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Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Dept. of Hospital Administration, PGIMER, Chandigarh.

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Presentation on theme: "Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Dept. of Hospital Administration, PGIMER, Chandigarh."— Presentation transcript:

1 Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Dept. of Hospital Administration, PGIMER, Chandigarh Bio-Medical Waste (Management and Handling) Rules, 1998: Issues, Challenges and Possible Solutions

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3 Environment (Protection) Act, 1986 BMW (Management and Handling) Rules, 1998 Non-compliance: punishable CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

4 Non-compliance to BMW (M & H) Rules, 1998 Imprisonment up to 5 years and fine up to 1 Lac or both Punishment for non-compliance Section 15 of Environment (Protection) Act, 1986 For first offence If contravention continues Additional fine to the tune of Rs per day If contravention continues beyond a period of 1 year Imprisonment up to 7 years CME Sep 26-27, 2013

5 Section 17 of Environment (Protection) Act, 1986 Deptt. of Hosp. Admn. PGI, Chd. and/ or CME Sep 26-27, 2013

6 Implication of section 17 for a health care administrator  Health care administrator should maintain documentary evidence of all steps taken by him to impress upon HCWs to follow all provisions of Rules  If violation occurs, the health care worker who did not manage BMW properly will be held liable  Health care administrator would be saved of vicarious liability. Agenda in Hospital Management Board for impressing upon doctors to Manage BMW properly at source Some of the notices issued for compliance of BMW (M & H) Rules, 1998

7 Section 5 of Environment (Protection) Act, 1986 Deptt. of Hosp. Admn. PGI, Chd. Closure of Health Care Facility may be ordered for non- compliance to the rules. CME Sep 26-27, 2013

8 Bio-Medical Waste (Management and Handling) Rules, 1998 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

9 Some Pictures Showing Poor BMW Management in Different Parts of Country

10 Hindustan Times, New Delhi, 22-May-2013  33 hospitals in Delhi found flouting BMW norms.  4 weeks time was given to dispose BMW as per norms otherwise authorities will face prosecution.  According to Times of India 24 th August, 2013 news item "These hospitals have not remedied all shortcomings and have not fully complied with disposal of biomedical waste rules.  33 hospitals in Delhi found flouting BMW norms.  4 weeks time was given to dispose BMW as per norms otherwise authorities will face prosecution.  According to Times of India 24 th August, 2013 news item "These hospitals have not remedied all shortcomings and have not fully complied with disposal of biomedical waste rules.

11  87% Army, 61% Air Force facilities lack proper authorization  Records not maintained for collection of waste, its movement to incinerator, disposal of incineration ash etc.  87% Army, 61% Air Force facilities lack proper authorization  Records not maintained for collection of waste, its movement to incinerator, disposal of incineration ash etc. The Tribune 11-Jan-2013 Many Hospitals and Nursing Homes are dumping their BMW on roadsides and vacant plots in Patiala The Tribune 16-Jan-2013

12 Legal proceedings initiated by PPCB against 10 Government and 15 Private hospitals in Panjab for violating norms of BMW (M & H) Rules, 1998 The Tribune 10-May-2011 The Tribune 23-July-2011 The HPCB served notices on 4 defaulting hospitals in Ambala. The hospitals were disposing untreated BMW

13 The Tribune 4-July hospitals in Punjab issued notice by PPCB The Tribune 11-July teams of Punjab Pollution Control Board inspected 108 hospitals on 02- July-2011  3 hospitals shut down  Prosecution proceedings initiated against 8 hospitals under Environment (Protection) Act, 1986  Bank guarantee varying from Rs 25,000 to Rs 2.5 Lac obtained from 34 hospitals  3 hospitals shut down  Prosecution proceedings initiated against 8 hospitals under Environment (Protection) Act, 1986  Bank guarantee varying from Rs 25,000 to Rs 2.5 Lac obtained from 34 hospitals The Tribune 17-July-2011

