1 BIOMEDICAL WASTE MANAGEMENT 2 Let the waste

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BIO-MEDICAL WASTE MANAGEMENT ” 2

Let the waste of the “sick” not contaminate the lives of “The Healthy” Dr kamal Deep J. R. First Year 3

Definition 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 4

Sources of health care waste � 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

BIOMEDICAL WASTE MANAGEMENT & HANDLING RULE � 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.

CLASSIFICATION 7

MAGNITUDE OF THE PROBLEM GLOBALLY- Developed countries generate 1 to 5 kg/bed/day Developing countries: meager data, but figures are lower. 1 -2 kg/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

CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I 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 Incineration@ / deep experimental animals used in research, burial* waste generated by veterinary hospitals and colleges, discharge from hospitals, animal houses) Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal Local autoclaving/ cell cultures used in research and microwaving / infectious agents from research and incineration@ industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures) 9

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 Incineration@ / with body fluids including cotton, dressings, soiled plaster casts, lines, autoclaving / bedding and other materials microwaving contaminated with blood. ) 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# 10

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

POINTS TO REMEMBER �@ : 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

SOLID WASTE � 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

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

� 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

Hospital waste disposal 17

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

Steps to Manage Hazardous Wastes (cont’d) 3. Limit use and access to trained persons with personal protective gear 19

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

Label with Agent, Concentration and Hazard Warnings � Examples of hazard labels: 21

Communicate about Workplace Hazards � � � 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

Recycle Products When Possible 23

Slide 24

TREATMENT/DI SPOSAL METHOD ADVANTAGES DISADVANTAGES Rotary kiln üAdequate v. High –all infect waste ü most Chemical waste üPharmaceutical waste Pyrolytic üAdequate –all incineration infect waste üMost pharmaceutical waste üChemical waste investment and operating costs v. Incomplete destruction of cytotoxics v. Relative high investment 25

ROTARY KILN PYROLYTIC INCINERATOR 26

Singlechamber incinerator üGood disinfection efficiency üDrastic reduction of wt & volume of waste üResidues disposed in landfills üNo need of high trained operators üLow investment/operating cost v. Significant Drum/ brick incinerator üDrastic v. Massive reduction of wt &volume of waste üVery low investment & operation emissions of atmos pollutants v. Need for periodic removal of slag &soot v. Inefficient in destroying thermally resistant chem /drugs emission of black smoke, ash toxic flue gas 27

SINGLE CHAMBER INCINERATOR DRUM/BRICK INCINERATION 28

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

CHEMICAL DISINFECTION 30

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

v. Operating requires qualified technicians v. Inadequate for anatomical, pharmaceutical, chemic al waste , waste that is not steam permeable MicroüGood disinfection v. High investment& wave efficiency under operating costs irradiation appropriate v. Potential operation conditions v. Maintenance üDrastic reduction in problems waste volume üEnvironmentally sound 32

MICROWAVE IRRADIATION 33

Encapsulation üSimple üLow cost üSafe burying üLow inertisation üRelatively v. Not recommended for non sharp infectious waste cost v. Safe only if access to üRelatively safe site is limited and if access to site certain precautions are taken is restricted inexpensive v Not applicable to infectious waste 34

ENCAPSULATION 35

Inertisation, Immobilisation 36

BIOMEDICAL WASTE MANAGEMENT IN TBHP � � 1. 2. 3. 4. 5. 6. 7. � � � 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: Emergency Ward 4 Ward 6 ICU Operation theatre Labortory 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 Semb. Ramky Environment pvt ltd. Luidhana where waste is treated in bioplant. 37

Conclusion • 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. 38

THANK YOU HCRW Management. ppt 7/03 Slide 39