1. Bio-Medical Waste Management in Indian Hospitals:
WELCOME
Workshop
Bio-Medical Waste Management in Indian Hospitals:
Trends, Technology & Challenges
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2. The problem
Health - Care Settings generates Bio-hazardous waste, which is managed casually
Bio-medical waste gets mixed with Municipal Solid Waste
Improper management & handling of waste
Dumping of waste
Adverse impact to Public Health & Environment
Occupational risk
Lack of will and lack of awareness
Misplaced priorities
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3. Who is at Risk ? • Doctors and nurses • Patients
• Hospital support staff
• Waste collection and disposal staff
• General public
Environment
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4. Evolution of Bio-medical Waste legislation
• 1860: The Indian Penal Code
269 – Negligent act likely to spread
infection of disease dangerous to life
270 – Malignant act likely to spread infection of disease dangerous to life
Whoever unlawfully/malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment for a term which may extend to six months or with fine, or with both
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5. Evolution of Bio-medical Waste legislation
• 1974: The Water Act
Restriction on discharge of effluents from Health care establishments (HSEs)‏
• 1981: The Air Act
Restriction imposed on emission of air pollutants into atmosphere by HSEs
• 1986: The Environment (Protection) Act
The Central Govt. to make rules in respect of handling of hazardous substances
No person shall handle hazardous substance except in accordance with procedures prescribed by law
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6. Evolution of Bio-medical Waste legislation
• 1989: BIS – 12625:1989
Solid Wastes – Hospitals – Guidelines for Management
1995:Delhi HC Case by B.L.Wadhera
• 1995: Draft Bio-medical Waste Rules
1997: Second Draft
• 1998: Bio-medical Waste Rules
Govt. of India Gazette notification on
2000: First Amendment to schedule VI
2000: Second Amendment
2003: Third Amendment
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7. Enforcement - Issues Definitions Segregation - containers
Packing – plastic covers
Transportation
Authorization – along with consents
Records & Reports – annual & accident
Common disposal facility - incinerators
Role of Municipal body
Applicability of Cess Act
Liquid waste
Radioactive waste
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8. Bio-Medical waste (Management & Handling) Rules,1998
Bio-Medical Waste (BMW)‏
Means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I
Occupier
In relation to any institution generating bio-medical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called, means a person who has control over that institution and/or its premises
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9. Bio-Medical waste(Management&Handling) Rules,1998
Applicable to all persons who
Generate
Collect
Receive
Store
Transport
Treat
Dispose
Handle Bio-Medical Waste in any form
Prescribed Authority for Enforcement
Karnataka State Pollution Control Board
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10. Duty of Occupier
It shall be the duty of every occupier of an institution generating bio-medical waste to:
Take all steps to ensure that waste is handled without any adverse effect to human health & the environment
To install an appropriate facility to ensure requisite treatment of waste in accordance with Schedule - I & in compliance with standards prescribed in Schedule - V
Ensure proper segregation of waste into containers/
bags at the point of generation in accordance with Schedule - II
Ensure proper labeling of containers/bags according to Schedule - III & IV
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11. Duty of Occupier
Make an application in Form - I to the KSPCB for grant of Authorisation
Submit an Annual Report to KSPCB in Form - II by st January every year
Maintain Records about generation, collection, storage, treatment & disposal of wastes
Report Accidents occurred while handling waste in Form - III to KSPCB
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12. Schedule I – Category, Treatment & Disposal
Local autoclaving/ Micro waving/ incineration
Microbiology & Biotechnology Wastes
(wastes from laboratory cultures,stocks or specimens of micro-organisms live or attenuated vaccines,human and animal cell culture used in research and infectious agents from research and industrial laboratories,waste from production of biologicals, toxins, dishes and devices used for transfer of cultures)‏ 3
Incineration/
deep burial
Animal Waste 2
Human Anatomical Waste
(Human tissues,organs,body parts)‏ 1
Treatment & Disposal
Waste Category
Waste Category
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13. Schedule I – Category, Treatment & Disposal
Incineration/autoclaving/
micro waving
Soiled waste
(item contaminated with blood and body fluids including cotton dressings, soiled plaster casts,lines beddings,other material contaminated with blood) 6
Incineration/destruction and drugs disposal in secured landfills
Discarded Medicines and Cytotoxic drugs
(wastes comprising of outdated, contaminated and discarded medicines) 5
Disinfection (chemical treatment/autoclaving/
micro waving and mutilation/shredding
Waste sharps
(Needles, syringes, scalpels, blades, glass etc. that may cause puncture and cuts. This include both used and unused sharps) 4
