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Biomedical waste management

Presenter: Dr.L.KarthiyayiniModerator: Dr. A.Mehendale

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Framework

• Definition• Burden of biomedical waste• Sources of waste• Types of health care waste & its health hazards• Legislations• Waste generation• Principles of managing waste

Waste minimization Managing sharps Chemical disinfectants

• Handling of health care waste Waste segregation & labeling Waste storage & transport Waste treatment & disposal

• Infection control• BWM at MGIMS• BMWM in national programs• Biomedical waste audit

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Definition

“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 biological”

[Source: Biomedical Waste (Management and Handling) Rules, 1998 of India]

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MAGNITUDE OF THE PROBLEMGLOBALLY:• Developed countries generate 1 to 5 kg/bed/day• Developing countries: 1-2kg/pt/day WHO Report: • 85% non hazardous waste • 10% infective waste • 5% non-infectious but hazardous. (Chemical,

pharmaceutical and radioactive)• 2002, 22 countries, health care facilities not using

proper disposal 18%-64%

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Hazardous waste generation

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INDIA:• No national level study• Hospitals generate 1-2 kg/bed/day • BMW generation :

4,05,702 kg/day 2,91,983 kg/day is disposed 28% of the wastes is untreated

• 53.25% HCE – not authorized

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Top 5 biomedical waste generating states

State Biomedical waste generation & disposal (kg/ day)

Waste Disposal

Karnataka 62,241 43,971

Uttar Pradesh 44,392 42,237

Maharashtra 40,197 40,197

Kerala 32,884 29,438

West Bengal 23,571 12,472

All India 4,05,702 2,91,983

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Sources of biomedical wastesMajor Sources:• Govt. hospitals/private hospitals/nursing homes/

dispensaries.• Primary health centres.• Medical colleges and research centres/

paramedic services.• Veterinary colleges and animal research centres.• Blood banks/mortuaries/autopsy centres.• Biotechnology institutions.

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Minor Sources:• Physician’s/ dentist’s clinics• Animal houses/slaughter houses.• Blood donation camps.• Vaccination centres.• Acupuncturists/psychiatric clinics/cosmetic piercing.• Funeral services.• Institutions for disabled persons

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Health hazards of various wasteWaste materials Potential hazards

Human anatomical waste Psychological stressHuman anatomical waste, soiled waste, microbial waste, sharps

Infections & disease

Animal wastes Infectious rabies, Anthrax & other

Sharps, cytotoxic & radioactive drugs, incinerator wastes

Injuries

Chemical, cytotoxic, radioactive, incinerator wastes

Dermatitis, conjunctivitis, bronchitis

Cytotoxic, radioactive drugs & materials, chemical wastes

Cancer, genetic mutation

Cytotoxic & other drugs, liquid & chemical wastes

Poisonings

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CATEGORIES OF BIO MEDICAL WASTE

OPTION WASTE CATEGORY TREATMENT & DISPOSALCategory No. 1 Human Anatomical Waste Incineration / deep burial

Category No. 2 Animal Waste Incineration / deep burial

Category No. 3 Microbiology & Biotechnology Waste

Local autoclaving / microwaving / incineration

Category No. 4 Waste Sharps Disinfection by chemical treatmet / atoclaving / microwaving and mutilation / shredding

Category No. 5 Discarded Medicines and Cytoxic drugs

Incineration / destruction and drugs disposal in secured landfills

Category No. 6 Solid Waste Incineration / autoclaving / microwaving

Category No. 7 Solid Waste Disinfection by chemical treatment / autoclaving / microwaving and mutilation / shredding

Category No. 8 Liquid Waste Disinfection by chemical treatment and discharge into drains.

Category No. 9 Incineration Ash Disposal in municipal landfill

Category No. 10 Chemical Waste Chemical treatment and discharge into drains for liquids and secured land for solids

Source: Bio-medical Waste Management Rules, 1998, Schedule I.

