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BIO-MEDICALWASTE

MANAGEMENT

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Let the waste of the “sick” not contaminate the lives of “The Healthy”

Dr kamal DeepJ.R.First Year

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DefinitionAcc to bio medical waste rules ,1998 of India “ Bio-medical waste” means any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of bio medicals.

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

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

Came into force on 28th july,1988. Prescribed by Ministry of environment & forest under the

environment protection act of India. It safeguard the public & the health care workers from the

risk arising due to biomedical waste. This rule apply to all persons who generate ,collect, receive,

store, transport, treat, dispose or handle biomedical waste in anyform.

Waste shall be treated & disposed of in accordance with schedule 1, and with the standards prescribed in schedule V.

Biomedical waste shall be segregated into containers / bags at the point of generation in accordance with schedule II prior to its storage, treatment , transportation & disposal. The containers shall be labelled according to schedule III.

BIOMEDICAL WASTE MANAGEMENT & HANDLING RULE

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CLASSIFICATION

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

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MAGNITUDE OF THE PROBLEM

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WASTE CATEGORY

TYPE OF WASTETREATMENT AND

DISPOSAL OPTION

Category No. 1Human Anatomical Waste (Human tissues, organs, body parts)

Incineration@ / deep burial*

Category No. 2

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

Incineration@ / deep burial*

Category No. 3

Microbiology & 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 biologicals, toxins and devices used for transfer of cultures)

Local autoclaving/ microwaving / incineration@

CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I

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Category No. 4

Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps)

Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding##

Category No. 5

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

Incineration@ / destruction and drugs disposal in secured landfills

Category No. 6

Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.)

Incineration@ / autoclaving / microwaving

Category No. 7

Solid 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# #

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Category No. 8

Liquid Waste^^ (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities)

Disinfecting by chemical treatment@@ and discharge into drains

Category No. 9Incineration Ash (Ash from incineration of any biomedical waste)

Disposal in municipal landfill

Category No.10

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

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

@ : There wil be no chemical pretreatment before inciniration. Chlorinated plastics shall not be incinerated.

* Deep burial shall not be option available only in town with population less than 5 lac & in rural area.

@@ chemicals treatment using atleast 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection.

# Multilation/ shredding must be such so as to prevant unauthorised reuse.

^^ About 4-250 litre/bed/day.12

POINTS TO REMEMBER

About 0.3-3.5 kg/bed/day1: GARBAGE-55%2:BMW A) wasted body remains blood,cultures,

anatomical waste -5% B)Pharmaceutical &chemical waste-2% C)Pathological waste-06% 3: Sharp object -20%

4:Pressurized container & discarded instruments- 2%

5: Radioactive wastes-0.3

SOLID WASTE

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WASTE SEGREGATION

Color coding Type of container

Waste category treatment option

YELLOW PLASTIC BAGCat 1,2,3,6 Incineration /deep burial

RED Disinfected container / plastic bag

Cat 3,6,7 Autoclave/microwave /chemical treatment

Blue/white translucent Plastic bag/ Puncture proof

Cat 4,7 Autoclave/microwave /chemical treatment / destruction shredding

BLACK Plastic bagCat 5,9,10 Disposal in secure landfill

Waste collection bags for waste type needing incineration shall not be made of chlorinated plastics.

Categories 8 & 10(liquid) do not require containers / bags

Body fluids like pleural fluid are mixed with 1% bleaching powder & then disposed off.

Cat 3 if disinfected locally need not to be put in containers / bags.

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Hospital waste disposal

1. Know what hazards you have

2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists

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Steps To Manage Hazardous Wastes

Before Disposal

**Use mercury-free thermometers

Steps to Manage Hazardous Wastes (cont’d)

3. Limit use and access to trained persons with personal protective gear

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Don’t accumulate unneeded products Don’t let peroxides and oxidising agents

turn into bombs

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Get Rid of Unnecessary Stuff

Photo of bomb robot called into hospital to dispose of picric acid.

Examples of hazard labels:

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Label with Agent, Concentration and Hazard Warnings

Communicate about Workplace Hazards

Job description Posters on doors Labels on hazards Give feedback on use of PPE

and disposal in evaluation Role model safe use and

disposal Contact point who is

responsible

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Recycle Products When Possible

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TREATMENT/DISPOSAL METHOD

ADVANTAGES DISADVANTAGES

Rotary kiln Adequate –all infect waste most Chemical wastePharmaceutical waste

High investment and operating costs

Pyrolytic incineration

Adequate –all infect wasteMost pharmaceutical wasteChemical waste

Incomplete destruction of cytotoxicsRelative high investment

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ROTARY KILN PYROLYTIC INCINERATOR

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Single-chamber incinerator

Good disinfection efficiencyDrastic reduction of wt & volume of wasteResidues disposed in landfillsNo need of high trained operatorsLow investment/operating cost

Significant emissions of atmos pollutantsNeed for periodic removal of slag &sootInefficient in destroying thermally resistant chem /drugs

Drum/ brick incinerator

Drastic reduction of wt &volume of wasteVery low investment & operation

Massive emission of black smoke, ash toxic flue gas

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SINGLE CHAMBER INCINERATOR

DRUM/BRICK INCINERATION

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Chemical disinfection

Highly efficient disinfection under good operating conditionsChemical disinfectants are relatively inexpensive

Requires highly qualified technicians for operating of the processUses hazardous substances that requires comprehensive safety measures

Wet thermal treatment

Environmentally soundRelatively low investment/operating costs

Shredders are subject to frequent breakdowns Poor functioning

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CHEMICAL DISINFECTION

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WET THERMAL TREATMENT

Off-site wet thermal (or "steam autoclave") treatment facility

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Operating requires qualified techniciansInadequate for anatomical, pharmaceutical,chemical waste ,waste that is not steam permeable

Micro- wave irradiation

Good disinfection efficiency under appropriate conditionsDrastic reduction in waste volumeEnvironmentally sound

High investment& operating costsPotential operation Maintenance problems

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MICROWAVE IRRADIATION

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Encapsulation SimpleLow costSafe

Not recommended for non sharp infectious waste

Safe burying Low costRelatively safe if access to site is restricted

Safe only if access to site is limited and certain precautions are taken

inertisation Relatively inexpensive

Not applicable to infectious waste

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ENCAPSULATION

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Inertisation, Immobilisation

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In our hospital there is 7 generation point of waste where biomedical waste is segregated into different buckets containing polythene of same color as bucket.

The generation points are:1. Emergency2. Ward 43. Ward 64. ICU5. Operation theatre6. Labortory7. Room no 10

From each generation point waste is carried to central point which is emergency of TBHP.

There waste in different polythene bag is weighed and tag is applied to the bag.

Waste from TBHP is managed by SembRamky Environment pvt ltd. Luidhana where waste is treated in bioplant.

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BIOMEDICAL WASTE MANAGEMENT IN TBHP

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Conclusion• Thus refuse disposal cannot be solved without public education.• Individual participation is required.• Municipality and government should pay importance to disposal of waste economically.• Thus educating and motivating oneself first is important and then preach others about it.• Start disposing waste first from within your home, then outside home, then neighborhood ,then your street, your area ,city and then the nation and the world.• Lets make this world a better place

to live in.

HCRW Management.ppt 7/03Slide 39

THANK YOU