biomedical waste management

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BIOMEDICAL WASTES MANAGEMENT By, Dr. Priyanka Sharma II Year MDS Dept of Public Health Dentistry Bio- weapons of Mass Destructio n !! Lets Make This World A Better Place to Live in!!

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Biomedical waste management along with dental waste management is been described in my presentation.

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Page 1: Biomedical waste management

BIOMEDICAL WASTES

MANAGEMENT

By,Dr. Priyanka SharmaII Year MDSDept of Public Health Dentistry

Bio-

weapons of

Mass

Destruction

!!Lets Make This World

A Better Place to Live in!!

Page 2: Biomedical waste management

CONTENTS

Introduction History Definitions Types of wastes Classification of healthcare wastes Waste management Solid waste management Biomedical waste management Dental waste management Conclusion References

Page 3: Biomedical waste management

INTRODUCTIONINTRODUCTION

Medical and dental care is vital in our life.

Biomedical waste – emerged as an issue of concern.

Biomedical waste is the real problem for the

MAN,COMMUNITY,ENVIRONMENT

Safe, scientific, cost-effective method for biomedical

waste management – need of hour.

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HISTORY

• In the late 1980’s– Items such as used syringes washed up on several

East Coast beaches USA  – HIV and HPV virus infection – Lead to development of Biomedical Waste

Management Law in USA.

• However in India the seriousness about the management came into lime light only after 1990’s.

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WHO has estimated that

• In 2000

• Injections with contaminated syringes caused:

• 21 million hepatitis B virus (HBV)

infections (32% of all new infections);

• Two million hepatitis C virus (HCV)

infections (40% of all new infections);

• 260 000 HIV infections (5% of all new)

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Laws of Biomedical Waste Management

On 20th July 1998• Ministry of Environment and

Forests (MoEF), Govt. of India, Framed a rule known as ‘Bio-medical Waste (Management and Handling) Rules, 1998,’

• Provides uniform guidelines and code of practice for Bio-medical waste management.

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BIOMEDICAL RULES 1998

• The 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.

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

Revised in 2011Now known as BMW Rules, 2011

2011 1998

Every 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 absent

Treatment 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

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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

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Duty of the Operator

The 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. 

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Setting up BMW treatment facility

Occupier 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.

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Biomedical waste Statistics

• Developed Countries- Developed Countries- 1-5 kg/bed/day, with variations among countries.In India- In India- 1-2 kg/bed/day with variation among

Govt. and Private establishments.

Approximately 506.74 tons/ day wastes generated

Out of which only 57% waste undergoes proper disposal

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Health waste Characterization

Hospital waste

Non Hazardous(≈ 75-90%)

Hazardous waste(≈ 10-25%)

InfectiousOthers

( Radioactive,Cytotoxic )

Page 14: Biomedical waste management

DEFINITIONS DEFINITIONS

• Acc 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.

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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.

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Infectious waste: are the portion of medical waste that could transmit an ‘infectious disease’.

Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.

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• Health care Waste: means all the waste generated by Hospital establishments, research facilities, and laboratories. In addition, it includes the waste originating from "minor" or scattered sources such as that produced in the course of health care undertaken in the home (dialysis, insulin injections, etc.)

• [Pruss, A., Giroult, E., and Rushbrook P. et. al; " Safe Management of Wastes from Health-Care activities", World Health Organisation, , Geneva, 1999. ]

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TYPES OF WASTES

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Sewage

• Waste water from a community containing solid and liquid excreta , derived from houses , streets and factories.

Sullage

• Waste water which does not contain human excreta .

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Categories of Bio-Medical Wastes

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Classification of health care wastes

Waste categoryWaste category Infectious wasteInfectious waste

Pathological wastePathological waste

Description And ExamplesDescription And Examples• Lab culturesLab cultures• Waste from isolation wardsWaste from isolation wards• Tissues(swabs)Tissues(swabs)• Materials/equipments of infected Materials/equipments of infected

patientspatients• ExcretaExcreta• Human tissues/fluidsHuman tissues/fluids• Body partsBody parts• Blood or body fluidsBlood or body fluids

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Pathological waste

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Pathological Waste

Blood bags found in the municipal waste stream in violation of rules for such waste.

