1. Disposal of waste Submitted by: Jijishma valsan
Guided by: Dr Mahamood muthedath & Dr Azeela

2. INDEX
INTRODUCTION DEFINITION CLASSIFICATION OF HEALTH CARE WASTE TREATMENT AND DISPOSAL OPTIONS ARE : INCINERATION CHEMICAL DINFECTION WET THERMAL TREATMENT MICRO WAVE IRRADIATION ENCAPSULATION SAFE BURYING INERTIZATION

3. DENTAL WASTE MANAGEMENT
CLASSIFICATION OF WASTE
EXTRACTED TEETH
SHARPS
SCRAP AMALGAM
PHOTOCHEMICAL WASTE
LEAD CONTAMINATION
NON HAZARDOUS WASTE

4. BIOMEDICAL WASTE MANAGEMENT IN INDIA
RULESOF BIOMEDICAL WASTE MANAGEMENT IN INDIA
CATEGORIES OF BIOMEDICAL WASTE IN INDIA
COLOUR CODING AND TYPES OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTE
CONCLUSION
REFERENCE

5. INTRODUCTION The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. These waste materials must be suitably disposed immediately or else it emit foul smell ,acts as a source of infection and disease and become a public health problem. Many of our hospitals neither have a satisfactory waste disposal system nor a waste management and disposal policy .The disposal of waste is exclusively entrusted to the junior most staff from the house keeping department without any supervision and even pathological waste are observed to be disposed off in the available open ground around hospitals with scant regard to aesthetic and hygeine consideration

6. Definition Health care waste is defined as all the waste generated by the health care establishments research facilities and laboratories. In addition it include the waste originating from minor or scattered sources such as produced in the course of health care under taken in the home (dialysis, insulin injection etc.)

7. Classification of health care waste
Waste category
Description and examples
Infectious waste
Waste suspected to contain pathogens
e.g. laboratory cultures; waste from isolation wards; tissues
(swabs), materials, or equipment that have been in contact
with infected patients; excreta
Pathological waste
Human tissues or fluids
e.g. body parts; blood and other body fluids; fetuses
Sharps
Sharp waste
e.g. needles; infusion sets; scalpels; knives; blades; broken
Glass

8. Waste category Eg:- Pharmaceutical waste
Waste containing pharmaceuticals
e.g. pharmaceuticals that are expired or no longer needed;
items contaminated by or containing pharmaceuticals
(bottles, boxes)
Genotoxic waste
Waste containing substances with genotoxic properties
e.g. waste containing cytostatic drugs (often used in cancer
therapy); genotoxic chemicals
Chemical waste
Waste containing chemical substances
e.g. laboratory reagents; film developer; disinfectants that
are expired or no longer needed; solvents

9. Waste category Eg:- Wastes with high content of heavy metals
Batteries; broken thermometers; blood-pressure gauges; etc.
Pressurized containers
Gas cylinders; gas cartridges; aerosol cans
Radioactive waste
Waste containing radioactive substances
e.g. unused liquids from radiotherapy or laboratory research;
contaminated glassware, packages, or absorbent paper;
urine and excreta from patients treated or tested with
unsealed radionuclides; sealed sources

10. HEALTH CARE WASTE GENERATION
Several surveys have provided an indication of typical health care waste generation system
80% of general health care waste which may be dealt with by the normal domestic and urban waste management.
15% pathologial and infectious waste
1% sharp waste
3%chemical and pharmacological waste

11. Less than 1% special waste such as radioactive or broken thermometers and used batteries A survey done in Bangalore reveals that the quantity of solid waste generated in hospitals and nursing homes generally varies from ½ to 4 kg per bed ,per day in govt.hospitals ½ to 2kg per bed per day in nursing homes . The total quantity of hospital waste generated in Bangalore is about 40 tones per day Segregation of non infectious waste from infectious waste is done only in 30% hospitals

12. HEALTH HAZARDS OF HEALTH CARE WASTE Exposure to hazardous health care waste can result in disease or injury due to one or more of the following characteristics 1)It contains infectious waste 2)It contains toxic or hazardous chemicals or pharmaceuticals 3)It contains sharps 4)It is genotoxic 5)It is radioactive

13. What is Infectious Medical Waste
Infectious Medical Waste is defined as medical waste capable of producing an infectious disease.
Waste is considered Infectious when it is:
Contaminated by an organism that is pathogenic to healthy humans;
The organism is not routinely available in the environment; and
The organism is in significant quantity and virulence to transmit disease.

