Biomedical waste managment rule 2011

BIOMEDICAL WASTE BIOMEDICAL WASTE MANAGEMENTMANAGEMENT

Dr. SANJAY SINGH NEGIAssistant Professor, Microbiology

AIIMS, Raipur, Chhattisgarh

Points to be discussed Points to be discussed …………………… Overview : Definition

Extent of Problem , Need, Present practices

BMW Management Rules, application, duty of occupier

Segregation, categories of BMW

Transport & storage

Treatment & Disposal

Authorization, Reporting of Accidents

BMW Mx Committee

Take Home Message

What is Biomedical Waste?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).

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

NEED FOR BMW MANAGEMENTNEED FOR BMW MANAGEMENTThe hospital waste, in addition to the risk for patients and personnel who handle these wastes poses a threat to public health and environmentHealth hazards of BMW

Type of wasteType of waste Health hazardHealth hazard

Human / Animal Human / Animal waste/ Soiled waste/ Soiled wastewaste

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

SharpsSharps HIV, HBV, HCV, InjuriesHIV, HBV, HCV, Injuries

Cytotoxic/ Cytotoxic/ radioactive wasteradioactive waste

Cancer, genetic mutation, birth Cancer, genetic mutation, birth defectdefect

Chemical wasteChemical waste Poisonings, dermatitis, Poisonings, dermatitis, conjunctivitis, bronchitisconjunctivitis, bronchitis

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.

India :India :Extent of the problemExtent of the problemCPCB,April,2011 dataCPCB,April,2011 data

>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

Extent of the problem-ContinuedCHHATTISGARH(Annual report on BMW, 2011, CPCB)

No. of HCE- 740

No. of Bed- 14678

Total quantity of BMW generated(Kg/day) approximately 4492Kg/DayBMW treated 4492Kg/DayNo. of HCF/CBWTF violated BMW rules 20No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 20

No. CBWTF 06No. of HCE using CBWTF/ Private agencies 446No. of HCE having own treatment facility & Disposal facility 181No. of HCE applied for authorization 478No. of HCE granted authorization 425No. of treatment equipmentsINCINERATOR’S 14AUTOCLAVES 305OVEN 7SHREDDERS 358

Present practice within many of the HospitalsPresent practice within many of the Hospitals•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

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, receive, store, transport, treat, dispose, or handle bio medical waste in any form.

BIOMEDICAL WASTE(MANAGEMENT & HANDLING) BIOMEDICAL WASTE(MANAGEMENT & HANDLING) RULES by Govt. of India, 1998RULES by Govt. of India, 1998

Revised in 2011Revised in 2011Now known as BMW Rules, 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 authorisation

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

Duty of the Occupier

It is the duty of every occupier i.e. head of an institution generating bio-medical waste, to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.

Provides training to HCW engaged in handling BMW

Duty of the OperatorThe operators now have to ensure that the BMW is collected from all the HCEs and is transported, handled, stored, treated and disposed in an environmentally sound manner. The operators also have to inform the prescribed authority in form VI if any HCEs are not handing the segregated BMW as per the guidelines prescribed in the rules.

Setting up BMW treatment facilityOccupier set up adequate treatment facilities like autoclave / microwave / incinerator / hydroclave, shredder prior to commencement of its operation or ensure that the wastes are treated at a common bio medical waste treatment facility or an authorized waste treatment facility.

The new Rules have omitted incinerator as one of the pre requisites for on-site treatment of BMW. The omission is owing to the various environmental impacts of incineration.

Promotion of new technologies for treatment and disposal of waste

Deep burial for disposal of BMW has also been removed from the Rules. The Rules says it can be an option only in rural areas with no access to CTF with prior approval from the prescribed authority.

Health waste CharacterizationHealth waste Characterization

Hospital waste

Non Hazardous(≈ 75-90%)

Hazardous waste(≈ 10-25%)

InfectiousOthers

( Radioactive,Cytotoxic )

Liquid wastesLiquid wastes 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.

