Practices in Biomedical Waste

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University Of LucknowDepartment Of Business Administration

Environmental ManagementAssignment On:

PRACTICES IN BIOMEDICAL WASTE

Submitted To: Submitted By:Prof Ajai Prakash Lalit GautamSection-BMBA Sem 1st

INDEXSr.No. Content Page No.

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Acknowledgement

Abstract

Introduction.

Biomedical Waste: Meaning.

Areas of waste generation.

Responsibilities of Hospitals.

Landmark Decisions

Classification of Biomedical Waste..

Biomedical Waste Management Process.

Biomedical Waste Management System.

Issues

The Indian Context..

Conclusion

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ACKNOWLEDGEMENTIt is no longer resources that limit decisions. It is the decision that makes resources. This fundamental revolutionary change perhaps the most revolutionary, man has ever known. For making this project I am highly thankful to my sir Prof. Ajai Prakash for helping me in selection of topic Practices In Biomedical Waste for my term paper assignment. I am also thankful to my family without their support I wouldnt be able to do this project. My mother gave her support so that I can work harder, my father supported financially so that I have the best resources and to my elder sister and younger brother who gave their ideas regarding the topic. My Friends are the encouragement to the project. The assignment is made directly and indirectly from books, articles and other publications including contents available on internet and hence, they should also be thanked. I would also thank GOD for making me a good human being and a part of this world. Lastly I would thank myself as some views expressed in this are my personal opinion. I had a great experience in making this project and gain knowledge on topic Practices In Biomedical Waste

Abstract

Hospitals generate waste which is chemically hazardous, infectious and often radioactive. Such waste because of inappropriate disposal/treatment strategies contributes to serious health hazards in the community. The main concern of infectious hospital waste is the transmission of HIV and infectious hepatitis viruses. As regulatory measures, the Bureau of Indian Standards, New Delhi has issued guidelines for the management of Solid Wastes-Hospitals 1989. The Ministry of Environment and Forests has also issued rules on the categorization of biomedical waste in 1997-98. The implementation of the above could mitigate the ill effects of the exponentially increasing problem of biomedical waste in India.

INTRODUCTIONHospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals are known for the treatment of sick persons but we are unaware about the adverse effects of the garbage and filth generated by them on human body and environment. Now it is a well established fact that there are many adverse and harmful effects to the environment including human beings which are caused by the Hospital waste generated during the patient care. Hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases. Air pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin, Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and the diseases transmitted through improper disposal of hospital waste. This problem has now become a serious threat for the public health and, ultimately, the Central Government had to intervene for enforcing proper handling and disposal of hospital waste and an act was passed in July 1996 and a bio-medical waste (handling and management) rule was introduced in 1998.A modern hospital is a complex, multidisciplinary system which consumes thousands of items for delivery of medical care and is a part of physical environment. All these products consumed in the hospital leave some unusable leftovers i.e. hospital waste. The last century witnessed the rapid mushrooming of hospital in the public and private sector, dictated by the needs of expanding population. The advent and acceptance of disposable has made the generation of hospital waste a significant factor in current scenario.

BIOMEDICAL WASTE: MEANINGAny solid, fluid and liquid or liquid waste, including its container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human being or animals, in research pertaining thereto, or in the production or testing of biological and the animal waste from slaughter houses or any other similar establishment. All biomedical waste are hazardous. In hospital it comprises of 15% of total hospital waste. Biomedical waste refers to all wastes generated from healthcare and health research facilities and associated laboratories. While most of this is communal waste, a small percentage can be deemed infectious and/or hazardous. These include infected sharps and wastes with infectious, hazardous, radioactive, or genotoxic characteristics, which if inadequately treated and managed can have adverse impact on the environment and on public health through air, land and water pollution. Therefore institutionalizing effective waste management systems in all healthcare facilities is a key prerequisite to improving efficiency and effectiveness of healthcare.The regulatory framework for environmental management in the health sector in India is provided by the Bio-Medical Rules (prepared in 1998; amended in 2000 and 2003), which apply to all persons/institutions generating and/or handling healthcare waste in any form. The Rules define bio-medical waste as any waste which is generated during diagnosis, treatment or immunization of human beings or animals, or in research activities or in the production or testing of biological and including categories mentioned in schedule-I of the rules. The Rules, besides identifying the various waste categories, also recommend treatment and disposal methods and the standards to be laid down for the same.