14. Infectious Wastes Specifically Are
Blood and blood products in a free flowing, unabsorbed state;
Contaminated sharps,
Isolation Wastes,
Laboratory wastes, and
Unfixed pathological tissues

15. Diseases Caused by Blood borne Pathogens
HIV / AIDS
Hepatitis B
Arboviral infections
Brucellosis
Creutzfeldt-Jakob Disease
Hepatitis C
Leptospirosis
Malaria
Rabies
Syphilis
Tularemia

17. Collection of Waste
medical wastes must be collected at the point of generation in the appropriate color coded bags
Orange bags for autoclaved waste, Red bags for all other treatment methods
Biohazard bags must be labeled with the international biohazard symbol and appropriate wording; “biohazard,” “biomedical waste,” “infectious medical waste,” or “regulated medical waste”
Waste should be collected daily &transported to the storage site

18. Packaging and Storage
Wastes shall be collected in a lined, cardboard box or reusable plastic container that is labeled with the biohazard symbol and appropriate wording.
Once the box or container is full, the bag lining it must be sealed and the container then sealed shut
Boxes must be labeled with facility name, address, phone and fax numbers, and the date
A full, sealed container can be stored on site for not more than 30 days and
Storage area should allow easy access for staff and vehecle

19. Shipping and Manifests
Every load of waste shipped off-site for destruction is tracked using a manifest system
The manifest is a multiple copy document that accompanies the waste to the treatment facility
Every individual who takes possession of the waste, including someone from your facility, must sign the manifest
As the waste generator, your facility is responsible for the waste until you receive the proof-of-destruction copy of the manifest

20. This manifest has been signed by the treatment facility, certifying that this load has been destroyed and is no longer infectious.

21. Waste Disposal Options Include21
Waste Disposal Options Include
Chemical Disinfection
Autoclaving
Wet thermal treatment
Microwave irradiation
Burial
Encapsulation
Incineration
Inertization
Managed Land-fill

22. Chemical disinfectant
In this method chemicals are added to waste to kill or to inactivate the pathogens.
This method is suitable for treating liquid waste such as blood,urine,stools or hospital sewage.
The effectiveness of disinfection is estimated from the survival rates of indicator organism in standard microbiologic test

23. Types of chemical disinfectants
Formaldehydes-It has got inactivating effect on all microorganism including bacteria,viruses,and bacterial spores. Used in cases only when high level of chemical safety can be maintained.
Ethylene oxide-inactivates all microorganism but due to carcinogenic property and related health hazard it is not recommended.
Gluteraldehyde- It is active against bacteria and parasitic spores.It should be used as 2% aqueous solution with acetate buffer

24. Cont…
Sodium hypochlorite- Active against most of the bacteria , virus and spores but not effective for disinfection of liquids with high organic content such as blood or stools, relatively less hazardous.
Chlorine dioxide-It is a reddish yellow gas at ambient temperature, it is widely used in drinking water preparation,sanitation,and waste treatment.

25. Autoclaving
It is a chambered device in which saturated steam is generated under high pressure(121 degree Celsius at 15 lb. pressure for 15 min is used)
Used for the disinfection of dressings ,instruments and laboratory wears, culture media and pharmaceutical products
Autoclaving of waste

26. Wet thermal treatment(steam disinfection)
It is based on exposure of shredded infectious waste to high temperature ,high pressure steam.
It inactivates most type of microorganism
This process requires that waste be shredded before treatment to increase disinfection efficiency.
Inappropriate for the treatment of anatomical waste& animal carcasses

27. Micro wave irradiation
Most of the organisms are destroyed by the action of microwave of frequency of about 2450 MHz and a wave length of 12.24cm.
The water contained within the waste is rapidly heated by the microwaves and the infectious components are destroyed by heat conduction
Relatively high cost & maintenance problem
So not recommended for use in developing countries

28. Burying Inside Hospital Premises
Apply the following rules:
Access to the site restricted and controlled
If waste is retained on site, ensure rapid burial to isolate from animal or human contact
Only hazardous HC Waste to be buried
Management controls on what is dumped
Each deposit covered with soil
Site lined with low permeable material-concrete
Groundwater pollution must be avoided
Not recommended for untreated hazardous waste

