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.

5

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.