14 Salient Features of BMW (M & H) Rules, 1998 These rules apply to all persons who handle Bio-Medical Waste in any form…Rule 2 It is duty of every occupier to ensure that BMW is handled in such a manner that it has no adverse effect on human health and environment… Rule 4 Deptt. of Hosp. Admn. PGI, Chd. Doctors Engineering section Administrators Sanitation workers Nurses BMW CME Sep 26-27, 2013 Team Work BMW (M & H) Rules, 1998.htm

15 Authorization for BMW management to be taken by every HCF serving 1000 or more patients per month Pre-requisites for authorization Authorization initially for one year, then for 3 years, to be renewed every 3 years. a a b b c c Submission of to prescribed authority i.e. pollution control board/committee Submission of prescribed fee i i ii Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

16 Bio-medical waste shall be segregated at source in colour- coded containers…Rule 6 (2) Salient Features of Rules…contd. Segregation at source No untreated bio-medical waste shall be kept stored beyond a period of …Rule 6 (5) Storage of BMW Records related to BMW to be maintained Records subject to inspection and verification by the prescribed authority at any time. Maintenance of Records … Rule 11

17 Chemical treatment of waste sharps and disposable items shall be done at source to ensure disinfection Mutilation of waste sharps such as hypodermic needles and disposable items shall be done at source to prevent their unauthorized re-circulation Items to be incinerated shall not be chemically pre-treated Chlorinated plastics shall not be incinerated Salient Features of Rules…contd. Rule 5 and Schedule I

18 Common Biomedical waste Treatment facility (CWTF) Clause 5 (2) of BMW (M & H) Rules, 1998 allow the occupier to avail facility of CWTF for disposal of waste generated in his premises. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

19 Symbols Over all containers having BMW Over all containers having cyto-toxic drugs Deptt. of Hosp. Admn. PGI, Chd. Over all containers having radioactive waste CME Sep 26-27, 2013

20 Salient Features of Rules…contd. Every occupier/operator shall submit an annual report to the prescribed authority in by 31 st January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. Annual report for BMW…Rule 10 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

21 Annual Report sent by PGI to CPCC Page 1Page 2Page 3 Quantity of waste generated for each category of BMW is mentioned Treatment modalities used for BMW are mentioned Name and address of agency to which recyclable waste sold is mentioned

22 When any accident occurs at any institution or facility or any other site where bio-medical waste is handled or during transportation of such waste, the authorized person shall report the accident in to the prescribed authority forthwith. Salient Features of Rules…contd. Deptt. of Hosp. Admn. PGI, Chd. ACCIDENT REPORTING…Rule 12 CME Sep 26-27, 2013

23 6 Schedules of BMW (M & H) Rules, 1998 Schedule IPrescribes 10 categories of BMW Schedule II Prescribes colour coding and type of container for disposal of BMW Schedule III Prescribes Label for BMW containers/bags Schedule IV Prescribes Label for transport of BMW containers/bags Schedule V Prescribes standards for treatment and disposal of BMW Schedule VIPrescribes time limit for installation of BMW treatment facilities

24 3 Forms of BMW (M & H) Rules, 1998 Form IApplication for Authorization/renewal Form IIAnnual Report Form III Accident Reporting Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

25 Summary of Salient Features of BMW (M & H) Rules,

26 Bio-Medical Waste (Management and Handling) Draft Rules, 2011 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

27 Bio-Medical Waste (Management and Handling) Draft Rules, 2011 Deptt. of Hosp. Admn. PGI, Chd. Notified on 24th August, 2011 Published by Ministry to invite objections and suggestions Will replace Bio-Medical Waste (management and handling) Rules, 1998 Will become applicable after their publication in Official Gazette CME Sep 26-27, 2013

28 Salient Features of Draft Rules, 2011 Every occupier shall take authorization irrespective of no. of patients visiting health care facility Categories of BMW reduced from 10 to 8 (liquid waste and incineration ash now not separate category) Colour coding of waste collecting bags and treatment options re-specified to avoid overlapping and confusion Non-Chlorinated plastic bags for all categories of BMW Occupier shall also observe applicable guidelines issued by CPCB from time to time Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

29 Following additional duties of Occupier To provide training to all HCWs To immunize all HCWs To ensure occupational safety of all HCWs by personal protective equipments Recyclable waste (plastics and glass) may be disposed through authorized recyclers after autoclaving or microwaving followed by shredding Salient features of Draft Rules, 2011…contd.