Areas of waste generation and kinds of waste generated:

S.No.Areas Of Waste GenerationActivities PerformedTypes Of Waste GeneratedConsumables Used For Managing Waste

1.OperationTheatreFamily planning procedures,Cataract surgeries. Minor Surgical ProceduresBlood and body fluids, soiled waste, swabs, cotton, syringes and needles,blades, gloves and masksColored bags, bins, hub cutter or destroyer, 1% bleaching powder solution, Puncture Proof Container.

2.Labour RoomChild birth(Deliveries)Placenta, blood and body fluids, soiled waste, cotton, swabs, syringes and needles, blades, tubings and IV sets masks and gloves- do-

3.LaboratoryMalarial smears, TB testingand other essential laboratoryservicesBlood and body fluids, syringes and needles, gloves, slides, sputum andsputum cups, chemical waste and liquid waste- do-

4.Injection RoomImmunizationand curativeinjectionsSyringes and needles, ampoules, vials, broken glasses, gloves and vaccine waste- do-

5.WardIn-patient servicesBlood and body fluids, syringe and needle, slides, ampoules, vials, chemical waste, liquid waste, broken thermometer and soiled waste- do-

6.OPDOut-patient services, routineexaminationof patientsBlood and body fluids, syringes and needles, slides, ampoules, vials, brokenthermometer, plaster cast chemical waste and liquid waste,

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7.StoreStoreDiscarded medicineGreen bag and bin

Responsibilities of hospitals

It is mandatory for such institutions to:

Set up requisite biomedical waste treatment facilities like incinerators, autoclave and microwave systems for treatment of the wastes, or ensure requisite treatment of the waste at a common waste treatment facility

Make an application to the concerned authorities for grant of authorization. A fee as prescribed shall accompany each application for grant of authorization.

Submit a report to the prescribed authority by 31 January every year. The report should include information about the categories and quantities of bio-medical wastes handled during the preceding year.

Maintain records about the generation, collection, reception, storage, transportation, treatment, disposal and / or any form of handling of bio-medical waste.

Report of any accident to the prescribed authority.

LANDMARK DECISIONS TO STREAMLINE HOSPITAL WASTE MANAGEMENT:With increasing awareness in general populations regarding hazards of hospital waste, public interest litigations were filed against erring officials. Some landmark decisions to streamline hospital waste management have been made in the recent past. These are:1. Supreme Court judgment dated 1st March 1996 in connection with safe disposal of hospital waste ordered that(a) All hospitals with 50 beds and above should install either their own incinerator or an equally effective alternative method before 30th November 1996.(b) The incinerator or the alternative method should be installed with a necessary pollution control mechanism conforming to the standard laid down by Central Pollution Control Board (CPCB).(c) Hazardous medical waste should be segregated as source and disinfected before final disposal.2. Ministry of Environment & Forest, Govt. of India issued a notification for Biomedical Waste(Management & Handling) Rules 1998 in exercise of powers conferred by Section 6, 8 & 25 of the Environment (Protection) Act, 1986 that was published in The Gazette of India Extraordinary, Part-II, Section 3-Sub-Section (ii) New Delhi, July 27, 1998 .3. The Delhi Pollution Control Committee has been designated as Prescribed Authority to implement these rules in the National Capital Territory of Delhi. The Financial Commissioner has been designated as appellate authority in Delhi.4. In exercise of the Powers conferred by Rule 9 of the Bio-Medical Waste (Management & Handling) Rules, 1998, the Lt. Governor of Delhi has constituted an Advisory Committee Vide to act such authority under the said Rules. The composition of the Advisory Committee has 10 members with Pr. Secretary (Health), Govt. of Delhi as Chairman and Director Health Services as Member Secretary / Convener. Under Chairmanship of Principal Secretary (Health & Family Welfare) this Committee meets from time to time to discuss and decide about various issues connected with these rules. It is primary responsibility of the government to implement the recommendations and directions of the Supreme Court and Biomedical Waste (Management & Handling) Rules 1998 in public interest, so that Bio-medical waste does not cause any harm to men, animal and environment.