29. Disposal to Land by Encapsulation29
Disposal to Land by Encapsulation
Fill metal or plastic containers to ¾ with waste, and add:
plastic foam
bituminous sand
cement mortar
clay material
When dry, label and seal containers and landfill
May be used for sharps, chemicals, drugs etc.
Not recommended for non sharp infectious waste
Low cost and safe method
Cement encapsulated waste

30. Incineration Combustible waste turned to ash at temps >800 C30
Incineration
Combustible waste turned to ash at temps >800 C
Reduces volume and weight
Residues are transferred to final disposal site
Treatment efficiency depends on incineration temperature and type of incinerator
Not all wastes can be incinerated
Costs vary greatly according to type of incinerator
Produces combustion gases
Questions for discussion:
What are alternatives to incineration for disposal of infectious waste?
Are any of these solutions economically viable?
If not, what recommendations would you have?

31. Types of incinerators:-
Double- chamber pyrolytic incinerator
Single chamber furnaces with static grate
Rotary kilns
Pyrolytic incinerators:-
Most reliable & commonly used process for HCW
It comprises of pyrolytic chamber & post combustion chamber
Suitable for infectious pathologic ,pharmaceutical & chemical wastes.
Not suitable for genotoxic and radioactive waste

32. Single chamber incinerator
Used in cases where pyrolytic incinerator cant be afforded(used as a last resort)
Treats wastes in batches
Loading and de-ashing operations are performed manually
A 210 litre steel drum is used
Chemical & pharmaceutical waste persist if temperature do not exceed 200 degree C
It will cause emission of black smoke, fly ash, and potentially toxic gases

33. Rotary kiln:- Comprised of rotating oven & post combustion chamber
The kiln rotates 2-5 times per minute and is charged with waste at the top
Ashes are evacuated at the bottom end of the kiln
Can be used for infectious ,pathologic, chemical and pharmaceutical wastes including cytotoxic waste

34. Disadvantages of Incineration of HC Waste:34
Disadvantages of Incineration of HC Waste:
Doesn’t destroy chemical waste at lower temperature for rotary kiln
Toxic air emissions if no control devices in place
Maintaining temperature levels (and efficiency) in field incinerators is difficult, need to balance loads with non- hazardous materials
High costs for high temperature incineration
5: Managing Medical Waste

35. Advantages of Incineration of HC Waste:35
Advantages of Incineration of HC Waste:
Good disinfection efficiency
Drastic reduction of weight and volume
Good for chemical + pharmaceutical waste
5: Managing Medical Waste

36. Land-fill in Municipal Landfills(safe burying)36
Land-fill in Municipal Landfills(safe burying)
If hazardous health-care waste cannot be treated or disposed elsewhere:
Designate a site for hazardous HC Waste
Limit access to this place
Bury the waste rapidly to avoid human or animal contact
Investigate more suitable treatment methods

37. Inertization
Mixing waste with cement and other substances before disposal in order to minimize the risk of toxic substances contained in the waste migrating into surface water or ground water.
Suitable for pharmaceuticals and for incineration ashes
Not applicable to infectious waste
Inertization plant

38. Dental 0ffice waste management

39. Classification of Waste
Because dental offices use substances that may be federally, state, or locally mandated, it is important to understand the types of waste for proper disposal.
OSHA regulates waste within the dental office since their primary function is to protect the employees.
The EPA regulates the disposal of waste as soon as it leaves the dental office.

40. Classifications of Dental Office General Waste (non-regulated)
Contaminated Waste
(regulated)
Infectious Waste
Hazardous Waste
Toxic Waste

41. Regulated Waste
Defined as waste that “requires special handling, neutralization or disposal.”
Includes all “sharps” such as disposable needles, scalpel blades, broken glass, burs, endodontic files and reamers.
Also includes blood and blood soaked or blood-caked items, human tissue, extracted teeth, and waste from pathology procedures.
Regulated waste requires special disposal in biohazard containers or bags. Dental offices should contact with licensed carriers to dispose of this waste.

42. Non-regulated Waste
Non-regulated waste includes items such as used patient bibs, barriers used during treatment, and saliva soaked gauze.
If this waste contains potentially infectious materials, even if it is considered non-regulated, it should be labeled with a biohazard label.

43. Sharps should be disposed of in an approved sharps container.
Do not overfill
Place sharps containers close to where they will be used.
Do not place your fingers into the sharps container for any reason.

