Biomedical Waste Management
Dr. Manu Mathur
manu.mathur@phfi.org
Presentation Outline
Introduction to Biomedical Waste
Indian Scenario
Laws regarding BMW Management Issues concerning BMW Group Work
Consider A Scenario
You have got an opportunity to work in a trauma center at a newly established hospital at Gangtok. As your first assignment you have to take care of a patient named Joseph, male aged 45 yrs, who has met an accident 7 days back and is suffering form multiple fractures and injuries, also he has lost his right foot because of trauma induced sepsis, and is still on multiple IV antibiotic and pain killers, his MRI has revealed concussion injuries, and whole body CT revealed fracture shaft femur, ribs, and vertebral dislocation. Also, the patient had gone into Nosocomial infection induced sepsis. You have been given the task to establish the Infection control and waste management system for the trauma center as it is assumed that the hospital infection rates are soaring because of their absence.
How will you address the problem?
Defining Biomedical Waste
Bio medical waste has been defined as waste generated during diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals.
Know your Hospital Waste
Non Hazardous (General Waste)
Kitchen waste Office waste Wrapping papers Dirty water Peels of Fruits Wrapping Foils
Biomedical Waste
Infectious Wastes sufficient concentration of bacteria, virus, parasites and fungi to cause diseases. Sharps items that can cause cuts or puncture wounds. E.g. needles, scalpels, blades, knifes, broken glass. Cytotoxic Drugs have the ability to stop growth of certain living cells and are used as chemotherapeutic agents.
Biomedical Waste
Pharmaceutical Waste expired drugs, spilled pharma products, vaccines which are not useful. Radioactive Waste produced during in vitro analysis of body tissue, organ imaging and tumour localization. Chemicals formaldehyde, glutaraldehyde and photographic chemicals. Used in diagnostic, experimental work and during cleaning and disinfecting.
Status of Health Care Waste Generation in South Asia
Status of Health Care Waste Generation in South Asia
Historical Perspective
Quantum jump in technological field applicable to us since last two decades .Synergized by increasing clientele Increased awareness in health professionals & public. Florida Beach Wash-up or Syringe Tides , awakening in USA. Dr. B.L.Wadhera Vs Union of India Honable Supreme Court of India 1996 Bio Medical Waste ( Management and Handling ) Rules , 1998 ( Min. of Environment & Forest)
Concerns in Infectious Waste
Infectious Waste
Can invade the body through cuts, abrasion, mucous membrane, inhalation. Body fluids acts as vehicles for transmission. Hospital labs develop resistant strains.
Sharps Waste
Radioactive Waste
Spread HIV infection, Hepatitis B and C Globally 2% of HIV infections (96000) are caused due to unsafe injection practices
Causes radiation burns, headache, dizziness, vomiting, genotoxicity. Goiania, Brazil (1988), Mexico City (1962), Algeria (1978), Morocco (1983)
Concerns in Infectious Waste
Mercury
Neuro and nephro toxic substance Can be spread through air, water, food or skin. Pulmonary oedema, confusion, tremors and even death.
Cytotoxic Drugs
Carcinogenic and mutagenic
Glutaraldehyde
Skin irritant Occupational Asthma
Vulnerable Populations
Doctors Nurses Patients Visitors to the patient Workers in waste handling facilities Ragpickers
Networks
Safe Injection Global Network (SIGN)
Global Alliance for Incineration Alternatives
Health Care Without Harm (HCWH)
Health and Us Medical Waste Action Network (HUMAN)
Biomedical Waste (Management & Handling) Rules 1998
First set of draft rules came out in 1995 They recommended on site incineration in all health facilities having 30 or more beds. Final rules came out on July 20, 1998. Schedule I categorises bio-medical waste into 10 categories and enumerates treatment and disposal options for each of them. Healthcare institutes are free to select the option best suited to them. Schedule V provides the standards for treatment and disposal of bio-medical waste, including standards for technologies, liquid waste and deep burial.
Snapshots
The law prescribes a maximum time limit of 48 hours for storing waste. Chlorinated plastics are not be incinerated. No chemical pretreatment of waste is allowed before incineration.
The label shall be non-washable and visible prominently. It should have details such as the date, category, class and description of waste. If transported off-site, the contact details of the sender and receiver should also be mentioned on the label. For use of treatment options not specified in the rules, one shall approach CPCB to get the standards laid down.