30 To conduct annual health check-up for all HCWs To establish a BMW management cell  if there are more than 30 beds in health facility  such cell will meet once every 6 months  records of the minutes to be sent to prescribed authority with annual report Following additional duties of Occupier Salient features of Draft Rules, 2011…contd.

31 New Forms and Schedule  Form IV  for grant of authorization,  Form V  for filing appeal and  form VI  for report of CWTF specified.  Schedule VI  for specifying duties of various authorities  Form IV  for grant of authorization,  Form V  for filing appeal and  form VI  for report of CWTF specified.  Schedule VI  for specifying duties of various authorities Deptt. of Hosp. Admn. PGI, Chd. Draft Rules…contd. CME Sep 26-27, 2013

32 Monitoring Committee Every State and Union Territory shall constitute a monitoring committee  to monitor compliance to rules  it shall submit its report to state advisory committee, CPCB and State Pollution Control Board/Committee every 6 months. Every State and Union Territory shall constitute a monitoring committee  to monitor compliance to rules  it shall submit its report to state advisory committee, CPCB and State Pollution Control Board/Committee every 6 months. Draft Rules Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

33 Deptt. of Hosp. Admn. PGI, Chd. Every healthcare facility to have equipments like autoclave or microwave, shredder etc. or Should join CWTF Every healthcare facility to have equipments like autoclave or microwave, shredder etc. or Should join CWTF Health Care Facility with more than 500 beds may install incinerator subject to environmental clearance Municipal corporation to provide land for CWTF or installation of incinerator Draft Rules CME Sep 26-27, 2013

34 Rules are thus intended to be made more comprehensive, more specific, increasing accountability at all levels. Draft Rules

35 Case Studies Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

36 6 Case Studies on BMW Management Segregation of waste Non-installation of syringe destroyers Installation of Autoclave/Hydroclave/ETP Authorization to handle BMW 1 and Deptt. of Hosp. Admn. PGI, Chd. To upgrade incinerator or to join CWTF 4 4 CME Sep 26-27, 2013

37 Case Study 1 On Segregation of BMW Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

38 Case study 1 In October 2005, the waste transportation vehicle of PGI was found allegedly dumping hazardous waste in municipal committee dumping ground that is meant for dumping general waste only. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

39 MC Chandigarh noticed on 5 th October 2005 that some plastic bags containing hazardous BMW were dumped by PGI vehicle at MC dumping site Issue

40 Notice issued by MC to PGI on 5 th Oct 2005 PGI asked to give undertaking that BMW will not be dumped at the MC dumping ground in future Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

41 Show-cause within 15 days as to why prosecution should not be initiated against you Notice by CPCC to PGI on 07 th Oct 2005

42 Provisions of BMW (M & H) Rules, 1998 violated This was also a violation of Rule 4 of BMW (M and H) Rules, 1998 which states that it shall be the duty of every occupier of waste generating institute to take all steps to ensure that BMW is handled in such a manner that there is no adverse effect to human health and environment. This was a violation of Rule 6 (1) which states that Bio-medical waste shall not be mixed with other wastes. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

43 Damage caused due to above violation Impounding of waste containing vehicle of PGI by MC Notices by MC and CPCC to PGI A risk of punishment under section 15 of Environment (Protection) Act, 1986 Adverse publicity by media affecting reputation of PGI