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Sharp wasteSharp waste

Pharmaceutical Pharmaceutical wastewaste

Genotoxic wasteGenotoxic waste

• NeedlesNeedles• Infusion SetsInfusion Sets• ScalpelsScalpels• Knives Blades Knives Blades • Broken GlassBroken Glass• Expired PharmaceuticalsExpired Pharmaceuticals• Contaminated PharmaceuticalsContaminated Pharmaceuticals• Banned PharmaceuticalsBanned Pharmaceuticals• Waste Containing Cytotoxic Waste Containing Cytotoxic

Drugs(often Used In Cancer Theraphy)Drugs(often Used In Cancer Theraphy)• Genotoxic ChemicalsGenotoxic Chemicals

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Pharmaceutical Waste

SharpWaste

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Chemical wasteChemical waste

Waste with high Waste with high content of heavy content of heavy metals metals

Pressurized Pressurized containerscontainers

Radioactive wasteRadioactive waste

• Lab reagentsLab reagents• Film developerFilm developer• Expired disinfectantsExpired disinfectants• Expired solventsExpired solvents• BatteriesBatteries• Broken thermometersBroken thermometers

• Blood pressure guages etcBlood pressure guages etc• Gas cylinders, Gas catridgesGas cylinders, Gas catridges

• Aerosol cansAerosol cans• Radiotherapy/lab research liquidsRadiotherapy/lab research liquids• Contaminated glass wares, packages, absorbent papersContaminated glass wares, packages, absorbent papers

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Cytotoxic drugs

Lab reagents

Genotoxic waste

Chemical waste

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Waste with high content of heavy metals

Worn out batteries

Blood pressure guages

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Radioactive wastes

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WASTE MANAGEMENT Let the waste of the “sick” not contaminate the lives

of “The Healthy”

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• Waste management is the collection ,transport,

processing ,recycling or disposal of waste materials.

• Term usually relates to materials produced by human

activity and is generally undertaken to reduce effect

on health, the environment and aesthetics.

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The Waste Management Hierarchy

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The 5 R’s of Waste Management

Refuse – Do not use non bio-degradable materials is the process in the first place

Eg. No Plastic bags as packaging for consumer products.

Reduce – don’t manufacture goods that will be discarded in the first place.

Eg. Reduced packaging for consumer products.

Re-use – use materials over again for the original intended purpose or for a new purpose.

Eg. Plastic grocery bags can be reused for groceries or you can use them as a lunch bag or something else.

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Recycle – break down materials and reform them into new products. Requires much less energy than manufacturing products from raw materials.

Eg. Pop cans. Aluminum is melted down and made into new pop cans, storm doors,etc.

Recover – recover as much energy as possible before a material is discarded.

Eg. Some places will burn garbage, then use the heat to generate electricity before disposing of the ash.

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SOLID WASTE DISPOSAL

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Dumping

• Easy method of disposal of “dry refuse”

• Dumped in low lying areas

• Decomposes: bacterial action, decreased in

volume & converted to humus.

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Dumping

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Dumping

Disadvantages

Refuse exposed to flies & rodents

Source of nuisance (smell & unsightly appearance)

Loose refuse dispersed by the action of wind

Pollution of surface & ground water.

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Controlled tipping (or) Sanitary land fill

• Method:

• Material placed in trench

• Adequately compacted

• Covered with earth at the end of the day

• “Modified sanitary land fill”

- Compaction & covering once or twice a week

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Controlled tipping

• Three methods used:

1. Trench method: 2-3 meter deep trench dug out 4 -12 meter

wide. Refuse upto a depth of 2meters - 1 acre of land /yr for

10000 popln

2. The ramp method: used in sloping terrain

3. The area method: used for filling land depressions, disused

quarries & clay pits

Page 43: Biomedical waste management

Controlled tipping

• Changes in the buried refuse:

Physical, chemical & bacteriological changes

During decomposition temp rises to 60 deg

In 7 days. Kills all the pathogens

2 – 3 weeks to cool down

4-6 months for decomposition

Page 44: Biomedical waste management

Incineration

• Burning the refuse

• More hygienic

• Hospital refuse

• Disadv: production of harmful gases &

chemicals (carcinogenic)

• Used: where suitable land is not available

• Not suitable in India

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Composting

Composting is a method of combined disposal of

refuse and nightsoil or sludge.

