BIO MEDICAL WASTE MANAGEMENT

Dr.Rahul.K.R

Guided by,

Dr.Jyothilal. K, HOD,

Dr.Vandana Rani (Associate prof),

Dept. of Swasthavritta.

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INTRODUCTION

Medical care – vital in our life and health.

BMW -emerged as issue of concern world over.

BMW real problem for

MAN, COMMUNITY,& ENVIRONMENT

Safe scientific cost effective methods of BMW management is needed.

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NEED OF WASTE MANAGEMENT

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DEFINITION:

Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals (WHO).

“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 thereto, or in the production or testing of biologicals.

(Act to BMW 1998 Govt of India)

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BIO MEDICAL WASTE STATISTICS

Developed Countries- 1-5 kg/bed/day, with variations among countries.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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LEGISLATIVE FRAMEWORK

Bio medical waste (Management and Handling)Rules was passed on 28th July 1998.

Amended in 2000 The rules define the Administrative Medical

Officers of healthcare facilities as biomedical waste ‘generators’ and fix responsibility on them for developing an effective waste disposal mechanism for the waste their facilities generate.

These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose or handle bio-medical waste in any form. All Institutions generating BMW must take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.

The PENALTIES are as specified in Environment (Protection) Act 1986.

• Imprisonment for upto five years with fine upto one lakh rupees, or both.

• In case the failure additional fine upto five thousand rupees for every day.

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SOURCES OF HEALTHCARE WASTE

Govt. Hospitals

Private Hospitals

Nursing Homes

Physician’s office/clinic

Dentist’s office/clinic

Dispensaries

Medical research and training establishments

Mortuaries

Blood bank and collection centers.

Animal houses etc……..

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WHO estimates

85% of hospital waste is non-hazardous

10% is infectious

5% is non-infectious.

Non-Infec-tious

waste, 85%

Pathological and Infec-

tious waste, 10%

Chemical and Pharmaceutical waste 3%

Sharps, 1%

Radioactive, Cytotoxic and heavy metals,

1%

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CLASSIFICATION OF HEALTH CARE WASTE

Waste category Description

1.Infectious waste Waste suspected to contain pathogens.Eg;laboratory cultures,materials or equipments that have been in contact with the infected patients.

2.Pathological waste Human tissues or fluids, body parts, fetus.

3.Sharps Eg; needles, scalpel, knives, blade, broken glass etc.

4.Pharmaceutical waste Waste containing pharmaceuticals that are expired or no longer needed, items contaminated by or containing pharmaceuticals (Box/Bottle)

Cont…

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CONT…Waste category Description

5.Genotoxic waste Waste containing chemical agents such as laboratory reagents, film developer, disinfectants, drugs used in chemotherapy, etc.

6.Wastes with heavy metal content Batteries, broken thermometres,blood pressure gauges etc.

7.Pressurised containersGas cylinders, gas cartridges, aerosol cans etc.

8.Radio active wastes Waste containing radioactive substances.Eg;unused liquids from radiotherapy or laboratory research.

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HOSPITAL WASTE MANAGEMENT STRATEGIES

1. Survey of waste generated

2. Reduction at source .

3. Segregation of hospital waste.

4. Collection & Categorization of waste.

5. Storage of waste.

6. Transportation of waste.

7. Treatment of waste.

BIO-MEDICAL WASTE FLOW CHART

In House Segregation(Collection, Segregation Packing

in Color Coded Poly Bags)

Common Storage PointAt

Hospitals

Transportation (Approved Special Vehicle)

Unloading and Temp Storage at CBWTF

Treatment(Incineration, Autoclaving

and Shredding)Disposal

( Recycling & Landfill)

Waste Water to TP

Re Use

Generator (HOSPITALS)

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CATEGORIES OF BIOMEDICAL WASTE IN INDIA

