BioMedical Waste Management and Handling Rules 1998 Issues

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

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

Environment (Protection) Act, 1986 BMW (Management and Handling) Rules, 1998 Non-compliance: punishable CME Sep 26 -27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

Punishment for non-compliance Section 15 of Environment (Protection) Act, 1986 Non-compliance to BMW (M & H) Rules, 1998 Imprisonment up to 5 years and fine up to 1 Lac or both CME Sep 26 -27, 2013 For first offence Additional fine to the tune of Rs. 5000 per day If contravention continues Imprisonment up to 7 years If contravention continues beyond a period of 1 year

Section 17 of Environment (Protection) Act, 1986 HOD is held guilty and/ or 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 CME Sep 26 -27, 2013 He exercised all care to prevent occurrence of offence Deptt. of Hosp. Admn. PGI, Chd.

Implication of section 17 for a health care administrator Ø Health care administrator should maintain documentary evidence of all steps taken by him to impress upon HCWs to follow all provisions of Rules Ø If violation occurs, the health care worker who did not manage BMW properly will be held liable Ø 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

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

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

Some Pictures Showing Poor BMW Management in Different Parts of Country

Hindustan Times, New Delhi, 22 -May-2013 Ø 33 hospitals in Delhi found flouting BMW norms. Ø 4 weeks time was given to dispose BMW as per norms otherwise authorities will face prosecution. Ø According to Times of India 24 th August, 2013 news item "These hospitals have not remedied all shortcomings and have not fully complied with disposal of biomedical waste rules.

The Tribune 11 -Jan-2013 The Tribune 16 -Jan-2013 Ø 87% Army, 61% Air Force facilities lack proper authorization ØRecords 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

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

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 Ø 3 hospitals shut down ØProsecution proceedings initiated against 8 hospitals under Environment (Protection) Act, 1986 ØBank guarantee varying from Rs 25, 000 to Rs 2. 5 Lac obtained from 34 hospitals

Salient Features of 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 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 BMW Sanitation workers Engineering section Team Work CME Sep 26 -27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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

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

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.

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.

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 31 st January every year, to include information about the categories and FORM II quantities of bio-medical wastes handled during the preceding year. CME Sep 26 -27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

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

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 prescribed authority forthwith. CME Sep 26 -27, 2013 to the FORM III Deptt. of Hosp. Admn. PGI, Chd.

6 Schedules of BMW (M & H) Rules, 1998 Schedule I Prescribes 10 categories of BMW Schedule II Prescribes colour coding and type of container for disposal of BMW 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

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

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

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

Bio-Medical Waste (Management and Handling) Draft Rules, 2011 Notified on 24 th 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.

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.

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

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 v v v 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

New Forms and Schedule Draft Rules…contd. Ø Form IV v for grant of authorization, Ø Form V v for filing appeal and Ø form VI v for report of CWTF specified. Ø Schedule VI v for specifying duties of various authorities CME Sep 26 -27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

Monitoring Committee Draft Rules Every State and Union Territory shall constitute a monitoring committee v to monitor compliance to rules v 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.

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.

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

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

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

Case Study 1 On Segregation of BMW CME Sep 26 -27, 2013 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.

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

Notice issued by MC to PGI on 5 th 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.

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

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.

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

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

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.

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

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

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

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.

Remedial measures taken 1 Addressing inadequate supervision Duties/roles well defined for supervisors: a) DNS/Sister Gr-I/sanitation Officers/Officer Incharge: Supervision, education and motivation of HCWs b) Sanitary Inspector (incharge of refuse collection point): (i) (ii) 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

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.

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.

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.

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.

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

Scan of some circulars Time to Time Meetings held and Instructions Issued for Strict Compliance to BMW Rules

Summary of remedial measures taken Plan Ø Written instructions to HCWs defining their duties TQM Ø Written instructions to first-line Do supervisors Authorities Deviations Act A team for daily supervision Monitoring of practices Check Training of HCWs Supply (bags, needle cutters)

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.

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

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, 4 th July 2013

Actions taken Case study 2…contd. • 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 biomedical waste in the SMC's door-to-door garbage collection vehicles. Times of India, Surat, 4 th July 2013

Case study 2…contd. Implications Ø It reflects ØPoor state of knowledge and attitude on the part of health care workers of the hospital. Ø Non-compliance to the rules led to ØFine amounting to Rs 12, 500. Times of India, Surat, 4 th July 2013

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

Case Study 3: Non-installation of autoclave/ETP/APCD In 2008 CPCC sent a notice to PGI for installation of : v Hydroclave or Autoclave and v. Effluent treatment Plant (ETP) and v. Air Pollution Control Device (APCD) CME Sep 26 -27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

Issue PGI has only incinerator and shredder for final disposal of BMW It has got no autoclave or hydroclave or microwave Case study 3…contd. Incinerator 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

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: www. CPCB. nic. in

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.

Case study 3…contd. Actions taken Regarding the installation of ETP, the ETP, 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.

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.

Case study 3… contd. Lesson learnt Ø Apart from incinerator, hospital should also have autoclave or hydroclave for final disposal of BMW or it should join a CWTF Ø Hospital should also have ETP for treatment of waste water CME Sep 26 -27, 2013 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.

Observations of Inspection in PGI by CPCB v Objections regarding incinerator: Ø No automatic device for charging BMW to incinerator Ø Tamper-proof Programmable Logic Control not attached to incinerator Ø Device for measuring air flow rate in incinerator chamber not attached with incinerator Ø Stack emission monitoring not carried out regularly Ø Flue gas analyzer not provided Ø DG set not attached with acoustic enclosure Ø Stack not of adequate height v Other observations Ø There is no autoclave/microwave in PGI to ensure complete sterilization of material meant for recycling

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.

Issue before PGI To incur huge expenditure on repair and upgradation 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

Action Taken Ø Chandigarh administration requested by PGI to intimate time frame by which CWTF would be functional so that PGI could take informed decision Ø Reply of Chandigarh Administration is awaited. CME Sep 26 -27, 2013 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.

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

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

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 30 th September 2010

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.

Case study 5 …contd. Implications Ø Not taking the mandatory authorization means: ØHospital is not authorized to handle BMW generated in its premises ØHospital liable to be shut down ØPunishment under section 15 of Environment (Protection) Act, 1986 CME Sep 26 -27, 2013 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.

Case Study 6 Non-installation of Syringe-destroyers 6 city hospitals in Gurgaon served notice by Haryana Pollution Control Board for noninstallation of needle destroyers. Times of India, 16. 09. 2010 “Needle destroyers not installed in hospitals”

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 reuse…Schedule I of BMW (M & H) Rules, 1998 CME Sep 26 -27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

Case study 6 …contd. Non-installation of Syringe-destroyers Implications Ø Not mutilating used disposables at source means: ØViolation of provisions of BMW Rules and thus: ØPunishment under section 15 of Environment (Protection) Act, 1986 CME Sep 26 -27, 2013 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.

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

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

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.

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.

Conclusion …contd. Annual report of preceding year should be submitted to pollution control board in FORM II by 31 st 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.

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

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.

Summary of BMW (M & H)Rules, 1998 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 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

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