Process of nature whereby organic matter breaks

down under bacterial action resulting in the relatively

stable humus like material called compost.

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Composting

• Principle by products are:

Carbon dioxide, water & heat.

Heat produced is 60 deg

Destroys eggs & larvae of flies, weed seeds &

pathogenic agents.

The end product - compost - contains few or no disease

producing micro organisms, contains plant nutrients -

nitrates & phosphates

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Composting • Principle methods:

1.Bangalore method

(Anaerobic method / Hot fermentation process)

2. Mechanical composting (Aerobic method)

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Composting

1. Bangalore method:

Indian council of Agricultural research at Indian

institute of Science, Bangalore.

Anaerobic compositing

Trenches are:

• 3 feet deep, 5-8 feet broad, 15-30 feet long

• Located ½ mile away from the city limits

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Composting

Bangalore method:

• Method:

• First a layer of refuse about 6 inches thick

• Over this night soil is added 2 inch thick

• Alternate layers of night soil & refuse added

• Till the heap rises to 1 feet above the ground level.

• Top layer - refuse at least 9 inches thickness.

• Heap covered with excavated earth.

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Composting

Bangalore method:

• Within 7 days heat generated

• Heat persists for 2 or 3 weeks

• Destroy all pathogenic & parasitic organisms

• End of 4-6 months decomposition is complete

• Manure: well decomposed, odourless, innocuous material, high manurial value, ready for application to the land.

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Composting

2. Mechanical composting:• Aerobic method Method:• Refuse first cleared of salvable material• Then pulverized in the pulverizing equipment• Reduce the particle size to 2 inches• Mixed with sewage, sludge or night soil in rotating

machine & incubated• 4-6 weeks composting completed.

Page 52: Biomedical waste management

Manure pits

• Rural areas

• Garbage, cattle dung, straw & leaves

• Covered with earth after each days dumping

• 2 pits required

• 5-6 months time refuse converted to manure

• Effective and simple.

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Burial

• Suitable for small camps

• Trench:

• 1.5m wide , 2 meters deep

• At the end of the day refuse is covered with 20-30cms

of earth

• 40cms from ground level, new trench is dug out.

• Contents removed after 4 -6 months

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Sanitation barrier

Concept found wide acceptance.Diseases due to insanitary conditions can be

prevented by blocking the channels/modes of transmission namely the 5 F’s.

Segregate the faeces & arrange for its proper disposal

water

Fingers

Flies

Soil

Food

Protected host

Faeces

San

itatio

n b

arrier

water

Fingers

Flies

Soil

Food

Protected host

Faeces

San

itatio

n b

arrier

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Sanitation barrier

Simple terms:

• Sanitary latrine & a Disposal pit

More elaborate schemes: Installation of a

sewerage system & Sewage treatment plans

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Water Carriage System

Duct systemExcrements are safely disposed off by carrying those

along with water.Sewage = 99.9% water & only 0.1% solidsSanitary sewage : waste water from residences and

industries and is also called DRY WEATHER FLOW (D.W.F).

Combined system of sewerages allows rainwater during monsoons.

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Water Carriage System

These are all carried through underground sewerages.

The amount of sewage produced per person is directly related to the water supplied per capita and ranges from 1.15 litres per day in small towns to 180 litres per day in large cities.

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WARNING!!!

Sewage gas is a mixture of gases in sewers and manholes comprising of CO2, methane, hydrogen sulphide and a little oxygen.

This is generated by putrefying bacteria and is combustible.

This is an important information should be kept in mind before anybody attempts to go into a manhole or a septic tank for repair works.

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Sea outfall

• Sea coast town and cities

• Nearly two-third of sewage of greater mumbai

• Purification by dilution and oxidation

• Drawback: offensive solid waste back to coast.

• Sewage outfall designed to discharge it deep into the

sea at many points.

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BIOMEDICAL WASTE MANAGEMENT

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S.NO

WASTE CATEGORY

WASTE TYPE TREATMENT & DISPOSAL

1 Category No.1 Human Anatomical waste (human tissues, organs, body parts

Incineration/deep burial

2 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, colleges, discharge from hospitals, animal houses

Incineration/deep burial

3 Category No.3 Microbiology & Biotechnology Wastes: Wastes from laboratory cultures, stocks of specimens of micro-organisms live or attenuated vaccines etc.