Solid wastesSolid 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%

WASTEWASTECATEGCATEG

ORYORY

WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL

Category Category 1 1

Human Anatomical waste (human tissues, Human Anatomical waste (human tissues, organs, body partsorgans, body parts

Incineration/deep burialIncineration/deep burial


Animal Waste: Animal tissues, organs, body Animal Waste: Animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste experimental animals used in research, waste generated by veterinary hospitals, colleges, generated by veterinary hospitals, colleges, discharge from hospitals, animal housesdischarge from hospitals, animal houses

Incineration/deep burialIncineration/deep burial


Microbiology & Biotechnology Wastes: Wastes Microbiology & Biotechnology Wastes: Wastes from clinical samples, pathology, biochemistry, from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures, hematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live or stocks specimens of micro-organisms, live or attenuated vaccines human and animal cell attenuated vaccines human and animal cell culture used in research and infectious agent culture used in research and infectious agent from research and industrial laboratories, from research and industrial laboratories, waste from production of biologicals, toxins, waste from production of biologicals, toxins, dishes and devices used for transfer of culturesdishes and devices used for transfer of cultures

Disinfection at source by Disinfection at source by chemical treatment or by chemical treatment or by Autoclaving / Autoclaving / Microwaving / followed by Microwaving / followed by Mutilation / shredding and Mutilation / shredding and after treatment final after treatment final disposal in secured landfills disposal in secured landfills or disposal of recyclable or disposal of recyclable waste (plastic or glass ) waste (plastic or glass ) through registered or through registered or authorized recyclerauthorized recycler

SCHEDULE I: CATEGORIES OF BIO-MEDICAL WASTE

WASTE WASTE CATEGORYCATEGORY


Category Category No. 4No. 4

Waste Sharps (needles, glass syringes Waste Sharps (needles, glass syringes or syringes with fixed needles, or syringes with fixed needles, scalpels ,blades, glass etc.) that may scalpels ,blades, glass etc.) that may cause puncture and cuts(Includes both cause puncture and cuts(Includes both used and unused sharps).used and unused sharps).

Disinfection (chemical Disinfection (chemical treatment / destruction by treatment / destruction by needle & tip cutter, needle & tip cutter, autoclaving/microwave and autoclaving/microwave and mutilation/shredding and mutilation/shredding and final disposal through final disposal through CBWTF / landfillsCBWTF / landfills


Discarded Medicines & Cytotoxic Discarded Medicines & Cytotoxic drugs (Wastes comprising of outdated, drugs (Wastes comprising of outdated, contaminated and discarded contaminated and discarded medicines)medicines)

Disposal in secured landfills Disposal in secured landfills or Incinerationor Incineration


Soiled Waste (Items contaminated with Soiled Waste (Items contaminated with blood, & body fluids including cotton, blood, & body fluids including cotton, dressings, soiled plaster casts, linens, dressings, soiled plaster casts, linens, beddings, other material contaminated beddings, other material contaminated with blood)with blood)

IncinerationIncineration

WASTE WASTE CATEGORYCATEGORY


CategoryCategory No.7No.7

Infectious Solid Waste (waste Infectious Solid Waste (waste generated from disposable generated from disposable items other than the waste items other than the waste sharps such as tubing's, hand sharps such as tubing's, hand gloves, saline bottles with IV gloves, saline bottles with IV tubes, catheters, glass, tubes, catheters, glass, intravenous sets etc.intravenous sets etc.

Disinfection by chemical Disinfection by chemical Treatment / Treatment / autoclaving autoclaving /Microwaving followed /Microwaving followed by mutilation / by mutilation / shredding & final shredding & final disposal through disposal through registered recyclerregistered recycler

Category Category No.8No.8

Chemical Waste ( Chemicals Chemical Waste ( Chemicals used in production ofused in production ofbiologicals, chemicals used in biologicals, chemicals used in disinfection as insecticides etc.)disinfection as insecticides etc.)