Environmental Protection Act
Section 6
Section 8 Section 10
This section empowers the Central Government to make rules in respect of all or any environmental issues.
no person shall handle, or cause to be handled, any hazardous substance except in accordance with such procedure and after complying with such safeguards as may be prescribed.
Power of entry or inspection.
Environmental Protection Act
Section 11 Section 15 Section 16 Section 17
Power to take samples
Penalty for contravention of the provisions of the Act and the Rules, Orders and Directions
Offences by companies
Offence by a Government agency
Categories of Biomedical Waste
Category
Category 1
Category 2 Category 3 Category 4
Type of Waste
Human anatomical wastes
Animal wastes Microbiology and biotechnology wastes Sharps waste
Disposal
Incineration /deep burial
Incineration /deep burial Local autoclaving/ micro waving/ incineration Disinfections (chemical treatment /autoclaving/micro waving and mutilation shredding Incineration / destruction & drugs disposal in secured landfills
Category 5
Discarded medicines and cytotoxic drugs
Categories of Biomedical Waste
Category 6 Soiled Waste (Items contaminated with blood and body fluids Solid Waste (waste generated from disposable items other than the waste sharps such as tubing, Catheters) Liquid Waste (waste generated from laboratory & washing, cleaning , hand disinfecting activities) Incineration Ash Chemical wastes Incineration, autoclaving/micro waving Disinfections by chemical treatment autoclaving/micro waving& mutilation shredding. Disinfections by chemical treatment and discharge into drain Disposal in municipal landfill Chemical treatment & discharge into drain for liquid & secured landfill for solids Category 7
Category
Type of Waste
Disposal
Category 8
Category 9 Category 10
Colour Codes for Waste Disposal Human, animal and
Yellow Plastic Bag
microbiological waste, soiled waste (Cat. 1,2,3,and 6) Microbiological and biotechnological waste, soiled waste, solid waste (Cat. 3,6,7) Incineration/Deep Burial Plastic Bag/Disinfectant Container Autoclaving/microwa ving/chemical treatment
Colour
Type of Container
Waste Category
Disposal
Red
Blue/White
Plastic Bag/ Puncture proof container
Sharps and solid waste (Cat. 4 and 7)
Autoclaving/microwa ving/chemical treatment/ Destruction and shredding
Disposal in secure land fills
Black
Plastic Bag
Discarded medicine, incineration ash, and chemical wasted (Cat. 5, 8 and 9)
Management of Rural waste
Used in areas with population less than 500,000 2m deep, when half filled it is covered with lime and then with soil. No shallow well should be near the pit.
Encapsulation
Way of disposing sharps. Sharps collected in leak/puncture proof containers and filled up to half level. Cement mortar or clay filled in the remaining half. Once it is completely filled, sealed and disposed in landfills.
Pit for Disposing Sharps
Segregation
Segregation refers to the storing of waste in separate containers. Segregation of waste is always done at the point of its generation and as soon as it is generated. Segregation not only reduces the chances of spreading infection, but also prevents occupational hazards. Segregation also reduces the investment in waste disposal.
Disinfection and Mutilation
Incineration
INCINERATION IS THE PROCESS OF BURNING HOSPITAL WASTE AT A MINIMUM TEMPERATURE OF 800-1000 degrees C ADVANTAGES : REDUCES WASTE/ORGANIC WASTE TO ASHES DISADVANTAGES: NOT ALL WASTE CAN BE INCINERATED INVESTMENT OPTION COST HIGH RUNNING EXPENSES ARE VERY HIGH COMBUSTION GASES- DIOXIN AND FURAN KNOWN CARCINOGENIC METHOD FOR MONITORING IS COMPLEX AND EXPENSIVE
Autoclaving
ADVANTAGES : LOW INVESTMENT COST/OPERATING COST ENVIRONMENT FRIENDLY DISADVANTAGES : WASTE REDUCTION MINIMAL WASTE MAY NEED TO BE SHREDDED AS IT IS RECOGNISABLE NOT FOR HUMAN WASTE
Microwave Irradiation
WASTE TREATMENT BY HEAT CONDUCTION RADIATION ADVANTAGES : WASTE SHREDDED, UNRECOGNIZABLE DISADVANTAGES : NOT FOR HUMAN TISSUE/CARCASS EXPENSIVE INVESTMENT/OPERATING COST HIGH TECH. APPARATUS HIGHLY TRAINED PERSONNEL FOR OPERATION/ MAINTENANCE NOT FOR CATEGORY 1& 2
Chemical Disinfection
AVAILABLE CHLORINE REQUIRED (1-5gm/l) HYPOCHLORITE SOLUTION-20ml-100ml/l) NADCC tablets(1-4 tablet/l) CHLORAMINE20gm/l MUTILATION / SHREDDING RECOMMENDED TO PREVENT REUSE. WASTE TYPE CATEGORY 4- SHARPS CATEGORY 7- PLASTICS
Collection
Proper training imparted to hospital staff. Specific staff can be trained to collect specific waste category. Waste bags should be 3/4th full. Different waste streams should be collected at different times (to avoid wastage) Closed container are aesthetic and prevents spillage.