44 For release of vehicle MC authorities were contacted with a request to release the van of PGI as impounding of van was adversely affecting further waste management in PGI Immediate actions taken by PGI Undertaking given to MC that every care will be taken to prevent dumping of hazardous BMW of hospital at the MC dumping ground in future The van was released in the evening of 05 th Oct in the interest of public service Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

45 Immediate actions taken… contd. An Enquiry was ordered by PGI authorities to ascertain cause of wrong segregation and to suggest remedial actions so that such violation does not happen in future Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

46 Findings of inquiry Lapse has occurred wherein BMW meant for incineration reached dumping ground of MC showing wrong segregation There is inadequate/improper supervision of waste collection, its segregation and disposal particularly from Research Block A and B areas The acute shortage of disposal bags is adding to the problem of waste collection To prevent such problems occurring in future concerning BMW, more educational activities need to be undertaken for all HCWs especially Research Block and Laboratory Staff

47 Inadequate supervision, Shortage of waste bags Main Causes of Wrong Segregation Remedial measures required to address these issues Lack of awareness /training of some of HCWs

48 Remedial measures taken Written Instructions to Sanitation deptt – Ensure BMW not dumped at MC ground – Concerned S.I. to certify that material being dumped has been inspected and verified by him and does not contain any BMW – Stickers containing name of ward/lab on bags to identify erring ward/lab – SI will maintain a register that will be checked by S.O. weekly – Any deficiency noted shall be brought to notice of higher authorities Written Instructions to Sanitation deptt – Ensure BMW not dumped at MC ground – Concerned S.I. to certify that material being dumped has been inspected and verified by him and does not contain any BMW – Stickers containing name of ward/lab on bags to identify erring ward/lab – SI will maintain a register that will be checked by S.O. weekly – Any deficiency noted shall be brought to notice of higher authorities Addressing inadequate supervision 1 1

49 Remedial measures taken Written Instructions to Nursing Staff: To pay utmost attention for proper segregation of BMW at source Written Instructions to Nursing Staff: To pay utmost attention for proper segregation of BMW at source Addressing inadequate supervision 1 1 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

50 Remedial measures taken Duties/roles well defined for supervisors: a)DNS/Sister Gr-I/sanitation Officers/Officer Incharge: Supervision, education and motivation of HCWs b) Sanitary Inspector (incharge of refuse collection point): (i)To ensure that only general waste (black bags) are loaded on dumpers for MC ground (ii)Information about those wards/labs, if any, from where un-segregated waste is sent to refuse collection point should be immediately brought to the notice of authorities Duties/roles well defined for supervisors: a)DNS/Sister Gr-I/sanitation Officers/Officer Incharge: Supervision, education and motivation of HCWs b) Sanitary Inspector (incharge of refuse collection point): (i)To ensure that only general waste (black bags) are loaded on dumpers for MC ground (ii)Information about those wards/labs, if any, from where un-segregated waste is sent to refuse collection point should be immediately brought to the notice of authorities Addressing inadequate supervision 1 1

51 Remedial measures taken Written request to all HODs – Resident doctors to follow practices of proper BMW management Written request to all HODs – Resident doctors to follow practices of proper BMW management Addressing inadequate supervision 1 1 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

52 Remedial measures taken Liaison officers for research blocks for close supervision Addressing inadequate supervision 1 1 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

53 Remedial measures taken A waste management team – To closely supervise all areas formulating a schedule of visits – To promptly report to higher authorities deficiencies for remedial action A waste management team – To closely supervise all areas formulating a schedule of visits – To promptly report to higher authorities deficiencies for remedial action Addressing inadequate supervision 1 1 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

54 Remedial measures taken Request to JMS (P) and Stores officer – Timely purchase and distribution of waste bags Request to JMS (P) and Stores officer – Timely purchase and distribution of waste bags Addressing shortage of supply of waste bags 2 2 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

55 Remedial measures taken  Training classes and workshops for all categories: – Doctors – Nurses – Sanitation staff  Training classes and workshops for all categories: – Doctors – Nurses – Sanitation staff Addressing lack of awareness of some of HCWs 3 3 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