Chemical treatment and Chemical treatment and discharge into drains for discharge into drains for liquids and secured liquids and secured landfill for solidslandfill 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-IISchedule-IIColour coding and Type of Containers forColour coding and Type of Containers for

Different Biomedical WastesDifferent Biomedical Wastes Colour Colour

codingcoding

Type of Type of containercontainer

Waste Waste categocatego

ryryTreatment /Treatment /

Disposal Disposal Non chlorinated Non chlorinated Plastic BagsPlastic Bags

Incineration/Incineration/Deep BurrialDeep Burrial

Non chlorinated Non chlorinated plastic bag / plastic bag / puncture proofpuncture proofContainer for Container for sharps sharps

Chemical Chemical Treatment / Treatment /

Autoclaving / Autoclaving / Microwaving and Microwaving and

followed by followed by Mutilation & Mutilation &

shredding and shredding and disposal in landfills disposal in landfills

or disposal of or disposal of recyclable wasterecyclable waste

Non chlorinated Non chlorinated Plastic Bags /Plastic Bags /ContainersContainers

Chemical Chemical TreatmentTreatment

and discharge into and discharge into drains for liquids drains for liquids

and secured landfill and secured landfill for solidsfor solids

Non chlorinated Non chlorinated Plastic BagsPlastic Bags

Municipal Municipal wastewaste

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

Segregation, Packing, Segregation, Packing, 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.

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 BIN

For Noninfectious Solid waste

Bandages

Hum

an a

nato

mic

al

was

te-p

lace

nta

Swab stick-decontaminated

WASTE DISPOSAL

SWABS

Dressing

soiled linen, contaminated gowns, drapes

Animal waste

Discarded medicine/cytotoxic

drugs

YELLOW BIN

Category 1,2, 5,6

Human/Animal tissue organs or body partsHuman/Animal tissue organs or body partsAnimal carcassesAnimal carcassesAny non plastic soiled waste( contaminated with Any non plastic soiled waste( contaminated with

blood/ body fluids )blood/ body fluids )Cotton dressings, bandagesCotton dressings, bandagesLinen beddingsLinen beddingsSoiled plaster casts, Soiled paperSoiled plaster casts, Soiled paperUsed/ removed suturesUsed/ removed sutures

Red Dustbin & BagsRed Dustbin & BagsCotton pads, Swabs, Gauge Pieces, Dressings,Bandages, Cloths, Bedsheets and Plaster castes Soiled with blood, Pus, Vomits, Sputum and other Body Fluids.

MANAGEMENT OF HOSPITAL WASTE

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

Microbiology & laboratory waste , Waste sharps, infectious solid waste(Category3,4,7)

Wastes from clinical samples, pathology, biochemistry, Wastes from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures, stocks hematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live or attenuated vaccines specimens of micro-organisms, live or attenuated vaccines human and animal cell culture used in research and human and animal cell culture used in research and infectious agent from research and industrial laboratories, infectious agent from research and industrial laboratories, waste from production of biologicals, toxins, dishes and waste from production of biologicals, toxins, dishes and devices used for transfer of cultures devices used for transfer of cultures

Waste Sharps (needles, glass syringes or syringes with fixed Waste Sharps (needles, glass syringes or syringes with fixed needles, scalpels ,blades, glass etc.) that may cause puncture needles, scalpels ,blades, glass etc.) that may cause puncture and cuts(Includes both used and unused sharps).and cuts(Includes both used and unused sharps).