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LEGISLATIONS

ENVIRONMENTAL REGULATIONS FROM MoEF:• Environment protection act,1986:• Bio-medical waste management

rules,1998(RENEWED 2011)• Municipal solid waste rules,2000• Hazardous waste rules,1989• EIA Notification, July 2004

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Bio-Medical Waste Rules 2011• Elaborate, stringent and several new

provisions have been added • Not applicable:

Radioactive waste, Hazardous waste,Municipal solid waste Battery waste

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• Accident reporting must• HCE- BMWM unit & meetings• Mandatory treatment & disposal

– Adequate treatment facilities– Promote new technologies– Omitted- Incinerator & deep burial

• District level monitoring committee• Allocation : Funds & Equipments • Lacking: guidelines for linen & mattress, blood

bags & pressurized containers

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Schedules

• Schedule I : Categories of Biomedical waste

• Schedule II : Color coding • Schedule III : Labels for Hazardous waste • Schedule IV : Label for transport of BMW container/bags

• Schedule V : Standards for – incineration , autoclaving, sewerage, deep burial

• Schedule VI : Deadlines for implementation

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SCHEDULE III LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS

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SCHEDULE-IV LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS

• Day... ...Month ….……. Year…………Date of generation

• Waste category No ... Waste Class ………• Waste description

………………………………………………….• Sender's Name & Address• Receiver's Name & Address .• In case of emergency please contact……….

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Forms • FORM-I : Application for authorization/ renewal of

authorization• FORM II : Annual report(To be submitted to the

prescribed authority by 31 January every year• FORM III :- Accident reporting• FORM IV: Authorization granting format• FORM V : Application for filing appeal against order

passed by the prescribed authority• FORM VI: Operator of CBMWTF filing against HCE- if

no proper segregation

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ANNEXURE-I

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ANNEXURE-II

• GUIDELINES FOR DESIGN AND CONSTRUCTION OF BIO-MEDICAL WASTE INCINERATOR

• Air Pollution Control Device (APCD) Emission limit - 150 mg/Nm3 (corrected to 12% CO2)

for Particulate Matter

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BMW Rules 2011 vs. 1998

2011 1998Every occupier irrespective of the quantum of wastes requires to obtain authorisation

Occupiers with more than 1000 beds required authorisation

Duties of the operator listed Operator duties absent

Categories of BMW eight Ten categories

Treatment and disposal of BMW mandatory for all the HCEs

Restricted to HCEs with more than 1000 beds

A format for annual report No format

Form VI present Form VI absent

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COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTES

COLOUR CODING

TYPE OF CONTAINER

WASTE CATEGORY

TREATMENT OPTIONS

Yellow Plastic Bag Cat.. 1, 2, 3 and 6 Incineration / deep burial

Red Disinfected container / Plastic Bag

Cat. 3, 6, and 7 Autoclaving / Microwaving / Chemical Treatment

Blue / White Translucent

Plastic Bag / puncture proof container

Cat. 4, Cat. 7 Autoclaving / Microwaving / Chemical treatment and destruction shredding

Black Plastic Bag Cat. 5, 9 and 10 (Solid)

Disposal in secured landfill

Source: Bio-medical Waste Management Rules, 1998,

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Colour Coding and Type of Container for Disposal of BMWColour Coding

Type of container to be used

Waste Category Number

Yellow Non Chlorinated plastic bags

Category 1,2,5,6

Red Non Chlorinated plastic bags/puncture proof container for sharps

Category 3,4,7

Blue Non Chlorinated plastic bags container

Category 8

Black Non Chlorinated plastic bags

Municipal Waste

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Number of CTF against HCEs in major statesState Health Care

EstablishmentsCommon Treatment Facility

Maharashtra 12,753 38

Gujarat 21,779 13

Karnataka 11,248 14

Delhi 1900 3

West Bengal 2747 6

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PRINCIPLES OF MANAGING HEALTH CARE WASTE

1. Waste minimization2. Safe reuse & recycling3. Managing sharps

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Waste minimization

• Source reduction• Management and control measures at

hospital level• Stock management of chemical and

pharmaceutical products

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SAFE REUSE & RECYCLINGSterilization methods for reusable items:Thermal sterilization• Dry sterilization - Exposure to 160 °C for 120 minutes or

170 °C for 60 minutes in a “Poupinel” oven.• Wet sterilization - Exposure to saturated steam at 121°C

for 30 minutes in an autoclave.Chemical sterilization• Ethylene oxide - Exposure to an atmosphere saturated

with ethylene oxide for 3–8 hours, at 50–60°C, in a reactor tank

• Glutaraldehyde - Exposure to a glutaraldehyde solution for 30 minutes

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Managing sharpsAuto disable syringes

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Disposables syringes

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Glass syringes

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• In 2000, WHO estimation-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 infections).