56 Scan of some circulars Time to Time Meetings held and Instructions Issued for Strict Compliance to BMW Rules

57 Summary of remedial measures taken  Written instructions to HCWs defining their duties  Written instructions to first-line supervisors  Written instructions to HCWs defining their duties  Written instructions to first-line supervisors A team for daily supervision Deviations Authorities Monitoring of practices Supply (bags, needle cutters) Training of HCWs Plan Do Check Act TQM

58 Final outcome Since it was the first violation of BMW rules noticed and commitment from PGI to improve was given to CPCC, the matter was closed against PGI. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

59 Closely supervise BMW management in all areas of hospitals with special emphasis on segregation of waste Regularly train all categories of employees for BMW management issues Ensure supply of colour-coded waste bags Message/Lesson learnt

60 Case study 2 On segregation of BMW Issue The Disable Welfare Trust of India (DWTI) run two hospitals in Surat were disposing off the Bio-medical waste in the Surat Municipal Corporation's (SMC’s) door-to-door garbage collection vehicles. Times of India, Surat,4 th July 2013

61 Actions taken The Surat Municipal Corporation's (SMC) health and the solid waste department jointly decided to carry out surprise inspection in the city hospitals to check the proper disposal of the bio-medical waste. During the surprise checking, the hospital was caught red-handed for disposing off the bio- medical waste in the SMC's door-to-door garbage collection vehicles. The Surat Municipal Corporation's (SMC) health and the solid waste department jointly decided to carry out surprise inspection in the city hospitals to check the proper disposal of the bio-medical waste. During the surprise checking, the hospital was caught red-handed for disposing off the bio- medical waste in the SMC's door-to-door garbage collection vehicles. Case study 2…contd. Times of India, Surat,4 th July 2013

62  It reflects  Poor state of knowledge and attitude on the part of health care workers of the hospital.  Non-compliance to the rules led to  Fine amounting to Rs 12,500.  It reflects  Poor state of knowledge and attitude on the part of health care workers of the hospital.  Non-compliance to the rules led to  Fine amounting to Rs 12,500. Implications Case study 2…contd. Times of India, Surat,4 th July 2013

63 All provisions of BMW (M & H) rules, 1998 should be followed with particular emphasis on segregation and proper disposal of BMW Lesson learnt Case study 2… contd.

64 Case Study 3: In 2008 CPCC sent a notice to PGI for installation of :  Hydroclave or Autoclave and  Effluent treatment Plant (ETP) and  Air Pollution Control Device (APCD) In 2008 CPCC sent a notice to PGI for installation of :  Hydroclave or Autoclave and  Effluent treatment Plant (ETP) and  Air Pollution Control Device (APCD) Deptt. of Hosp. Admn. PGI, Chd. Non-installation of autoclave/ETP/APCD CME Sep 26-27, 2013

65 Issue ETP Incinerator Autoclave Case study 3…contd.

66 Issue Latest Guidelines* Incinerator only for following categories of BMW Category 1 Human anatomical waste Category 2 Animal waste Category 5 (if secured landfill not available) Discarded medicine and cyto-toxic drugs Autoclave or Hydroclave or Microwave for following categories of BMW Category 3 Category 4 Category 6 Category 7 Microbiology /Biotechnology waste Waste sharps Soiled waste Solid waste *Source:

67 Actions taken 1.APCD (ventury-scrubber) was promptly installed with the incinerator 2.For purchase of autoclave, the process of procurement was initiated. – Later on it was decided that PGI would join the Common Waste Treatment Facility (CWTF) being set up by Chandigarh Administration under the directions of Hon’ble Panjab and Haryana High court. – So process of installation was not found cost-effective and was shelved after informing CPCC and taking its permission. 1.APCD (ventury-scrubber) was promptly installed with the incinerator 2.For purchase of autoclave, the process of procurement was initiated. – Later on it was decided that PGI would join the Common Waste Treatment Facility (CWTF) being set up by Chandigarh Administration under the directions of Hon’ble Panjab and Haryana High court. – So process of installation was not found cost-effective and was shelved after informing CPCC and taking its permission. Case study 3…contd.