Storage
Indian Laws 48 hour storage Storage within the hospital should be done in labelled, colour-coded bins and bags in secured, balanced, easily washable containers that do not have any sharp edges. The main storage site of the hospital should be accessible to vehicles so that the collection vans can reach it. The hospital should ensure that there are written instructions to handle spills
Waste Management Team
Head of the Hospital Waste Disposal Officer Infection Control Officer HODs Chief Pharmacist Hospital Supervisor Nursing Superintendent Hospital Engineer Radiation Protection Officer Stores Officer
Role of Head of the Hospital
Responsible for overall supervision of Generation, Collection, Receiving , Storing, Transportation , Treatment and Disposal of BMW. Seeking Authorization from the prescribed authority for the above functions. He/She is the Authorized Person and the Occupier Submission of the Annual Report of the Preceding year by 31st January in Form II Accident Reporting : All accidents to be reported in Form III to the prescribed authority.
Role of the Waste Disposal Officer
Day to day control of internal collection, storage, transportation and disposal of waste. Reports to Head of the Institution. Liaise with Infection Control Officer, Pharmacists, Engineers to familiarize himself with correct procedures of handling and disposing wastes. Overall monitoring of waste cycle, maintenance of records and supply chain. Shall ensure that emergency procedures in case of accidents are available.
Role of Generators (Doctors, Nurses , Technicians)
Segregation of Various categories of waste in to different Coloured Containers. Ensure that Plastics and Sharps are Chemically treated before being dumped in to the Coloured Bags.
Create Awareness amongst Fellow Colleagues.
Try to Minimize Wastes.
Role of Infection Control Officer
Advice and liaise with the waste disposal officer on control of infection and maintaining standards of waste disposal. Identify needs of all grades of staff and conduct training programmes.
Role of Chief Pharmacist and Radiation Protection Officer
Liaise with the waste control officer and advice on policy and guidelines on safe disposal of pharmacological and radioactive waste. Responsible for continuous monitoring of procedures related to disposal of pharmacological and radioactive waste.
Role of Hospital Engineer
Ensuring proper Functioning and Maintenance of their units . Recording of Operational Parameters. Conducting Validation tests. Maintaining Proper Standards for Processes.
Waste Audit
A waste audit is the complete survey of a hospitals waste management practices. Aims Differentiate types of waste Quantify waste generated Determine point of generation and type of waste generated at each point. Determine level of generation and disinfection within the hospital. Find out type of disposal mechanism carried out.
Developing a Waste Management Plan
Be well versed with the entire functioning of the hospital Training Monitoring
Waste Management Committee
Waste Management Policy Giving a human angle Educating General Public and keeping the safety of personnel in mind
Good Waste Management Depends On:
A dedicated team Good Administration Careful Planning Sound Organization Underpinning legislation Adequate financing Full participation by trained staff
The Waste Management Plan
Assess present situation and carry a waste audit. Identify opportunities for minimization, reuse and recycling. Identify handling, treatment and disposal options. Evaluate options Establish a record keeping system. Estimate related costs Prepare training programme Prepare implementation strategy
Implementation of the Plan
Phased introduction Opportunities for expansion Identify key personnel network Arrange regular trainings Review annually Prepare annual report for the Government
Conclusions
Developing an action plan
Waste Auditing Training Collection Segregation
Storage
Transport to land fill/recycling
A Video on Biomedical Waste Management