Autoclave/ Microwave/ Incineration

4 Category No.4 Waste Sharps (needles, syringes, scalpels ,blades, glass etc.) that may cause puncture and cuts.

Disinfection (chemical treatment/autoclavE/microwavE and

mutilation/shredding

CATEGORIES OF BIO-MEDICAL WASTE

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S.No WASTE CATEGORY

WASTE TYPE TREATMENT AND DISPOSAL

5 Category No.5 Discarded Medicines and Cytotoxic drugs Wastes comprising of outdated, contaminated and discarded medicines

Incineration/destruction

and drugs disposal in

secured landfills

6 Category No.6 Soiled Waste (Items contaminated with

blood, and body fluids including cotton,

dressings, soiled plaster casts, linens,

beddings, other material contaminated

with blood)

Incineration

autoclaving/ microwaving

7 Category No.7 Solid Waste (waste generated from

disposable items other than the waste

(sharps) such as tubing's, catheters,

intravenous sets etc.

Disinfection by chemical

treatment/autoclaving/

Microwaving &

mutilation/shredding

8 Category No.8 Liquid Waste generated from laboratory and washing, cleaning, house keeping and disinfecting activities

Disinfection by chemical

treatment and

discharge into drains

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S.No WASTE CATEGORY

WASTE TYPE TREATMENT AND DISPOSAL

9 Category No.9 Incineration Ash: Ash from incineration of any bio-medical waste

Disposal in municipal landfill

10 Category No.10 Chemical Waste

Chemicals used in production of

biologicals, chemicals used in

disinfection as insecticides etc.

Chemical treatment and

discharge

into drains for liquids and

secured landfill 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.

4. Deep burial shall be an option available only in towns with population less than five lakhs and in rural area.

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COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTE

Color Color CodingCoding

Type of Type of ContainerContainer

WasteWaste

CategorCategoryy

Treatment Treatment options as peroptions as per

Schedule ISchedule I

YellowYellow Plastic bagPlastic bag Cat.1, 2,3,6Cat.1, 2,3,6 Incineration/deep Incineration/deep burialburial

RedRed Disinfected Disinfected container/Plasticontainer/Plastic bagc bag

Cat 3,6,7Cat 3,6,7 Autoclave/Microwave/ Autoclave/Microwave/ Chemical TreatmentChemical Treatment

Blue/White Blue/White translucenttranslucent

Puncture proofPuncture proof

containercontainer

Cat.4,7Cat.4,7 Autoclave/Microwave/ Autoclave/Microwave/ Chemical Treatment & Chemical Treatment & destruction/shreddingdestruction/shredding

BlackBlack Plastic bagPlastic bag Cat 5,9,10Cat 5,9,10 Disposal in secured Disposal in secured landfilllandfill

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Segregation and Collection

Safe transportation and Storage

Treatment & Disposal of BMW

To ensure clean & healthy environment:

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Use of plastic bags makes the transportation easier, it prevents the spillage and the

waste remains outside the view of others. This also keeps the original containers

clean. The plastic bags are not to be reused.

When bag or container, as the case may be, is three fourth full, it should be sealed

by tying it. The disposable sharps container should be sealed by tape. All bags or

containers must be labeled which shall be non washable/prominently visible

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SAFE TRANSPORTATION &

STORAGE

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TRANSPORT TO THE CENTRAL STORAGE AREA

While transporting the waste to the central storage area certain rules

must be followed:

1. Check that waste bags/containers are properly and effectively sealed.

2. Waste bag is properly labeled.

3. Bags should be picked up by the neck and placed, so that bags can be

picked up by the neck again for further handling. Hand should not be put

under the bag. At a time only one bag should be lifted.

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4. Manual handling of waste bags should be minimized to reduce the risk of

needle prick injury and infection. Avoid close contact between body and bag

container. 5. Waste bag or container should not be thrown or dropped.

6.After removal of the bag, clean the container including lid with an appropriate disinfectant.

7.Bags or containers containing the waste should be transported in covered wheeled containers or large bins in covered trolleys dedicated for this purpose. The bags and containers should be replaced by fresh bag/container .