68 Actions taken Deptt. of Hosp. Admn. PGI, Chd. Case study 3…contd. CME Sep 26-27, 2013

69 Final outcome CPCC was informed about above measures taken by PGI along with the justification which convinced CPCC and no adverse action was initiated. Deptt. of Hosp. Admn. PGI, Chd. Case study 3…contd. CME Sep 26-27, 2013

70  Apart from incinerator, hospital should also have autoclave or hydroclave for final disposal of BMW or it should join a CWTF  Hospital should also have ETP for treatment of waste water  Apart from incinerator, hospital should also have autoclave or hydroclave for final disposal of BMW or it should join a CWTF  Hospital should also have ETP for treatment of waste water Lesson learnt Case study 3… contd. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

71 Case Study 4 To carry out costly repair of in-house incinerator and install costly autoclave/microwave or to wait for CWTF to be operational Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

72 Observations of Inspection in PGI by CPCB  Objections regarding incinerator:  No automatic device for charging BMW to incinerator  Tamper-proof Programmable Logic Control not attached to incinerator  Device for measuring air flow rate in incinerator chamber not attached with incinerator  Stack emission monitoring not carried out regularly  Flue gas analyzer not provided  DG set not attached with acoustic enclosure  Stack not of adequate height  Other observations  There is no autoclave/microwave in PGI to ensure complete sterilization of material meant for recycling  Objections regarding incinerator:  No automatic device for charging BMW to incinerator  Tamper-proof Programmable Logic Control not attached to incinerator  Device for measuring air flow rate in incinerator chamber not attached with incinerator  Stack emission monitoring not carried out regularly  Flue gas analyzer not provided  DG set not attached with acoustic enclosure  Stack not of adequate height  Other observations  There is no autoclave/microwave in PGI to ensure complete sterilization of material meant for recycling

73 Joining CWTF PGI has already given undertaking that it will join CWTF being set up in Chandigarh under orders from Hon’ble court Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

74 Issue before PGI After joining CWTF, the whole expenditure incurred on incinerator and autoclave/microwave will go waste To incur huge expenditure on repair and up- gradation of incinerator and installation of autoclave/microwave To wait for CWTF to come up or

75 Action Taken  Chandigarh administration requested by PGI to intimate time frame by which CWTF would be functional so that PGI could take informed decision  Reply of Chandigarh Administration is awaited.  Chandigarh administration requested by PGI to intimate time frame by which CWTF would be functional so that PGI could take informed decision  Reply of Chandigarh Administration is awaited. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

76 CPCB informed by PGI that because institute is to join CWTF being set up in Chandigarh, up-gradation of incinerator and installation of autoclave/microwave has been deferred Deptt. of Hosp. Admn. PGI, Chd. Action Taken…contd. CME Sep 26-27, 2013

77 Will CWTF be set up: judgment of court awaited Recent news paper reports show that Chandigarh administration has informed Hon’ble court that it will not hand over land for setting up CWTF and thus there would be no CWTF in Chandigarh Final judgment of court is awaited Recent news paper reports show that Chandigarh administration has informed Hon’ble court that it will not hand over land for setting up CWTF and thus there would be no CWTF in Chandigarh Final judgment of court is awaited The Indian express March 31, 2012 Chandigarh administration informed court that it wants to scrap the project of installing CWTF. Instead, it wants to install an incinerator, if required in future, on its own.