WASTE CATEGORY TYPE OF WASTE TREATMENT/DISPOSAL

Category no.1 Human Anatomical Waste

Incineration/deep burial

Category no.2 Animal waste Incineration/deep burial

Category no.3 Microbiology and biotechnology waste

Local autoclaving/ microwaving/ incineration

Category no.4 Waste sharps Disinfection/autoclaving/microwaving

Category no.5 Discarded medicine and cytotoxic drugs

Incineration/ destruction and drugs disposal in

secured land fillCont…

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CONT.… CATEGORIES OF BIOMEDICAL WASTE IN INDIA

WASTE CATEGORY TYPE OF WASTE TREATMENT/DISPOSAL

Category no.6 Solid waste(Items contaminated

with blood fluids including cotton,

dressing, solid plaster casts)

Incineration/autoclaving/microwaving

Category no.7 Solid waste(Wastes from disposable items such as catheters,

tubing, IV sets)

Disinfection by chemical treatment/autoclaving/

microwaving / shredding.

Category no.8 Liquid waste(Wastes from laboratory,

washing, cleaning, house keeping etc.)

Disinfection by chemical treatment and discharge into drainage systems.

Category no.9 Incineration ash Disposal in municipal landfill

Category no.10 Chemical waste(chemicals used in

disinfection/ as insecticide

Chemical treatment and discharge into drainage for liquid and secured

landfill for solids.

COLOR CODING OF CONTAINER

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COLOR CODE TYPE OF CONTAINER

WASTE CATEGORY TREATMENT OPTIONS

Yellow Plastic bags 1, 2, 3 and 6 Incineration

Red Disinfected container/plastic bag

3, 6 & 7 Autoclaving/MicroWaving/Chemical treatment

Blue/white transparent Plastic bags/puncture proof container

4 & 7 Autoclaving/Microwaving/chemical treatment, Destruction & shredding

Black Plastic bag 5, & 9, and 10 (SOLID)

Disposal in secured land fills

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LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

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COLLECTION, TRANSPORTATION, STORAGE

Waste collected and stored in thick non-corrosive

disposable plastic bags or containers of specific

colour code.

The waste in bags or containers should be stored in

a separate area, room, or building (not more than

48hrs) of a size appropriate to the quantities of

waste produced and the frequency of collection.

Health care waste should be transported within the

hospital or other facility by means of hand cart

wheeled trolley .

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COLLECTION, TRANSPORTATION, STORAGE (WITHIN THE HOSPITAL)

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SAFE TRANSPORTATION IN A REGISTERED, AUTHORIZED, BMW TRANSPORTERS

BIO-SPILL KIT

Container of undiluted household bleach Several pairs of gloves Safety glasses Absorbent material Bio hazardous waste (autoclave) bags

Dust pan & scoop or tongs for broken glass

Place in a labeled bag or bucket and keep in areas where biohazards are handled.

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TREATMENT AND DISPOSAL TECHNOLOGIES

Incinerators

Chemical disinfection

Wet and dry thermal treatment

Deep burial or land filling

Recycling

Worm composting

Newer Technologies

Micro wave irradiation

Plasma torch technology

Gamma irradiation

Hydroclave

Pyrolator

Electron beaming

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INCINERATION

Burning the waste in simple kiln up to1000ºC

Organic and combustible waste is changed to inorganic and incombustible and finally to fly ash.

Ash is collected in thick puncture proof bags and stored for periodic dump into community landfill.

TYPES OF INCINERATOR

DOUBLE CHAMBER PYROLITIC SINGLE CHAMBER FURNACES ROTARY KILN

It involves preparation(segregation)Waste chargingWaste combustionTreatment of emission through controlHandling of incineration ash. 27

DOUBLE CHAMBER PYROLITIC

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SINGLE CHAMBER FURNACES

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ROTARY KILN

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CHEMICAL DISINFECTION

Destruction of most of pathogens from liquids.

By using chemical disinfectants such as bleaching powder, glutaraldehyde, alcohols or quaternary ammonium compounds.

Best for treating liquid wastes such as blood,urine,stools or hospital sewage.

