subject to the inspection & All records subject to the inspection & verification by the MPPCBverification by the MPPCB

Accident during handling & Transportation Accident during handling & Transportation of BMW needs to be reported by the of BMW needs to be reported by the authorized person in Form – III to authorized person in Form – III to

MPPCB forthwith.MPPCB forthwith.

Please Remember!Please Remember! The Primary The Primary

responsibility of responsibility of the disposal of the the disposal of the Bio-Medical Waste Bio-Medical Waste lies with the lies with the GeneratorGenerator

And also do not forget thatAnd also do not forget that

Bio-medical waste shall not be mixed with other Bio-medical waste shall not be mixed with other Wastes such as Municipal WasteWastes such as Municipal Waste

Segregate the Bio-medical Waste in separate Segregate the Bio-medical Waste in separate containers at point of generation (schedule-II) containers at point of generation (schedule-II) and label as prescribed (schedule-III)and label as prescribed (schedule-III)


Biomedical waste that are to be transported, Biomedical waste that are to be transported, must be securely packed, and Labeled as per must be securely packed, and Labeled as per (schedule-IV).(schedule-IV).

Transportation of BM Waste is allowed only in Transportation of BM Waste is allowed only in vehicles authorized by the prescribed Authorityvehicles authorized by the prescribed Authority

A day -to -day record of the Quantity under A day -to -day record of the Quantity under different categories of the Bio – Medical Waste different categories of the Bio – Medical Waste generated in premises must be maintained generated in premises must be maintained


No untreated Bio-medical Waste shall be kept No untreated Bio-medical Waste shall be kept stored beyond 48 Hrs.stored beyond 48 Hrs.

if for any reason, the Bio-Medical Waste is if for any reason, the Bio-Medical Waste is required to be stored beyond this time limit, the required to be stored beyond this time limit, the Authorized person must seek a permission from Authorized person must seek a permission from Prescribed Authority and take adequate measures Prescribed Authority and take adequate measures to ensure that waste does not affect the human to ensure that waste does not affect the human life & environment adversely.life & environment adversely.

The contravention of the Act The contravention of the Act , ,

Rules, Orders & directions Rules, Orders & directions may lead to legal actionmay lead to legal action

The punishment may lead to the The punishment may lead to the imprisonment up to 5 years with fine imprisonment up to 5 years with fine up to Rs. 1 lakh.up to Rs. 1 lakh.

For failure or continued contravention a For failure or continued contravention a fine @ Rs.5000 /Day may be charged.fine @ Rs.5000 /Day may be charged.

If the failure or the contravention If the failure or the contravention continues beyond one year, the continues beyond one year, the imprisonment may be extended up imprisonment may be extended up to 7 yearsto 7 years..

Liquid Infectious Medical WastesLiquid Infectious Medical Wastes

Placed directly in the Placed directly in the Biohazardous waste, Biohazardous waste,

Autoclaved & the poured Autoclaved & the poured down a sanitary sewer,down a sanitary sewer,

Solidified using an approved Solidified using an approved disinfectant solidifier and disinfectant solidifier and discarded in the solid wastediscarded in the solid waste

Liquid Infectious Medical Waste, i.e., the contents of Liquid Infectious Medical Waste, i.e., the contents of suction canisters, may be disposed as followssuction canisters, may be disposed as follows

Disposal Procedure – PlasticsDisposal Procedure – Plastics

Laboratory plasticsLaboratory plastics Render safe firstRender safe first If non-identifiable following autoclave then non-If non-identifiable following autoclave then non-

clinical disposal [Black Bag and label “Safe for clinical disposal [Black Bag and label “Safe for Disposal”]Disposal”]

If identifiable still then possibly “offensive” - If identifiable still then possibly “offensive” - Orange Bag and label as for Clinical WasteOrange Bag and label as for Clinical Waste

Disposal ProcedureDisposal Procedure GlasswareGlassware

Render safe firstRender safe first Designated boxes – clearly labelled “Broken Glassware Designated boxes – clearly labelled “Broken Glassware

– Safe for Disposal”– Safe for Disposal”

Except if contains hazardous chemicals – special Except if contains hazardous chemicals – special disposal route via Chemistrydisposal route via Chemistry