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14. Schedule I – Category, Treatment & Disposal
Chemical treatment and discharge into drains for liquids and secured landfill for solids
Chemical waste
(chemicals used in production of biologicals, chemicals used in disinfection, as insecticides etc)‏ 10
Disposal in municipal landfill
Incineration Ash
(ash from incineration of any bio-medical waste)‏ 9
Disinfection by chemical treatment and discharge into drain
Liquid Waste
(waste generated from laboratory and washing, cleaning, house-keeping and disinfecting activities)‏ 8
Disinfection by chemical treatment/ autoclaving/ micro waving and mutilation/shredding
Solid Waste
(waste Generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc)‏ 7
Act
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15. Segregation, Packing, Transportation & Storage
BMW shall not be mixed with other wastes
BMW shall be segregated into containers/bags at the point of generation accordance with Schedule II prior to its storage, transportation, treatment & disposal
Containers shall be labelled according to Schedule
If containers transported outside the premises also carry information prescribed in Schedule IV
BMW shall be transported only by the authorised vehicle
Untreated BMW shall not be stored beyond 48 hours
Municipal body shall continue to pick up and transport segregated Bio-medical solid waste and treated BMW from hospitals & nursing homes for disposal at municipal dump site
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16. Colour coding & Type of container for disposal of BMW
Disposal in secured landfill
5,9,10
Plastic bag
Black
Autoclaving/Micro waving/Chemical treatment and Destruction/Shredding
Autoclaving/Micro waving/Chemical treatment
Incineration/Deep burial
Treatment options as per Schedule I
4,7
Plastic bag/Puncture proof container
Blue/ White translucent
3,6,7
Disinfected container/ plastic bag
Red
1,2,3, 6
Yellow
Waste Category
Type of Container
Colour coding
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17. Prescribed Authority and Authorisation
Karnataka State Pollution Control Board (KSPCB) is the prescribed authority in the State to enforce the provisions of the Rules
Every occupier of an institution generating, collecting, receiving, storing, transporting, treating, disposing & handling BMW in any other manner form except occupier of clinics, dispensaries, pathological labs, blood banks provide treatment/service to less than 1000 patients per month shall apply to KSPCB for grant of authorisation in Form I
KSPCB shall make enquiry and after satisfied that the applicant possesses the necessary capacity to handle BMW, grant or renew authorisation within 90 days
KSPCB will give reasonable opportunity of being heard before refusing, canceling or suspension of authorisation
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18. Annual Report, Records, Accident Reporting, Appeal
Every occupier shall submit Annual Report to KSPCB in Form II by 31st January every year to include information about the categories & quantities of BMW handled during the previous year
Occupier shall maintain records related the generation, collection, storage, transportation, treatment & disposal of BMW
All records are subject to inspection & verification by KSPCB at any time
When any accident occurs while handling BMW the occupier shall report the accident in Form III to KSPCB
Any person aggrieved by an order made by KSPCB under these Rules may prefer an appeal in Form V within 30 days to the Appellate Authority
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19. Common Disposal / Incineration Sites
Without prejudice to Rule 5, the Municipal Corporations, Municipal Boards or Urban Local Bodies shall be responsible for providing suitable common disposal/incineration sites for the BMW generated in their area
In areas outside the Municipal area it shall be the responsibility of the occupier to arrange for suitable sites individually or in association
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20. Other issues Liquid waste management Sharps management
Plastics waste management
Location of color coded bins
Common BMW treatment facility
Training
BMW from home patients
Waste audit
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21. Waste Origin and Disposal
Scenario in Bangalore :
Total Bedded hospitals : 417
Total non- bedded HCEs : 595
Total bed strength of bedded hospitals : 19769
Total Solid Biomedical Waste in Bangalore : 10 T/d
Source: As per records of KSPCB
92% of waste is disposed off at two Common
Biomedical Waste Disposal Facilities
Semb Ramkey
Maridi Ecoservices
Rest of the Bio-medical waste
(mostly from house and clinics)‏
finds its way to Municipal Solid Waste

22. The Biomedical Waste (Management and Handling) Rules 1998
Scenario in Karnataka :
Total Biomedical Waste generating units (Human Hosp + Vet Hosp + Blood Banks + Diagnostic Centers + Hospitals) : 10537
Waste generated : 52 t/d
Total Common Biomedical Waste Treatment and Disposal Facility (CBMWTF): 13
Total districts covered : 23
Districts not covered : 6 (Kolar, Chikballapur, Bagalkot, Koppal, Uttra Kannada and Kodagu)‏
Waste Collected from CBMWTF : 60%
Rest of the Biomedical Waste is disposed by captive facility

25. Disinfection Facility provided at General Hospital, Yelahanka, Bangalore

26. Thank you,
C.D.Kumar
KSPCB
Bangalore
Call
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