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Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD

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

2 Contents Salient Features of BMW (M & H)Draft Rules, 2011
Salient Features of BMW (M & H) Rules, 1998 Salient Features of BMW (M & H)Draft Rules, 2011 Case studies on BMW Management and lessons learnt Conclusion 2 1 4 3

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
Section 15 of Environment (Protection) Act, 1986 Punishment for non-compliance Non-compliance to BMW (M & H) Rules, 1998 Imprisonment up to 5 years and fine up to 1 Lac or both For first offence Additional fine to the tune of Rs per day If contravention continues 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
HOD is held guilty Any other officer/HCW who did not manage BMW properly is also held guilty HOD not held guilty if he proves Offence occurred without his knowledge He exercised all care to prevent occurrence of offence and/or CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

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 24th August, 2013 news item "These hospitals have not remedied all shortcomings and have not fully complied with disposal of biomedical waste rules.

11 The Tribune 11-Jan-2013 The Tribune 16-Jan-2013 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. Many Hospitals and Nursing Homes are dumping their BMW on roadsides and vacant plots in Patiala

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

13 54 hospitals in Punjab issued notice by PPCB
The Tribune 4-July-2011 The Tribune 11-July-2011 22 teams of Punjab Pollution Control Board inspected 108 hospitals on 02-July-2011 54 hospitals in Punjab issued notice by PPCB The Tribune 17-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

14 Salient Features of BMW (M & H) Rules, 1998
BMW (M & H) Rules, 1998.htm These rules apply to all persons who handle Bio-Medical Waste in any form…Rule 2 Doctors Administrators Nurses BMW 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 Sanitation workers Engineering section Team Work CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

15 Deptt. of Hosp. Admn. PGI, Chd.
Authorization for Handling BMW…Rule 8 Authorization for BMW management to be taken by every HCF serving 1000 or more patients per month a b Authorization initially for one year, then for 3 years, to be renewed every 3 years. Pre-requisites for authorization c Submission of to prescribed authority i.e. pollution control board/committee i FORM I ii Submission of prescribed fee Fee prescribed by PPCB CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

16 Salient Features of Rules…contd.
Segregation at source Maintenance of Records … Rule 11 Bio-medical waste shall be segregated at source in colour-coded containers…Rule 6 (2) Records related to BMW to be maintained Records subject to inspection and verification by the prescribed authority at any time. Storage of BMW No untreated bio-medical waste shall be kept stored beyond a period of …Rule 6 (5) 24 hrs.

17 Salient Features of Rules…contd.
Rule 5 and Schedule I 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

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

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

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

21 Annual Report sent by PGI to CPCC
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 Page 1 Page 2 Page 3

22 Salient Features of Rules…contd.
ACCIDENT REPORTING…Rule 12 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. FORM III CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

23 6 Schedules of BMW (M & H) Rules, 1998
Schedule I Prescribes 10 categories of BMW Prescribes colour coding and type of container for disposal of BMW Schedule II 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 VI Prescribes time limit for installation of BMW treatment facilities

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

25 Summary of Salient Features of BMW (M & H) Rules, 1998
Application for authorization/renewal of authorization in Form I to pollution control board Management of BMW in accordance with Schedules I to VI of BMW ( M & H) Rules, 1998 Submission of annual report of preceding year in Form II before 31st Jan. Accident, if any, to be reported in Form III Maintenance of records at all stages 1 5 2 4 3

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

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

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

29 Salient features of Draft Rules, 2011…contd.
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

30 Salient features of Draft Rules, 2011…contd.
Following additional duties of Occupier 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

31 Deptt. of Hosp. Admn. PGI, Chd.
Draft Rules…contd. 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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

32 Deptt. of Hosp. Admn. PGI, Chd.
Draft Rules 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. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

33 Deptt. of Hosp. Admn. PGI, Chd.
Draft Rules 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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

36 6 CASE STUDIES 6 Case Studies on BMW Management Segregation of waste
1 and 2 Installation of Autoclave/Hydroclave/ETP 3 6 CASE STUDIES To upgrade incinerator or to join CWTF 4 5 Authorization to handle BMW 6 Non-installation of syringe destroyers CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

38 Deptt. of Hosp. Admn. PGI, Chd.
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. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

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

42 Deptt. of Hosp. Admn. PGI, Chd.
Provisions of BMW (M & H) Rules, 1998 violated This was a violation of Rule 6 (1) which states that Bio-medical waste shall not be mixed with other wastes. 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. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