Mercury -Mercury -Collect through spill kit and send for recyclingCollect through spill kit and send for recycling

Comparison of Treatment TechnologiesComparison of Treatment Technologies

Biomedical Waste Management - IssuesBiomedical Waste Management - Issues

• Not considered importantNot considered important

– Lack of interest from senior management Lack of interest from senior management – No ownership of the processNo ownership of the process

– Awareness of problems Awareness of problems

– Appreciate the need for constant monitoringAppreciate the need for constant monitoring

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–Segregation of waste not taken seriously at user level Segregation of waste not taken seriously at user level

–Non compliance with color codingNon compliance with color coding

–Monitoring segregation at source – low budgets allocated – Monitoring segregation at source – low budgets allocated – costs are not always known/nor worked out properlycosts are not always known/nor worked out properly

–Cost of color coding, staff, transport and disposal is a major Cost of color coding, staff, transport and disposal is a major deterrentdeterrent

–Quantification of waste generated is not accurately doneQuantification of waste generated is not accurately done


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–Protection of healthcare workers not given Protection of healthcare workers not given adequate thoughtadequate thought

–Clinical waste dumped with non infectious waste - Clinical waste dumped with non infectious waste - Risk for healthcare workers and publicRisk for healthcare workers and public

–Residual Waste disposal not effective, often Residual Waste disposal not effective, often dumped in open landfillsdumped in open landfills


Over Classification makes it complexOver Classification makes it complex The disposal of solid wastes that are not infectious The disposal of solid wastes that are not infectious

medical waste, is often done as if they were medical waste, is often done as if they were infectiousinfectious

It is the most commonly cited violationIt is the most commonly cited violation

It increases the financial burden on patients and It increases the financial burden on patients and taxpayers in the form of increased disposal costs taxpayers in the form of increased disposal costs for health care facilitiesfor health care facilities

ProblemsProblems When large volumes of plastics, When large volumes of plastics,

common in medical waste, are common in medical waste, are incinerated there is an increased incinerated there is an increased potential for atmospheric potential for atmospheric release of reformed gaseous release of reformed gaseous carcinogenic agents such as carcinogenic agents such as Dioxins & FuransDioxins & Furans

Increased medical waste generation increases the Increased medical waste generation increases the risk of costly accidents and spills due to the risk of costly accidents and spills due to the increased number of trucks required to haul the increased number of trucks required to haul the wastewaste

When infectious waste and regular solid When infectious waste and regular solid waste mixes together, it can not be waste mixes together, it can not be permitted to separate thempermitted to separate them

Once combined, Once combined, the entire the entire contents are contents are considered considered infectious waste!infectious waste!

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ChallengesChallenges

Establishing robust waste management policies within the Establishing robust waste management policies within the Health Care Facility/organizationHealth Care Facility/organization

Organization wide awareness about the health hazardsOrganization wide awareness about the health hazards

Sufficient financial and Trained human resources neededSufficient financial and Trained human resources needed

Monitoring and control of waste disposal Monitoring and control of waste disposal

Clear responsibility and tracebility for appropriate handling Clear responsibility and tracebility for appropriate handling and disposal of waste.and disposal of waste.

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ADRESSING THE ISSUES

1. Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal

2. This is a long-term process, sustained by gradual improvements.

3. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital.

4. Man power needs and other resources for the BMWM of hospital to be addressed.

5. Quality assessment of bio-medical waste management should be done from time to time.

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ADRESSING THE ISSUES- continued

6. Segregated collection and transportation – need for Non-ambiguous color coding and labeling of wastes.

7. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages.

8. Safety of handlers is a big concern that is still not addressed adequately.

9. Raising Awareness about risks related to health-care waste; training staff & Waste handlers on safe practices.

10.Selection of safer & environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing waste.

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ADRESSING THE ISSUES

11.Issue of all protective clothing such as, gloves, aprons, masks etc. to all HCW & Waste handlers.

12.Regular medical check-up (half-yearly) of staff associated with BMWM.

13.Maintenance of Record registers for this purpose.

14.Containers should be robust and leak proof

15.Tracking of Bio Medical Waste up to point of Disposal.

16.Proper treatment and final disposal.

Biomedical Waste Management

Education

Transcript of Biomedical Waste Management