CLASSIFICATION OF BIO MEDICAL WASTEBiomedical waste is categorized into ten categories and treatment process is different for every category. This could be easily understood by the following table:WasteCategoryType of wasteTreatment And Disposal Option

Category 1Human Anatomical Waste (Human tissues, organs, body parts)Incineration/deep burial

Category 2Animal Waste (Animal tissues, organs, body parts, carcasses, Bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals andcolleges, discharge from hospitals, animal houses)Incineration/deep burial

Category 3Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal cell cultures used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins and devices used for transfer of cultures)Local autoclaving/ microwaving / incineration

Category 4Waste Sharps (Needles, syringes, scalpels, blades, glassDisinfecting (chemical treatment / autoclaving / microwaving and mutilation / shredding

Category 5Discarded Medicine and Cytotoxicdrugs (Wastes comprising of outdated, contaminated and discarded medicines)Incineration / destruction anddrugs disposal in secured landfills

Category 6Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.)Incineration / autoclaving / microwaving

Category 7Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.)Disinfecting by chemical treatment/ autoclaving / microwaving and mutilation / shredding

Category 8Liquid Waste (Waste generated from the laboratory and washing, cleaning, housekeeping and disinfecting activities)Disinfecting by chemical Treatment and discharge into drains

Category 9Incineration Ash (Ash from incineration of any biomedical waste)Disposal in municipal landfill

Category 10Chemical Waste (Chemicals used in production of biological, chemicals used in disinfecting, as insecticides, etc.)

Chemical treatment and discharge into drains for liquids and secured landfill for solids.

BIOMEDICAL WASTE MANAGEMENT PROCESS:Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India).1. Segregation of wasteSegregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms, treatment rooms etc. The responsibility of segregation should be with the generator of biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical personnel).Dos1. Always segregate waste into infectious and non-infectious waste at source of generation as per the color coding in the health care facility like CHC/PHC/Sub centre2. Infectious waste includes Sharps: Needles, blades, broken glass which are to be disposed in white/ blue puncture proof container Non-Sharps (soiled waste): Infected plastics, syringes, dressings, gloves, masks, blood bags, urine bags are to be disposed in red plastic bins/bags Anatomical waste: Placenta, body parts to be disposed in yellow plastic bins/bags3. Non-infectious (General) waste includes waste similar to household waste like packaging material, cartons, fruit and vegetable peels, syringe and needle wrappers, medicine covers to be disposed in green/black plastic bins or bags.

DontsNever mix infectious and non-infectious waste either at source of generation, during waste collection, waste storage, waste transportation or during final disposal of waste2. Collection of bio-medical wasteCollection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At ordinary room temperature the collected waste should not be stored for more than 48 hours.Dos Always collect the waste in covered bins Fill the bins up to the 3/4th level Clean the bins regularly with soap and water/disinfect the bins regularly

Donts Never overfill the bins Never mix infectious and non-infectious waste in the same bin Never store waste beyond 48 hrs3. Transportation of wasteWithin hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separate time should be earmarked for transportation of bio-medical waste to reduce chances of its mixing with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment.Dos Always carry/transport the waste in closed containers Use dedicated waste collection bins/trolleys/wheel barrows for transporting waste Transport waste through a pre-defined route within the health care facility

Donts Never transport the waste in open containers or bags, it may spill and lead to spread of infections Never transport waste through crowded areas4. Treatment of biomedical waste Deep burial Autoclave Microwave treatment Shredding Disposal to Secured landfills IncinerationDos Always remember to disinfect and mutilate the waste before its final disposal Remember the following while treating the waste streams Anatomical waste to be deep buried Syringes to be cut (with hub cutters) and chemically disinfected with 1% bleaching powder solution at source of generation before final disposal into sharps pit Infected plastics to be chemically disinfected or autoclaved, shredded and recycled and sent for final disposal into municipal dumps General waste without any treatment to be sent to waste dumps for final disposal

Donts Never throw infectious waste into general waste without any pre-treatment and mutilation

Biomedical waste treatment system

The Biomedical waste treatment and disposal are to be done very carefully, as it is infectious in nature. Considering the then level of information and knowledge, the Government of India has specifically laid down the treatment and disposal options. All health care institutions are required to follow this without fail. As per the Rule, the biomedical waste has to be treated and disposed of in accordance with options suggested under Schedule I, and in compliance with the standards prescribed in Schedule V of the Rule.Any biomedical waste treatment system should comprise of segregation at source, storage in color coded containers, systematic collection, transportation to treatment site, treatment considering the type of waste and disposal considering the type of waste. Segregation of biomedical waste is based on the category of waste. Storage and collection of waste in color-coded containers is based on the treatment adopted. The treatment options for biomedical waste as per the schedule I of the Rules are incineration, deep burial, autoclave, microwave, chemical treatment, destruction and shredding, and disposal in secured landfills. Disinfection refers to procedures, which reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganisms or spores. Sterilization on the other hand, refers to procedures, which would remove all microorganisms, including spores, from an object. Sterilization is undertaken either by dry heat (for 2 hours at 170oC in an electric oven - method of choice for glass ware and sharps) or by various forms of moist heat (i.e. boiling in water for an effective contact time of 20 minutes or steam sterilization in an autoclave at 15 lb/sq inch at 121oC for 20 minute)