Bio- medical waste storage areas must be separate from general waste storage sites and should have clear signs indicating "For Biomedical Waste only".

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8. In case, a lift is to be used during transportation of biomedical waste it should be designed and reserved for this purpose only.

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To reduce the impact on the community

To reduce the chances of infection and accidental injury to

the workers

To support conservation of natural resources and preservation

of environmental quality.

To reduce the cost and handling time

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CENTRAL STORAGE

The central storage area should be ideally situated on the ground floor and near the rear entrance. This will make the transportation of waste to the site of final disposal easier.

The central storage area should be big enough to store the required number of waste bags at a time. There should be sufficient storage capacity to store at least two day's waste.

It should have a good flooring, light, ventilation and water supply. There should be special drain to discharge the washing, which should go to the sewer.

A full time storekeeper should be responsible to receive and dispatch the waste and maintain proper records.

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Unauthorized people should not be

able to enter the storage area.

An accidental spillage should be

properly attended.

As per rules, biomedical waste cannot

be stored for more than 24 to 48 hours.

Refrigerated storage room (cold

rooms) can be considered where wastes

have to be stored in bulk for over 48

hours.

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TRANSPORT TO THE FINAL DISPOSAL SITE

Transportation from the health care establishment to the site of final disposal

should preferably be done in a motor vehicle, as these sites are likely to be

situated at a distance from the hospital.

Closed transportation in these motor vehicles (truck, tractor, trolley, etc) is

desirable as it prevents the spillage on the way.

All these vehicle must have the biohazard symbol and they should not be used

for any other purpose.

Proper servicing is a must regular basis.

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Temporary storage of biomedical waste may also be needed at the site of final

disposal. It should have all characteristics similar to that described for the central

storage area of the hospital.

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To reduce the impact on the community

To reduce the chances of infection and accidental injury to

the workers

To support conservation of natural resources and preservation

of environmental quality.

To reduce the cost and handling time

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Treatment is a term used for those processes that modify the waste in some

way before it is finally disposed off.

According to the draft Biomedical (Management and Handling) R 1995…..

Treatment means: "a method, technique, or process designed to change the

physical, chemical or biological characteristics or composition of any biomedical

waste so as to render such waste non-hazardous to health and environment".

The primary aim of treatment is to disinfect or decontaminate the waste to

eliminate the pathogens before it reaches the site of its final disposal.

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Five technology options for treatment

Incineration

Chemical disinfectionWet and dry thermal treatment 1. Wet thermal treatment 2. Screw-feed technology

Micro wave irradiationLand disposal 1. Municipal disposal sites 2. Sanitary landfills

Inertization

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INCINERATION

Incineration is the complete destruction of materials to their inert

constituents by a process of combustion.

Safe way of disposal

There is reduction of volume and weight by approximately--- 95%

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Types of incinerators:

•Double-chamber pyrolytic incinerators: designed to burn infectious

health-care waste.

•Single-chamber furnaces with static grate, used only if pyrolytic

incinerators are not affordable.

•Rotary kilns operating at high temperatures, capable of causing

decomposition of genotoxic substances and heat-resistant chemicals.

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Characteristics of the waste suitable for incineration are:

a) Low heating volume-above 2000 Kcal/kg for single-chamber

incinerators, and above 3500 Kcal/kg for pyrolytic double-chamber

incinerators

b) Content of combustible matter above 60%

c) Content of non-combustible solids below 5 %

d) Content of non-combustible fines below 20 %

e) Moisture content below 30%

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Chemical treatment Plastic, rubber and metallic items (like IV sets, blood bags, gloves, catheters, syringes and needles must be chemically disinfected before they are sent for final disposal (landfill).

Chemical disinfection can be done in following steps:

1. Mutilate the syringes and needles with a needle destroyer. Cut all other plastic/rubber item with the help of scissors (so that they cannot be reused),

2. Make 1 per cent hypochlorite solution (fresh everyday) by dissolving 10 gms of this powder (approx 2 spoonfuls) in 1 litre of water in a plastic bucket.

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3. Keep another, smaller bucket with perforations inside the main bucket (having the solution). Put all the items that are to be disinfected inside the perforated bucket and keep well- dipped for about 30-60 minutes.

