BIO-MEDICAL WASTE MANAGEMENT

With specific reference to RML Hospital, New Delhi

PROJECT TEAM
DEV SAROHA
ISHAN GUPTA SHARVIE JAIRATH SURBHI GUPTA

INTRODUCTION
WHAT IS BIO MEDICAL WASTE?
Bio Medical waste is any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining to or in the production or testing of biologicals and categories mentioned in schedule 1 of Bio-Medical Waste(Management and Handling).

SOURCE OF BIO MEDICAL WASTE Biomedical waste is generated in hospitals, nursing homes, clinics, medical laboratories, blood banks, animal houses etc. Such a waste can also be generated at home if health care is being provided there to a patient (e.g. injection, dressing material etc.)

NEED FOR BIO-MEDICAL WASTE MANAGEMENT

The objectives of BMW management are:
(a) (Statutory) Legal Obligation : In accordance with the provisions of the Bio-Medical Waste (Management and Handling) Rules 1998,by which the rules must be conformed with, failing which legal action can be initiated. (b) Health hazards associated with improper hospital waste management: A number of hazards and risks are associated with this like injuries from sharps to hospital personnel and waste handlers, infections in patients, risks associated with hazardous chemicals being handled by persons handling wastes at all levels. (c) Environmental hazards: Improper hospital waste management also results in air, water and soil pollution, especially due to imperfect treatment and faulty disposal methods.

CLASSIFICATION OF HOSPITAL WASTE

PROVISIONS OF THE LAW

Safe disposal of biomedical waste is now a legal requirement in India:-

The ministry of Environment and Forests notified the Bio Medical Waste (Management and Handling) Rules, 1998 in July 1998. In acc. with these rules, it is the duty of every occupier i.e. a person who has the control over the institution or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. The hospitals, nursing homes, clinics, dispensaries, pathological laboratories etc., are therefore required to set in place the biological waste treatment facilities. Environment Protection Act, 1986 (29 of 1986) Motor Vehicles Act, 1988 The Air (Prevention And Control Of Pollution) Act, 1981

BIO-MEDICAL WASTE MANAGEMENT PROCESS

The vital steps for safe and scientific management of biomedical waste management in any establishment are:-

WASTE TREATMENT AND DISPOSAL STORAGE OF BIO-MEDICAL WASTE SEGREGATION AND PACKAGING LABELING AND LOCATION TRANSPORTATION OF WASTE FINAL DISPOSAL

CATEGORIES OF WASTE AND METHODS OF THEIR DISPOSAL

Category
Category 1 Category 2 Category 3 Category 4 Category 5 Category 6 Category 7

Waste Type
Human Wastes (Tissues, organs, body parts Animal Waste Microbiology and Biotechnology waste

Treatment and Disposal Method

Incineration / deep burial * Incineration / deep burial * Autoclave/microwave/incineration Disinfection (chemical treatment)+/autoclaving/microwaving and mutilation shredding** Incineration/ destruction and drugs disposal in secured landfills Incineration/autoclaving / microwaving Disinfection by chemical treatment+ microwaving/autoclaving & mutilation shredding*

Sharps Discarded Medicines and Cytotoxic Drugs Contaminated solid waste Solid waste (disposable items other than sharps) Liquid waste (generated from laboratory washing, cleaning, housekeeping and disinfecting activity) Incineration ash

Category 8

Disinfection by chemical treatment+ and discharge into the drains Disposal in municipal landfill Chemical Treatment + and discharge in to drain for liquids and secured landfill for solids

Category 9 Category 10

Chemical Wastes

STORAGE OF BIOMEDICAL WASTE

The central storage area in a hospital should be ideally situated on the ground floor near the rear entrance.This makes the transportation of waste to the site of final disposal easier. The central storage area should have sufficient storage capacity to store the required number of waste bags, depending upon the quantum of waste generated in the hospital. It should have good flooring, light, ventilation, water supply and drainage system.

A full time storekeeper should be there to receive and dispatch the waste and to maintain proper record
As per rules BMW can not be stored for more than 24 to 48 hrs.

SEGREGATION AND PACKAGING

1. 2. Bio-medical waste is not mixed with other wastes. Bio-medical waste is segregated into containers/bags at the point of generation in accordance with Schedule II prior to its storage, transportation, treatment and disposal. The containers are labeled according to Schedule III. If a container is transported from the premises where biomedical 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. Notwithstanding anything contained in the Motor Vehicles Act, 1988 or rules there under, untreated biomedical waste is transported only in such vehicle as is authorized for the purpose by the competent authority as specified by the government.

3.

4.

COLOUR CODING OF DISPOSAL

LABELING AND LOCATION

1. All the bags and containers are labeled bio-hazard or cytotoxic with symbols according to the rules. 2. The quantity of collection is documented in a register. The colour plastic bags are replaced and the garbage bin is cleaned with disinfectant regularly. 3. The bags are filled three-fourth capacity, tied securely and removed from the site of the generation to the storage area regularly and timely. 4. All containers having different colored plastic bags are located at the point of waste generation i.e. near OT tables, injection rooms, dressing trolleys etc.