44. Scrap amalgam
Scrap amalgam should be collected and stored in a air tight
Container
Scrap amalgam that is not recycled must be
managed as hazardous waste
The container of scrap amalgam i.e. recycled must be labeled
with the name address and telephone number of dental
office along with date on which they started collecting waste

45. Information about extracted teeth
Since extracted teeth are potentially infectious, they are considered regulated waste.
CDC regulations allow extracted teeth to be returned to the patient.
To save for educational use, only teeth without amalgam may be heat sterilized.
Teeth containing amalgams can be placed in biohazard containers for pickup.

46. Hazardous Waste
Hazardous waste is defined as waste that could pose a risk to human beings or to the environment.
Examples:
Scrap amalgam
Photochemical waste (developer and fixer)
Lead foil from traditional x-ray packets
Some disinfectants
Batteries

47. Biomedical waste management
In India

48. BIO-MEDICAL WASTE RULES 1998
Implementation of
BIO-MEDICAL WASTE RULES 1998
BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment.

49. BIO-MEDICAL WASTE RULES 1998
Implementation of
BIO-MEDICAL WASTE RULES 1998
Health care waste includes
Waste generated by the health care facilities
Research facilities
Laboratories
Biomedical waste in hospitals
85% are non-infectious
10% are infectious
5% are hazardous 49

50. Basic Principles
Bio-medical waste shall not be mixed with other wastes.
Segregation at source – both at ward and unit level
Color coding to support segregation at source
Bio-medical waste shall be segregated into containers/ bags at the point of generation in accordance with Schedule II (BMW Rules 1998) prior to its storage, transportation, treatment and disposal. 50

51. Basic Principles
The containers shall be labeled according to Schedule III (BMW Rules 1998)
Transport waste safely to pick up site
Identify destination for each type of waste and ensure safe disposal
Keep track of usage 51

52. Use/Reuse of equipment
Biomedical Waste Management - Issues
Use/Reuse of equipment
Unsafe collection
Unsafe disposal 52

53. CATEGORIES OF BIO-MEDICAL WASTE
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE
Option
Waste Category
Treatment & Disposal
Category No. 1
Human Anatomical Waste (human tissues, organs, body parts)
burial*
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)
burial*
Category No. 3
Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures)
local
Category No. 4
Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps)
disinfection (chemical treatment claving/microwaving and mutilation/shredding##
Category No. 5
Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines)
and drugs disposal in secured landfills

54. CATEGORIES OF BIO-MEDICAL WASTE (continued)
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continued)
Category No. 6
Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood)
Category No. 7
Solid Waste (Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.)
disinfection by chemical autoclaving/microwaving and mutilation/shredding##
Category No. 8
Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)
disinfection by chemical and discharge into drains
Category No. 9
Incineration Ash Ash from incineration of any bio-medical waste)
disposal in municipal landfill
Category No. 10
Chemical Waste (Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in  disinfection, as insecticides, etc.)
chemical and discharge into drains for liquids and secured landfill for solids

55. CATEGORIES OF BIO-MEDICAL WASTE (continue)
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continue)
Note : @
There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. *
Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas.
Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that chemical treatment ensures disinfection. ##
Multilation/shredding must be such so as to prevent unauthorised reuse.

56. Schedule-II
COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO MEDICAL WASTES
Colour Coding
Type of Container
Waste Category
Treatment options
Yellow
Plastic Bag
Categories 1, 2, 3 & 6.
Incineration/ deep burial
 Red
Disinfected container/Plastic bag
Categories 3, 6, 7
Autoclaving/Micro-waving/Chemical Treatment
Blue/White Translucent
Plastic Bag /puncture proof containers
Cat. 4,
Cat. 7
Autoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding
Black
Categories 5, 9, 10
Disposal in secured landfill.
Notes: 1. Colour coding of waste categories with multiple treatment options as defined in schedule 1, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I. 2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics. 3. Categories 8 and 10 (liquid) do not require containers/bags.

58. Conclusion Because no disposal method is easy or completely58
Conclusion
Because no disposal method is easy or completely
safe prevention is best!
Eliminate purchase by buying safer alternatives
Recycle
Use smallest quantities possible, use with engineering controls and Personal Protective Equipment
Segregate hazards into separate waste streams at source
Supervise disposal using best available ecologic option

59. Reference Parks preventive & social medicine(17 th edition)
Essentials of preventive and community dentistry(4 th edition)
Modern dental assisting(8 th edition)-Doni .l bird&Debbi.s.Robinson
Dental office administration
Hospital administration &planning- Dr A .G Chandorkar
Internet sources-IMW program website

60. Thank you…………….