78 Case Study 5 On Authorization for Handling BMW Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

79 Case Study 5 On Authorization for Handling BMW “Ludhiana Hospital may face legal action”. …The Tribune dated 30 th September 2010 Punjab Pollution Control Board initiated legal proceedings against a teaching hospital in Ludhiana for violation of BMW (M and H) Rules, 1998 Hospital had not taken mandatory authorization for handling BMW for last 5 years

80 Case study 5 …contd. It is mandatory for every health care facility serving more than 1000 patients per month to take authorization from concerned pollution control board for handling BMW …Section 8 of BMW (M & H) Rules, 1998 Section 8 of BMW (M & H) Rules, 1998 Violation Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

81  Not taking the mandatory authorization means:  Hospital is not authorized to handle BMW generated in its premises  Hospital liable to be shut down  Punishment under section 15 of Environment (Protection) Act, 1986  Not taking the mandatory authorization means:  Hospital is not authorized to handle BMW generated in its premises  Hospital liable to be shut down  Punishment under section 15 of Environment (Protection) Act, 1986 Case study 5 …contd. Implications Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

82 Authorization should be taken by every healthcare facility serving more than 1000 patients per month Case study 5 …contd. Lesson learnt Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

83 “Needle destroyers not installed in hospitals” Case Study 6 Non-installation of Syringe-destroyers 6 city hospitals in Gurgaon served notice by Haryana Pollution Control Board for non- installation of needle destroyers. Times of India,

84 Case study 6 …contd. Mutilation of disposables should be done at source so as to prevent unauthorized re- use … Schedule I of BMW (M & H) Rules, 1998 Schedule I of BMW (M & H) Rules, 1998 Violation Non-installation of Syringe-destroyers Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

85  Not mutilating used disposables at source means:  Violation of provisions of BMW Rules and thus:  Punishment under section 15 of Environment (Protection) Act, 1986  Not mutilating used disposables at source means:  Violation of provisions of BMW Rules and thus:  Punishment under section 15 of Environment (Protection) Act, 1986 Case study 6 …contd. Implications Non-installation of Syringe-destroyers Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

86 All disposables should be mutilated at source so as to prevent unauthorized re-use in compliance with schedule I of BMW (M & H) Rules, Case study 6 …contd. Lesson learnt Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

87 Conclusion of Presentation Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

88 Every healthcare facility must manage its BMW in such a manner that it has no harmful impact on human health and environment. Conclusion

89 Every healthcare facility serving more than 1000 patients per month should take authorization from concerned pollution control board for handling BMW generated in its premises in FORM I Hospital waste must be segregated properly so that infected waste does not land into municipal site meant for general waste Conclusion …contd. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

90 Conclusion …contd. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

91 Annual report of preceding year should be submitted to pollution control board in FORM II by 31 st JANUARY. Accident, if any, should be reported to pollution control board in FORM III. Conclusion …contd. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

92 Doctors Engineering section Administrators Stores officials Sanitation workers Nurses BMW All stakeholders need to cooperate with one another Repeated TRAINING regarding the management of BMW of all categories of employees needs to be done Conclusion contd.

93 A team should be constituted by health care facility to proactively and regularly monitor BMW management practices so that deviations could be corrected promptly Conclusion Deptt. of Hosp. Admn. PGI, Chd. Monitoring and Control Mechanism CME Sep 26-27, 2013

94 Summary of BMW (M & H)Rules, Rule 1: Short title and commencement 2.Rule 2: Application 3.Rule 3: Definitions 4.Rule 4: Duty of occupier 5.Rule 5: Treatment and Disposal 6.Rule 6: Segregation, packaging, transportation and storage 7.Rule 7: Prescribed authority 8.Rule 8: Authorization 9.Rule 9: Advisory Committee 10.Rule 10: Annual Report 11.Rule 11: Maintenance of records 12.Rule 12: Accident reporting 13.Rule 13: Appeal

95 Acknowledgements Dr. Rajiv Kumar, Chief Medical Officer Dr. Shweta Talati, Senior Resident Dr. Prerna Babbar, Junior Resident Dr. Rajiv Kumar, Chief Medical Officer Dr. Shweta Talati, Senior Resident Dr. Prerna Babbar, Junior Resident

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