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WET THERMAL TREATING(AUTOCLAVE)

The infectious wastes are steam heated at specified temperature and pressure for specific period of time.

Decontamination occurs when steam penetrates the waste.

Autoclaves which functions within specified range of temperature, pressure etc is used.

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DRY THERMAL TREATMENT (SCREW FEED TECHNOLOGY)

Waste is treated in a rotating auger. Waste is reduced by 80% in volume and

20-30% in weight. Suitable for treating infectious wastes

and sharps. Not used to process pathological,

cytotoxic, or radioactive waste.

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DEEP BURIAL

Wastes belonging to category 1,3,6 collected in yellow containers are disposed by this method.

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LAND FILLING

Land filling means disposal of residual solid wastes on land in a facility designed with protective measures against pollution of ground water, surface water, air and ground.

Sanitary landfills are specially constructed for disposal of nonbiodegradable infectious hospital wastes.

It should have an impermeable clay and pebble base.

Stored earth for covering at the end of each disposal operation.

Frequent spray of insecticide is done.

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WORM COMPOSTING

Biodegradable general waste from areas like kitchen, dining places, cafeteria which mostly contain organic wastes, peelings of vegetables etc collected in white containers with black stripes are disposed off.

Rectangular pit of 1 m deep bound by brick wall is built.

A few 100 earthworms are introduced to earth bed on which waste is dumped and some water sprinkled daily.

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MICROWAVING

•Heat is generated inside equipment during bombardment of EM waves into the retaining molecules of waste.•Waste should have some water content to enhance molecular mobility.•Highly efficient•30-40% weight reduction.•Minimal environmental pollution and occupational risk.•Cost effective.

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PLASMA TORCH TECHNOLOGY

It consists of a flame at about 2,200 to 13,900 °C

It takes various types of garbage and vaporizes into 4th state of matter ,plasma (plasma pyrolysis).

It reduces thrash that otherwise would fill up landfills.

It can dispose bio hazardous wastes safely. It is extremely costly and needs a complex set

up.

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HYDROCLAVE

An advanced autoclave method for treating infectious waste, utilizing steam, but much faster and with much heat penetration.

It is a double walled cylindrical vessel mounted horizontally.

The vessel is fitted with a mixing arm that rotates slowly inside vessel.

It totally sterilizes the waste. complete dehydration of waste ,reduces volume

by 70%. Very low operating cost.

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WASTE SHARP

They are needles, syringes, scalpels, blades, broken glass capable of causing injuries or introducing infection.

Their segregation reduces the chances of injury. Final disposal is done by mutilation. Must be collected at the point of generation, in a leak-

proof and puncture-resistant container. Containers must bear the international biohazard

symbol and appropriate wording. Containers should never be completely filled, nor filled

above the full line indicated on box.

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PLASTIC WASTE

Plastics being non biodegradable remain in the soil for more than 1000 yrs contaminating the soil and surrounding water bodies.

Collection and reuse of disposable plastics without adequate treatment will result in spread of infections.

Improper burning leads to release of toxic gases like Sulphur dioxides, hydrochlorides etc which are potent carcinogens.

cont….

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CONT….. PLASTIC WASTE

Use of plastic should be minimized. Plastics should be properly

disinfected. They are better managed by non

burning technologies. Microwaves, autoclaves, hydroclaves,

chemical disinfection are most suited.

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Most of the waste produced during Ayurveda treatments can be managed by the above mentioned processes like incineration, land filling, chemical disinfection etc.

Used oil is the main challenge for the disposal as when they are disposed on soil or water resources produces many adverse effects to the ecosystem. Used oils can be used as fuel in incinerators. They can be recycled by chemical processes like

bleaching.

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CONCLUSION Refuse disposal cannot be solved without

public education. Individual participation is required. Municipality and government should pay

importance to disposal of waste economically.

Personal protective equipment (PPE) does not replace proper procedures and techniques.

Thus educating and motivating oneself first is important and then preach others about it.

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“Let the waste of the “sick” not

contaminate the lives of “The

Healthy”Thankyou