Specifications of equipments:

Incinerator: The biomedical waste incinerator shall meet the following operating and emission standards: Operating standards1. Combustion efficiency (CE) shall be at least 99.00 %.2. The temperature of the primary chamber shall be 800 +/-50Oc3. The secondary chamber gas residence time shall be at least 1 (one) second at 1050 +/- 50Oc Emission standards: Waste to be incinerated not to be disinfected with chlorine containing substances. Chlorinated plastics should not be incinerated. Toxic metals in incineration ash should be limited to within regulatory quantities. Only low sulphur fuels like LDO/LSHS to be used as fuel

Deep Burial A pit or trench should be dug about 2 m deep. It should be half filled with waste, and then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil. It must be ensured that animals do not have access to burial sites. Covers of galvanized iron/wire meshes may be used. On each occasion, when wastes are added to the pit, a layer of 10cm of soil be added to cover the wastes. Burial must be performed under close and dedicated supervision. The deep burial site should be relatively impermeable and no shallow well should be close to the site. The pits should be distant from habitation, and sited so as to ensure that no contamination occurs of any surface water or ground water. The area should not be prone to flooding or erosion. The location of the deep burial site will be authorised by the prescribed authority. The institution shall maintain a record of all pits for deep burial.

AutoclavingThe basic objective of autoclaving is to disinfection and treating biomedical waste.1. When operating a gravity flow autoclave, medical waste shall be subjected to: A temperature of not less than 1210C and pressure of 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes; or A temperature of not less than 1350C and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes; or A temperature of not less than 1490C and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes.2. When operating a vacuum autoclave, medical waste shall be subjected to a minimum of one pre vacuum pulse to purge the autoclave of all air. The waste shall be subjected to the following A temperature of not less than 1210C and a pressure of 15 psi for an autoclave residence time of not less than 45 minutes; or A temperature of not less than 1350C and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes. Medical waste shall not be considered properly treated unless the time, 4. Temperature and pressure indicators indicate that the required time, temperature and pressure are reached during the autoclave process. If for any reason, time, temperature or pressure indicator indicates that the required temperature, pressure or residence time was not reached, the entire load of medical waste must be autoclaved again until the proper temperature, pressure and residence time were achieved.5. Recording of operational parameters: Each autoclave shall have graphic or computer recording devices which will automatically and continuously monitor and record dates, time of day, load identification number and operating parameters through out the entire length of the autoclave cycle.6. Validation test7. Spore testing: The autoclave should completely and consistently kill the approved biological indicator at the maximum design capacity of each autoclave unit. Biological indicator for autoclave shall be Bacillus stearothermophilus spores using vials or spore strips, with at least 1*104 spores per million. Under no circumstances will an autoclave have minimum operating parameters less than a residence time of 30 minutes, regardless of temperature and pressure, a temperature less than 121 0C or a pressure less than 15 psi.8. Routine tests: A chemical indicator strip/tape that changes colour when a certain temperature is reached can be used to verify that a specific temperature has been achieved. It may be necessary to use more than one strip over the waste package at different location to ensure that the inner content of the package has been adequately autoclaved.

Microwave Treatment1. Microwave treatment shall not be used for cytotoxic, hazardous or radioactive wastes, contaminated animal carcasses, body parts and large metal items.2. The microwave system shall comply with the efficacy tests/routine tests and a performance guarantee, may be provided by the supplier before operation of the unit.3. The microwave should completely and consistently kill bacteria and other pathogenic organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit. Biological indicators for microwave shall be Bacillus subtilis spores using vials or spore strips with a least 1*104 spores per ml.

Chemical Treatment1 % hypochlorite solution can be used for chemical disinfection.

Destruction and ShreddingThe discarded medicine shall be destructed before disposal. It is advisable that the discarded medicines are returned to the manufacturer for destruction. The solid materials, particularly plastic shall be shredded before sending to the recyclers. These materials are to be disinfected before shredding.

Disposal in Secured Land fillsThis is an arrangement for disposal of discarded medicine and chemical waste. The waste is disposed in certain landfills which are meant for it. These landfills are far away from society so that no one can be harmed by the waste.