TRANSPORTATION
Transportation within the hospital: Within the hospital, waste routes are
designed to avoid the passage of waste through patient care areas. Separate time schedules are prepared for transportation of bio-medical waste and general waste. Dedicated wheeled containers, trolleys or carts with proper label are used to transport the waste from the site of treatment. Transportation outside the hospital: Notwithstanding anything in the Motor Vehicles Act, 1988, bio- medical waste is transported only in such vehicles as may be authorized for the purpose by the competent authority.

FINAL DISPOSAL OF WASTE

Treatment is done in-house, but it could also be done by Common Bio-Medical Waste Treatment Facility (CBWTF) which is set up across each state and union territory. In Delhi it is taken up by Synergy Waste Management Company and Biocare Tech. Services. The treated BMW is disposed as follows:
SNo.
1. 2.

Waste Category
Plastic wastes after disinfection and shredding Disinfected Sharps (except syringes) (i) If encapsulated (ii) If non-encapsulated

Disposal Method
Recycling or municipal landfill

Municipal landfill Municipal landfill/ Possibility of recycling shall be explored Secured landfill Municipal landfill

3. 4.

Incineration ash Other treated solid wastes

5.
6.

Oil & grease

Treated waste water

Incineration
Sewer/drain or recycling

FIELD RESEARCH

ON BIO-MEDICAL WASTE MANAGEMENT IN INDIA

TO Dr. Ram Manohar Lohia Hospital

This hospital is fully funded by the Government of India (Ministry of Health and Family Welfare). In a year this hospital provides services to about 12 lakh patients as OPD cases, admits about 46,000 patients in Indoor and about 1.5 lakh patients are attended in the Emergency. Similarly about 5,000 CT Scan, 1.70 lakh X-Ray cases, 28 lakh laboratory tests and about 17,000 Ultrasound are done. Hospital conducts about 9,000 Major and 40,000 Minor operations during a year.

RESEARCH FINDINGS
For the treatment of BMW generated the hospital has: TWO INCINERATORS consisting of:

TREATMENT AND DISPOSAL OF WASTE

1.

Rotary Kiln (primary chambers)

2.

Afterburner (secondary chambers)

3.

Heat recovery

4.

Ventury (Radiation Control System)

ONE MICROWAVE MACHINE to sterilize the waste

 TWO SHREDDERS The disinfected waste is then shredded in the

shredder which makes the disinfected waste form into finer particles.

The central storage area in the hospital is situated near the rear entrance. The central storage area had sufficient storage capacity. A full time storekeeper was employed to dispatch the waste and to maintain proper records.

STORAGE OF WASTE

Bio-medical waste is not mixed with other wastes. Medical waste is segregated into containers in accordance with Schedule II prior to its storage, transportation, treatment and disposal.

SEGREGATION AND PACKAGING

All the bags and containers are labeled bio-hazardous with symbols according to the rules. The bags are filled three-fourth capacity, tied securely and removed from the site of the generation to the storage area regularly and timely.

LABELLING AND LOCATION

TRANSPORTATION OF WASTE WITHIN THE HOSPITAL

Within the hospital, waste routes are designed to avoid the passage of waste through patient care areas. Dedicated wheeled trolleys or carts with proper label are used to transport the waste from the site of treatment.

Treatment is done in-house, but it could also be done by Common Bio-Medical Waste Treatment Facility (CBWTF).

FINAL DISPOSAL OF BIO-MEDICAL WASTE

CONCLUSION
Among ten categories of biomedical waste, sharps are the most vulnerable as they transmit the infection directly by body puncture. The hospital ensures that they perform whatever they can in this field. The Information, Education and Communication (IEC) approach is followed by enhanced knowledge, changed attitude and safe practices through appropriate education, training and the commitment of the healthcare staff, management and healthcare managers within an effective policy and legislative framework. The hospital demonstrates its actions to dispose of waste and uphold its statutory responsibilities. The results of the study demonstrate that the strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste in hospitals as well can reduce the BMW to a large extent. The BMW policy needs to be further refined to achieve a ZERO WASTE STATE as has been achieved by many countries by Reducing, Recovering, Reusing and Disposing.

The report found that the primary steps to ensure better waste management in India are as follows:
Evaluate the present scenario. This entails preaudit and auditing of hospital wastes. Preparation of job charts for hospital waste management. Asses all cost associated with waste management. Define management policies for waste management.

Train the trainees and employers. Evaluate technical procedures , costs and policies yearly. Steps in waste management:-waste survey, waste minimization, waste segregation and safe storage and waste treatment and waste handling, waste transportation, waste disposal.

Do not burn any waste in the hospital premises. Keep the Hospital premises clean.

THIS IS THE BEGINNING OF HEALTH CARE WITHOUT HARM..

THANK YOU