43 Damage caused due to above violation
Impounding of waste containing vehicle of PGI by MC 1 2 Notices by MC and CPCC to PGI A risk of punishment under section 15 of Environment (Protection) Act, 1986 3 Adverse publicity by media affecting reputation of PGI 4

44 Immediate actions taken by PGI
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 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 05th Oct in the interest of public service CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

46 Findings of inquiry Lapse has occurred wherein BMW meant for incineration reached dumping ground of MC showing wrong segregation 1 There is inadequate/improper supervision of waste collection, its segregation and disposal particularly from Research Block A and B areas 2 The acute shortage of disposal bags is adding to the problem of waste collection 3 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 4

47 3 Main Causes of Wrong Segregation
Inadequate supervision, 1 Shortage of waste bags 2 Remedial measures required to address these issues Lack of awareness /training of some of HCWs 3

48 Remedial measures taken
1 Addressing inadequate supervision 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

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

50 Remedial measures taken
1 Addressing inadequate supervision Duties/roles well defined for supervisors: DNS/Sister Gr-I/sanitation Officers/Officer Incharge: Supervision, education and motivation of HCWs b) Sanitary Inspector (incharge of refuse collection point): To ensure that only general waste (black bags) are loaded on dumpers for MC ground 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

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

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

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

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

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

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 TQM Plan Do Authorities Deviations Act A team for daily supervision Monitoring of practices Training of HCWs Supply (bags, needle cutters) Check

58 Deptt. of Hosp. Admn. PGI, Chd.
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. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

59 Message/Lesson learnt
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

60 Times of India, Surat,4th July 2013
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,4th July 2013

61 Times of India, Surat,4th July 2013
Case study 2…contd. 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. Times of India, Surat,4th July 2013

62 Times of India, Surat,4th July 2013
Case study 2…contd. Implications 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.  Times of India, Surat,4th July 2013

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

64 Deptt. of Hosp. Admn. PGI, Chd.
Case Study 3: Non-installation of autoclave/ETP/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) CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

65 Issue PGI has only incinerator and shredder for final disposal of BMW
Case study 3…contd. PGI has only incinerator and shredder for final disposal of BMW Incinerator It has got no autoclave or hydroclave or microwave Autoclave PGI also does not have Effluent Treatment plant (ETP). Air Pollution Control Device was also not installed with the incinerator at that time. ETP

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 Category 6 Soiled waste Autoclave or Hydroclave or Microwave for following categories of BMW Category 3 Microbiology /Biotechnology waste Category 4 Waste sharps Category 7 Solid waste *Source:

67 Actions taken Case study 3…contd.
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.

68 Deptt. of Hosp. Admn. PGI, Chd.
Case study 3…contd. Actions taken Regarding the installation of ETP, the process had been initiated by the concerned engineering section and it would be installed in due course. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

70 Deptt. of Hosp. Admn. PGI, Chd.
Case study 3… contd. Lesson learnt 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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

71 Deptt. of Hosp. Admn. PGI, Chd.
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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

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

75 Deptt. of Hosp. Admn. PGI, Chd.
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. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

76 Deptt. of Hosp. Admn. PGI, Chd.
Action Taken…contd. 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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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 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. The Indian express March 31, 2012

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

79 Case Study 5 On Authorization for Handling BMW
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 “Ludhiana Hospital may face legal action”. …The Tribune dated 30th September 2010

80 Deptt. of Hosp. Admn. PGI, Chd.
Case study 5 …contd. Violation Section 8 of BMW (M & H) Rules, 1998 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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

81 Deptt. of Hosp. Admn. PGI, Chd.
Case study 5 …contd. Implications 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 CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

83 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, “Needle destroyers not installed in hospitals”

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

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

86 Deptt. of Hosp. Admn. PGI, Chd.
Case study 6 …contd. Lesson learnt All disposables should be mutilated at source so as to prevent unauthorized re-use in compliance with schedule I of BMW (M & H) Rules, 1998. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

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

90 Deptt. of Hosp. Admn. PGI, Chd.
Conclusion …contd. Adequate supply of plastic bags/containers and needle cutters should be ensured Apart from incinerator, hospital should also have autoclave or should join CWTF for final disposal of waste. ETP should be installed in hospital. CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

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

94 Summary of BMW (M & H)Rules, 1998
Rule 1: Short title and commencement Rule 2: Application Rule 3: Definitions Rule 4: Duty of occupier Rule 5: Treatment and Disposal Rule 6: Segregation, packaging, transportation and storage Rule 7: Prescribed authority Rule 8: Authorization Rule 9: Advisory Committee Rule 10: Annual Report Rule 11: Maintenance of records Rule 12: Accident reporting Rule 13: Appeal

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

96


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