Serious Issues Regarding Biomedical Waste: The segregation of waste in almost all hospitals is not satisfactory. Color coding for various categories of waste is not followed. The storage of biomedical waste is not in isolated area and proper hygiene is not maintained. Personal protective equipment and accessories are not provided. Most of the hospitals do not have proper waste treatment and disposal facilities. In the cities where common treatment facilities have come up, many medical establishments are yet to join the common facility. Emission monitoring of five incinerators indicated that they do not meet the emission norms. Most of the incinerators are not properly operated and maintained, resulting in poor performance. Sometimes plastics are also incinerated leading to possible emission of harmful gases. Several hospitals have not applied to State Pollution Control Board for authorization under the rules. General awareness among the hospital staff regarding biomedical waste is lacking.

The Indian ContextUntil recent times, hospital waste in India was not segregated before disposal to the dump or incinerator. Traditionally, recycling in India is conducted from the dumping grounds of immense waste where freelance workers or rag pickers scour the waste manually and sort for recyclable material. These workers then contact relevant industries, which acquire the waste from them. Since most of these rag pickers are women and children from the lowest socio-economic strata, awareness of health risks in general is poor. As a result many of them contract diseases from syringes and needles and other biomedical waste and become carriers of great health risk to the general populace. Since their traditional rejection from mainstream society (as untouchables) and their re-emergence as a political front in recent times, it is germane to call for further legislation to ensure education, awareness and health care facilities for their special status, in the context of health hazards in the recycling industry. The Government of India in a recent Gazette notification of 20th July 1998 has classified biomedical waste under Schedule I, into ten categories. Under this notification, rules have been framed for the management and disposal of biomedical wastes. These are:

Human anatomical wastes, blood and body fluids. Animal and slaughter house waste. Microbiology and biotechnology waste. Waste sharps. Discarded medicines Solid waste.

Hospitals should not exclusively depend on incinerators for disposal of biomedical wastes. There is no single technology available for the treatment of hospital waste. Hospitals should segregate the waste and decide about the technological option appropriate for the management of waste disposal. For example, contaminated plastics need to be disinfected and shredded while pathological waste may be incinerated. In India, most of the medical administrations have focused on installing disposal technologies while not implementing waste management practices within the hospital premises. New emerging technologies are being developed in order to have more effective control, with proclivity on complete recycling of wastes such as: Plasma Torch Technology Detoxification Technology Advanced Wet Oxidation Technology Thermal Dry Heat Technology Irradiation Gas sterilization

CONCLUSION AND SUGGESTIONS TO COMBAT BIOMEDICAL WASTE IN HOSPITALS:The hospitals and bio medical facilities meant to ensure better health have unfortunately become a potential health risk due to mismanagement of the infectious waste. BMW from hospitals, nursing home and other health centers composed of variety of wastes like hypodermic needles, scalpels blades, surgical cottons, gloves bandages, clothes, discarded medicine, blood and body fluids, human tissues and organs, radio-active substances and chemicals etc. This area of waste management is grossly neglected.The researcher, therefore, states that there needs to be requisite emphasis on the following which could be done through a program that includes:1. Updated Guidelines for the segregation, management and disposal of infectious or potentially infectious biomedical waste.2. Reduce the incidence of health care worker and the public from contacting a disease or injury from biomedical waste.3. Provide guidance to the health care system on the opportunities for waste minimization and the reduction of air contamination from incineration of biomedical waste.4. Strategies and appropriate handling techniques for bio-medical waste management5. Create awareness about Hospital accreditation with focus on guidelines related to healthcare safety issues related with disposal of Bio-Medical Waste.6. Understand the new technologies available for Safe disposal of Bio medical Waste from Environment friendliness point of view & infection control in hospitals7. Economic issue involved in Management of Bio-Medical Waste & Role of Public-Private Partnership8. Also, it should be made mandatory for the following to be a part of the above mentioned programme in order to increase the awareness among them so as to ensure better treatment of the bio-medical waste in the hospitals: Medical Superintendents/ Hospital Administrators Doctors running their own healthcare facility Hospital Laboratory Services Providers. Hospital Administrators Senior Nurses and paramedical staff Allied Health Professionals Consultants Healthcare Waste Management related industry Owners Quality Managers Hospital House Keeping Officers

BibliographyI have taken reference from the following links:1. www.legalindia.in/bio-medical-waste-management-in-hospitals1. envfor.nic.in/legis/hsm/biomed.html1. en.wikipedia.org/wiki/Biomedical_waste1. www.iapsmupuk.org/journal/index.php/IJCH/article/view/1501. www.thehindu.com/todays-paper/tp national/tp.../article2864380.ece