Microbiology & laboratory waste , Waste sharps, infectious solid waste(Category3,4,7)--- Continued

Infectious Solid Waste (waste generated from Infectious Solid Waste (waste generated from disposable items other than the waste sharps such asdisposable items other than the waste sharps such as Gloves,tubing, saline bottles with i. v tubes, I. V sets ,Catheters, Urine bags, Blood bags, Syringes, Suction tips, Infected plastic containers, Rubber base materials, Retraction cords

In Blue Nonchlorinated bags

Chemical waste

Chemical Treatment Chemical Treatment and and discharge into drains for discharge into drains for liquids and secured landfill liquids and secured landfill for solidsfor solids

Segregated incinerable wastes kept in Yellow bagSegregated incinerable wastes kept in Yellow bag

Segregated Autoclavable waste in red bagSegregated Autoclavable waste in red bag

General wastes of health care unit in Black bagGeneral wastes of health care unit in Black bag

Sharps in sharp containerSharps in sharp container

Personnel safety devicesPersonnel safety devicesThe use of protective gears should be made The use of protective gears should be made

mandatory for all the personnel handling waste.mandatory for all the personnel handling waste.

StorageStorageIn an area away from general traffic and accessible

only to authorized personnelDO 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

TransportTransport 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 Trolleys ,Wheelbarrows: covered

Transportation and StorageTransportation 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.

Schedule-IVSchedule-IVLabel for Transportation of Bio-Medical Waste Label for Transportation of Bio-Medical Waste

Containers / BagsContainers / Bags 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.

Treatment and DisposalTreatment and Disposal

SCHEDULE V STANDARD FOR TREATMENT AND DISPOSAL OF

BMWSTANDRAD for IncineratorSTANDARD for AutoclaveSTANDARD for Microwave

IncinerationIncineration 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

DrawbackDrawbacktoxic products like furanes and dioxins - can cause air pollution

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

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%

AutoclaveAutoclaveA 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 minutes

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

STANDARD FOR MICROWAVING

SHOULD 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.

Common waste treatment facility( CWTF)

AuthorizationAuthorizationEvery 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.

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

Annual ReportAnnual Report 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.

Maintenance of Records & Accident ReportingMaintenance of Records & Accident Reporting

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

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

Dos and DonDos and Don’’tsts

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

BMW management committeeBMW management committee

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

Responsibility of WMC Responsibility of WMC 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 )

BMW Spills & Surface DisinfectionBMW Spills & Surface Disinfection Proper spill handling:– Notify people in the area– Don appropriate PPE– Place absorbent material on spill– Apply appropriate disinfectant – allow sufficient contact time (30

min)– Pick up material (watch for glass – use tongs or dust pan); dispose

of material into biomedical waste– Reapply disinfectant and wipe– For large/high hazard spills use 10% hypochlorite For routine disinfection of surfaces where BMW is handled, use

a 1:10 solution of freshly diluted bleach or 1% hypochlorite (ethanol evaporates too quickly!)

Hand WashingHand Washing Handwashing is the single most

effective way to stop the spread of disease.

Make certain that jewelry is limited to wedding rings, certain areas such as OR< C-section,Cath Lab and NBN allow no jewelry. Nails should be kept short and clean.

Gloves do not replace handwashing. Hand sanitizer may be used if no visible soiling is present and the sinks cannot be readily accessed. This is in every patient room. It can also be used when the water is out of service.

Inspect your hands each time they are washed. Only use hospital approved soaps and lotions, do not bring in any from home

Alcohol based hand rubs at point of care Sinks and clean running water Training

Steps to Effective HandwashingSteps to Effective Handwashing Thorough hand washing

after any procedure involving nursing care or close contact with the patient is essential.

Alchol based hand antiseptics gaining importance where washing with water and soap are not practicable.

Biomedical Waste Management - Biomedical Waste Management - IssuesIssues

• 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

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

– Non compliance with color codingNon compliance with color coding– Monitoring segregation at source – low budgets Monitoring segregation at source – low budgets

allocated – costs are not always known/nor worked allocated – costs are not always known/nor worked out properlyout properly

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

– Quantification of waste generated is not accurately Quantification of waste generated is not accurately donedone

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

ConclusionConclusionBio-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.

Dr. SANJAY SINGH NEGIAssistant Professor, Microbiology,AIIMS, Raipur, Chhattisgarh

Biomedical waste managment rule 2011

Health & Medicine

Transcript of Biomedical waste managment rule 2011