4. After 30 to 60 minutes take out the disinfected items and put them in a proper waste bag. Sharps should be first kept in a tough cardboard box then only put in the plastic bag so as to avoid damage to the bags.

5. Change the solution every 12 hours. Commonly used – Sodium hypochlorite solution, Cresol, Savlon, Bleaching powder

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Wet and dry thermal treatment

Wet thermal treatment:

•Based on exposure of shredded infectious waste to high temperature, high pressure steam.

•Similar to the autoclave sterilization process.

•Inappropriate for the treatment of anatomical waste and animal carcasses.

•Will not efficiently treat chemical and pharmaceutical waste.

Screw-feed technology

•Screw-feed technology is the basis of a non-burn, dry, thermal disinfection process in which

waste is shredded and heated in a rotating auger.

•The waste is reduced by 80 % in volume and by 20-35 % in weight.

•Suitable for treating infectious waste and sharps.

•Should not be used to process pathological, cytotoxic or radioactive waste.

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Microwave irradiation

•Most microorganisms are destroyed by the action of microwave of a frequency of

about 2450 MHZ and a wavelength of 12.24 cm.

•The water contained within the waste is rapidly heated by the microwave and the

infectious components are destroyed by heat conduction.

• The efficiency should be checked routinely through bacteriological and virological

tests

STANDARDS OF MICROWAVE

•Not be used for cytotoxic, hazardous,/radioactive wastes, contaminated animal

carcasses, body parts, & large metal items.

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Disposal means placing the biomedical waste in its final resting

place

According to the draft Biomedical Waste (Management and

Handling) Rules, 1995.

Disposal means : "burial, discharge, deposit, dumping, land filling or

placing on land of any biomedical waste".

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Two types of disposal:- 1) Land open dumps. 2) Sanitary landfills.

Health-care waste should not be deposited on or around open dumps.

Advantages of sanitary landfill over open dumps:

Geological isolation

Appropriate engineering preparation of the site.

Staff present on site to control operations,

Organized deposit and daily coverage of waste.

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Sanitary landfills

It is another choice for final disposal of biomedical waste and it can be quite

effective if practiced appropriately.

While open dumping of biomedical waste cannot be recommended for the reasons of

acute pollution problems, fires, higher risk of disease transmission and open access to

scavengers and animals.

Some essential elements for design and operation of a sanitary landfill are given below:

1. A specifically designated place should only be used for the landfill.

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2. The site should preferably be away from the residential areas.

3. Location should be such that vehicles carrying waste can easily approach it in all weathers.

4. The area should be under constant supervision and security control. Unauthorized entry must be strictly prohibited.

5. It should not be in the vicinity of a drinking water source as pollution may result.

6. The site should be divided into various manageable phases and all of them should be adequately prepared before the actual and fill starts.

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7. The site should be so organized that the waste can be spread, compacted and covered

daily.

8. A final cover should be constructed to prevent the rain water infiltration when each

phase of landfill is completed. A temporary cover should be provided if rains are

expected in between and before the site is completed.

9. Waste should be buried as rapidly as possible so as to minimize the exposure to

humans or animals.

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Inertization

•The process of “Inertization” involves mixing waste with cement and other substances before disposal.

proportion of the mixture : •65% pharmaceutical waste, 15 % lime, 15% cement and 5 % water.

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The purpose of treatment of biomedical waste

To reduce or eliminate pathogens so that they no longer pose a hazard to

persons exposed to it

It changes the physical appearance of waste to make it unrecognizable so

that it is not aesthetically offensive or frightening.

It also reduces the bulk volume of waste to reduce requirements for

storage and transport.

It makes recyclable items unusable so that unauthorized reuse is

prevented.

To reduce the cost and handling time

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Statewise status of common Biomedical waste management facilities

(As per the informationprovided by the SPCBs/PCCs for the year 2008)

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• There are a number of wastes typically generated by a dental office which,

if improperly handled may pose a risk to human health and the

environment. These are:

Mercury and silver residues from amalgam

Lead found in lead-foil packets and lead shields

Silver found in X-ray fixer solutions

Chromium, used in many X-ray cleaners

Chemical wastes, such as formaldehyde, acetones, and ketones

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ADA Best Management Practices for Amalgam Waste

• Do’s :1. Do use precapsulated alloys and stock a variety of capsule sizes

2. Do recycle used disposable amalgam capsules

3. Do salvage, store and recycle non-contact amalgam (scrap amalgam)

4.Do salvage (contact) amalgam pieces from restorations after removal and recycle the amalgam

waste

5. Do use chair-side traps, vacuum pump filters and amalgam separators to retain amalgam and

recycle their contents.

