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2. BIO-MEDICAL WASTE MANAGEMENT 2

3. 3 Dr kamal Deep J.R. First Year

4. 4 Acc to bio medical waste rules,1998 of India “ Bio-medical waste” means any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of bio medicals. Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use Medical waste: refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals

5.  Government/private hospitals  Nursing homes  Physician/dentist office or clinic  Dispensaries  Primary health care centers  Medical research and training centers  animal./slaughter houses  labs/research organizations  Vaccinating centers  Bio tech institutions/production units 5

6.  Came into force on 28 th july,1988.  Prescribed by Ministry of environment & forest under the environment protection act of India.  It safeguard the public & the health care workers from the risk arising due to biomedical waste.  This rule apply to all persons who generate,collect, receive, store, transport, treat, dispose or handle biomedical waste in anyform.  Waste shall be treated & disposed of in accordance with schedule 1, and with the standards prescribed in schedule V.  Biomedical waste shall be segregated into containers / bags at the point of generation in accordance with schedule II prior to its storage, treatment, transportation & disposal. The containers shall be labelled according to schedule III.

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8. GLOBALLY- Developed countries generate 1 to 5 kg/bed/day Developing countries: meager data, but figures are lower. 1-2kg/pt./day  WHO Report: 85% non hazardous waste : 10% infective waste : 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive) INDIA:-No national level study - local or regional level study shows hospitals generate roughly 1-2 kg/bed/day 8

9. 9 WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOSAL OPTION Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep 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 and colleges, discharge from hospitals, animal houses) Incineration@ / deep burial* Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal cell cultures used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures) Local autoclaving/ microwaving / incineration@ CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I

10. 10 Category No. 4 Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding## Category No. 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Incineration@ / destruction and drugs disposal in secured landfills Category No. 6 Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.) Incineration@ / autoclaving / microwaving Category No. 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# #

11. 11 Category No. 8 Liquid Waste^^ (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities) Disinfecting by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Category No.10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfecting, as insecticides, etc.) Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids.

12.  @ : There wil be no chemical pretreatment before inciniration. Chlorinated plastics shall not be incinerated.  * Deep burial shall not be option available only in town with population less than 5 lac & in rural area.  @@ chemicals treatment using atleast 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection.  # Multilation/ shredding must be such so as to prevant unauthorised reuse.  ^^ About 4-250 litre/bed/day. 12

13.  About 0.3-3.5 kg/bed/day 1: GARBAGE-55% 2:BMW  A) wasted body remains blood,cultures, anatomical waste -5%  B)Pharmaceutical &chemical waste-2%  C)Pathological waste-06% 3: Sharp object -20% 4:Pressurized container & discarded instruments- 2% 5: Radioactive wastes-0.3

15. 15 Color codingType of container Waste category treatment option YELLOW PLASTIC BAG Cat 1,2,3,6 Incineration /deep burial RED Disinfected container / plastic bag Cat 3,6,7 Autoclave/microwave /chemical treatment Blue/white translucent Plastic bag/ Puncture proof Cat 4,7 Autoclave/microwave /chemical treatment / destruction shredding BLACKPlastic bag Cat 5,9,10 Disposal in secure landfill

16.  Waste collection bags for waste type needing incineration shall not be made of chlorinated plastics.  Categories 8 & 10(liquid) do not require containers / bags  Body fluids like pleural fluid are mixed with 1% bleaching powder & then disposed off.  Cat 3 if disinfected locally need not to be put in containers / bags. 16

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18. 1. Know what hazards you have 2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists 18 **Use mercury-free thermometers

19. 3. Limit use and access to trained persons with personal protective gear 19

20.  Don’t accumulate unneeded products  Don’t let peroxides and oxidising agents turn into bombs 20 Photo of bomb robot called into hospital to dispose of picric acid.

21.  Examples of hazard labels: 21

22.  Job description  Posters on doors  Labels on hazards  Give feedback on use of PPE and disposal in evaluation  Role model safe use and disposal  Contact point who is responsible 22

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25. TREATMENT/DI SPOSAL METHOD ADVANTAGESDISADVANTAGES Rotary kiln Adequate –all infect waste most Chemical waste Pharmaceutical waste  High investment and operating costs Pyrolytic incineration Adequate –all infect waste Most pharmaceutical waste Chemical waste  Incomplete destruction of cytotoxics  Relative high investment 25

26. ROTARY KILN PYROLYTIC INCINERATOR 26

27. Single- chamber incinerator Good disinfection efficiency Drastic reduction of wt & volume of waste Residues disposed in landfills No need of high trained operators Low investment/operating cost  Significant emissions of atmos pollutants  Need for periodic removal of slag &soot  Inefficient in destroying thermally resistant chem /drugs Drum/ brick incinerator Drastic reduction of wt &volume of waste Very low investment & operation  Massive emission of black smoke, ash toxic flue gas 27

28. SINGLE CHAMBER INCINERATOR DRUM/BRICK INCINERATION 28

29. Chemical disinfection Highly efficient disinfection under good operating conditions Chemical disinfectants are relatively inexpensive  Requires highly qualified technicians for operating of the process  Uses hazardous substances that requires comprehensive safety measures Wet thermal treatment Environmentally sound Relatively low investment/operating costs  Shredders are subject to frequent breakdowns  Poor functioning 29

30. CHEMICAL DISINFECTION 30

31. WET THERMAL TREATMENT Off-site wet thermal (or "steam autoclave") treatment facility 31

32.  Operating requires qualified technicians  Inadequate for anatomical, pharmaceutical,chemic al waste,waste that is not steam permeable Micro- wave irradiation Good disinfection efficiency under appropriate conditions Drastic reduction in waste volume Environmentally sound  High investment& operating costs  Potential operation  Maintenance problems 32

33. MICROWAVE IRRADIATION 33

34. Encapsulation Simple Low cost Safe  Not recommended for non sharp infectious waste Safe burying Low cost Relatively safe if access to site is restricted  Safe only if access to site is limited and certain precautions are taken inertisation Relatively inexpensive  Not applicable to infectious waste 34

35. ENCAPSULATION 35

36. Inertisation, Immobilisation 36

37.  In our hospital there is 7 generation point of waste where biomedical waste is segregated into different buckets containing polythene of same color as bucket.  The generation points are: 1. Emergency 2. Ward 4 3. Ward 6 4. ICU 5. Operation theatre 6. Labortory 7. Room no 10  From each generation point waste is carried to central point which is emergency of TBHP.  There waste in different polythene bag is weighed and tag is applied to the bag.  Waste from TBHP is managed by SembRamky Environment pvt ltd. Luidhana where waste is treated in bioplant. 37

38. 38 Thus refuse disposal cannot be solved without public education. Individual participation is required. Municipality and government should pay importance to disposal of waste economically. Thus educating and motivating oneself first is important and then preach others about it. Start disposing waste first from within your home, then outside home, then neighborhood,then your street, your area,city and then the nation and the world. Lets make this world a better place to live in.

39. HCRW Management.ppt 7/03 Slide 39 THANK YOU