• One needle stick injury risks: – 30% -HBV– 1.8% -HCV– 0.3% -HIV.

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Handling of health care waste

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Waste generation globallyCOUNTRIES TOTAL WASTE % OF INFECTED

WASTE

USA 7-10 10-15Western Europe

3-6 10-15

India 0.5-2 30-60Source: International healthcare workers network, Patil & Shekdar 2001

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Quantity of waste generation in a 30 bedded CHCWaste type Quantity Percentage

1. Infectious waste

Pathological & anatomical

1.5 6

Sharps including syringes

1 4

Non-sharp wastes 7.5 30

Total 10 40

2. General waste 15 60

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Average composition of hospital waste in India

Material Percentage(wet-weight basis)

Paper 15Plastics 10Rags 15Metals 1Infectious waste 1.5Glass 4General waste 53.5SOURCE: National engineering research institute

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Steps of waste management

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Segregation

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Collection

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Storage

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Transport

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DEEP BURIAL PIT

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Disinfectants commonly used for disinfection of materials contaminated with blood & body fluids

Name of the disinfectant

Available chlorine

Required Chlorine

Required contact period

Amount of disinfectant to be dissolved in 1 L

of H2O

Sodium Hypochlorite

5% 0.5% 30 min 100 ml

Calcium Hypochlorite

70% 0.5% 30 min 7.0 gm

NaOCl powder - 0.5% 30 min 8.5 gm

Na dichloro Isocyanate (Na DCC) tablets

60% 0.5% 30 min 4 tabs

Chloramine 25% 0.5% 30 min 20 gm

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Infection control

• Hand washing• Personnel protective equipment• Safe handling of waste• Prevention of needle stick injuries• Environmental cleaning & spillage

management• Proper training to health care workers• Immunization of health care workers

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Hospital waste management structure

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BMW committee – MGIMS, Sevagram• Occupier - Secretary, KHS• Dean, MGIMS• Medical superintend• Officer in charge - HOD, Community Medicine• HOD, Microbiology • Faculty member, community medicine• Faculty Member, Microbiology • CAO KHS & KH• Matron• Engineering Section-In-charge & civil section• Sanitary Inspector• Infection control Nurse

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At MGIMS

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GOPD

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BOILER & NEEDLE CUTTER - GOPD

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AUTOCLAVE

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DOUBLE DOOR AUTOCLAVE

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SHREDDER

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DOUBLE CHAMBERED DIESEL FIRE INCINERATOR

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200 kg/day

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BMWM – NATIONAL PROGRAMS

• NVBDCP• RNTCP• NACO-ICWM plan

BIOMEDICAL WASTE AUDIT

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References

• Pruss A, Giroult E and Rushbrook P. (1999) Safe Management of Wastes from Health Care Activities, World Health Organization, Geneva

• Kishore J and Ingle G.K. (2004) Biomedical Waste Management in India, Century Publications, New Delhi

• Srishti - Managing Hospital Waste, A Guide for Healthcare Facilities, September 2000

• Agarwal, A.G. and Singh, R. (2005) Understanding and Simplifying Bio-Medical Waste Management, Toxics Link, New Delhi

• Mandal S. K & Dutta J , Integrated Bio-Medical Waste Management Plan for Patna City, Institute of Town Planners, India Journal 6-2:01-25 (2009)

• The Bio Medical Waste(Management & Handling) Rules, (1998)& (2011)• WHO - Healthcare Waste Management – www.Healthcarewaste.org • NRHM-Infection management & environment plan. Policy framework

march 2007. Ministry of Health & Family Welfare , Government of India.• http://www.cseindia.org -Biomedical waste rules made stringent . 2012.

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Thank you