6. Do recycle teeth that contain amalgam restorations.

7. Do manage amalgam waste through recycling as much as possible

(Note: Ask your recycler whether or not extracted teeth with amalgam restorations require

disinfection.)

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ADA Best Management Practices for Amalgam Waste

• Don’ts1. Don’t use bulk mercury

2. Don’t put used disposable amalgam capsules in biohazard containers, infectious waste containers (red

bags) or regular garbage.

3. Don’t put non-contact amalgam waste in biohazard containers, infectious waste containers (red bags) or

regular garbage

4. Don’t put contact amalgam waste in biohazard containers, infectious waste containers (red bags) or

regular garbage

5. Don’t rinse devices containing amalgam over drains or sinks

6. Don’t dispose of extracted teeth that contain amalgam restorations in biohazard containers, infectious

waste containers (red bags), sharps container or regular garbage

7. Don’t flush amalgam waste down the drain or toilet

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Never dispose of scrap amalgam in the sharps container, red biohazard bag or the trash.

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SHARPS

• Sharps waste is in the form of medical waste in the form of devices or objects used to puncture or lacerate the skin.

• Sharps waste is designated as biohazard and is to be carefully handled.

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SHARPS Contaminated sharps are capable of transmitting the disease

from injection needles, orthodontic bands,burs, scalpel blades, sutures, instruments and broken glass.

Sterilization of sharp containers

• Use labeled and specified container

• Spore test the sterilizer.

• Label the disposable containers as to local regulations.

• Keep containers in upright position.

• Process containers for 40- 60 minutes.

• Leave containers vent open.

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SHARPS

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SHARPS CONTAINERS

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Handling of Sharps

• Needles should not be bend, break, or manipulated for the avoidance of accidents in clinic

• Protective cap holdings devices capping sheath by scoop technique

• Size of sharp container also influence overall efficacy of sterilization

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X-RAY FIXER AND DEVELOPER

• Separate fixer and developer solutions in the container provided by the approved waste carrier and supplier.

• Label the container.

• Once the container is full contact appropriate waste carrier for disposal.

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CONTAMINATED LAUNDRY

• Contaminated laundry is to be placed and transported in bags containers that are color coded or labeled with a biohazard symbol.

• If the contaminated laundry is sent off site for cleaning, it must be placed in bags or containers that are color coded or labeled with a biohazard symbol, unless the laundry uses universal precautions in handling all soiled laundry.

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CONCLUSION

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• Safe and effective management of bio-

medical waste is not only a legal

necessity but also a Social

Responsibility.

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• Bio-Medical Waste Management cannot successfully be implemented without the willingness, devotion, self-motivation, cooperation and participation of all sections of employees of any health care establishment.

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• If we want to protect our environment and health of the community we must see ourselves to this important issue not only in the interest of health managers but also in the interest of community.

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REFERENCES• Textbook of preventive and social medicines – Park-

Ed 21

• Text of essential of preventive and community

dentistry – Soben Peter – Ed 5

• “Infection Control & Management of Hazardous

Materials for Dental Team” Chris H.Miller,Charles

John Palenik.

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REFERENCES

• http://www.moef.nic.in/downloads/public-information/salient-features-draft-bmwmh.pdf

• http://www.mercvt.org/PDF/nwfdentalguide.pdf

• http://www.cpcb.nic.in/wast/bioimedicalwast/CBWTF_Status_2008.pdf

• International journal of environmental science and development, Vol 1.No3,August 2010 ISSN:2010-0264

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• http://dpcc.delhigovt.nic.in/bio-medical-waste.html

• An introduction of essentials of biomedical waste management : Sing et al: MJAFI,Vol 57.No.2 : 2001.

• Biomedical Waste Disposal -  Singh Anantpreet, Kaur Sukhjit : Ed 1 : 2010

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