BIO-MEDICAL WASTE MANAGEMENT-  SELF LEARNING DOCUMENT FOR DOCTORS, SUPERINTENDENTS AND         ADMINISTRATORS             ...
Environment Protection Training & Research Institute, (EPTRI)                                  AcknowledgmentBio- Medical ...
Environment Protection Training & Research Institute, (EPTRI)                                               Content       ...
Environment Protection Training and Research Institute (EPTRI)    Bio-Medical Waste Management- Self Learning Document For...
Environment Protection Training and Research Institute (EPTRI)       Bio-Medical Waste Management - Self Learning Document...
Environment Protection Training and Research Institute (EPTRI)environment. These two basic category of wastes (hazardous a...
Environment Protection Training and Research Institute (EPTRI)radioactive waste and heavy metals also finds its way in was...
Environment Protection Training and Research Institute (EPTRI)       the possibility of survival, proliferation and mutati...
Environment Protection Training and Research Institute (EPTRI)             2. Regulations on Bio-medical Waste ManagementA...
Environment Protection Training and Research Institute (EPTRI)waste collection and disposal, as well as provide health and...
Environment Protection Training and Research Institute (EPTRI)   •   The Municipal Solid Wastes (Management and Handling) ...
Environment Protection Training and Research Institute (EPTRI)prescribed authority to generate, collect, receive, store, t...
Environment Protection Training and Research Institute (EPTRI)The Treatment and Disposal of bio-medical waste shall be in ...
Environment Protection Training and Research Institute (EPTRI)Category No. 9 Incineration Ash (Ash from incineration of an...
Environment Protection Training and Research Institute (EPTRI)                                    Schedule IIILabel for Bi...
Environment Protection Training and Research Institute (EPTRI)       3. Role of Doctors, Medical Superintendent and Admini...
Environment Protection Training and Research Institute (EPTRI)with regulatory notifications. Estimate the amount of non-in...
Environment Protection Training and Research Institute (EPTRI)waste and its appropriate placement , defining route of move...
Environment Protection Training and Research Institute (EPTRI)                               General Units in Hospitals   ...
Environment Protection Training and Research Institute (EPTRI)       it daily at least for one week and then average to mo...
Environment Protection Training and Research Institute (EPTRI)discarded for recycling industries. Long-term radionuclides ...
Environment Protection Training and Research Institute (EPTRI)Units in Hospitals - Assessment of Waste Generation and Wast...
Environment Protection Training and Research Institute (EPTRI)       3.1.3    Items and Equipments Required for Bio- Medic...
Environment Protection Training and Research Institute (EPTRI)    Items And Equipments Required For Bio-Medical Waste Mana...
Environment Protection Training and Research Institute (EPTRI)Weighing Machine                                            ...
Environment Protection Training and Research Institute (EPTRI)Deep Burial                                         Incinera...
Environment Protection Training and Research Institute (EPTRI)     3.1.4 Placement of Required Items:Waste will be generat...
Environment Protection Training and Research Institute (EPTRI)representative from each cadre and one from Common Bio-Medic...
Environment Protection Training and Research Institute (EPTRI)waste. The committee members should guide the staff in asses...
Environment Protection Training and Research Institute (EPTRI)    •   Be aware of procedures for treatment of injuries, cl...
Environment Protection Training and Research Institute (EPTRI)    •   Boots or closed-toe shoes- rubber boots or leather s...
Environment Protection Training and Research Institute (EPTRI)    6. Provide first aid and medical care to injured individ...
Environment Protection Training and Research Institute (EPTRI)7. It should not be swept down the drain and wherever possib...
Environment Protection Training and Research Institute (EPTRI)privatization of waste management system ( common bio-medica...
Environment Protection Training and Research Institute (EPTRI)care by common bio-medical waste treatment facility along wi...
Environment Protection Training and Research Institute (EPTRI)       4. Implementation of Bio- Medical Waste Management Pl...
Environment Protection Training and Research Institute (EPTRI)           4.1 Bio- Medical Waste Management in Hospitals Wh...
Environment Protection Training and Research Institute (EPTRI)•   Category 1: Human Anatomical Waste (body parts, organs, ...
Environment Protection Training and Research Institute (EPTRI)                           Categories of Bio-medical Waste  ...
Environment Protection Training and Research Institute (EPTRI)Segregation, Handling and Storage:Segregation is a very impo...
Environment Protection Training and Research Institute (EPTRI) Segregation of Waste in Specific Colored Bins Depending on ...
Environment Protection Training and Research Institute (EPTRI)    •   The storage area should afford easy access for staff...
Environment Protection Training and Research Institute (EPTRI)Category 2 Animal Waste (animal tissues, organs, body parts,...
Environment Protection Training and Research Institute (EPTRI)Category 6 Soiled waste (items contaminated with blood, and ...
Environment Protection Training and Research Institute (EPTRI)disinfection, as insecticides, etc. should be treated by usi...
Environment Protection Training and Research Institute (EPTRI)                     BIO-MEDICAL WASTE MANAGEMENT           ...
Environment Protection Training and Research Institute (EPTRI)                  BIO-MEDICAL WASTE MANAGEMENT              ...
Environment Protection Training and Research Institute (EPTRI)            BIO-MEDICAL WASTE MANAGEMENT               CATEG...
Environment Protection Training and Research Institute (EPTRI)               BIO-MEDICAL WASTE MANAGEMENT                 ...
Environment Protection Training and Research Institute (EPTRI)          BIO-MEDICAL WASTE MANAGEMENT     CATEGORY 5: DISCA...
Environment Protection Training and Research Institute (EPTRI)              BIO-MEDICAL WASTE MANAGEMENT                 C...
Environment Protection Training and Research Institute (EPTRI)            BIO-MEDICAL WASTE MANAGEMENT               CATEG...
Environment Protection Training and Research Institute (EPTRI)           BIO-MEDICAL WASTE MANAGEMENT          CATEGORY 7:...
Environment Protection Training and Research Institute (EPTRI)                BIO-MEDICAL WASTE MANAGEMENT                ...
Environment Protection Training and Research Institute (EPTRI)               BIO-MEDICAL WASTE MANAGEMENT                 ...
Environment Protection Training and Research Institute (EPTRI)                  BIO-MEDICAL WASTE MANAGEMENT              ...
Environment Protection Training and Research Institute (EPTRI)          BIO-MEDICAL WASTE MANAGEMENT           CATEGORY 10...
Environment Protection Training and Research Institute (EPTRI)           BIO-MEDICAL WASTE MANAGEMENT            CATEGORY ...
Environment Protection Training and Research Institute (EPTRI)The details of category wise treatment and disposal methods ...
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators
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Chemical safety bio-medical_waste_management_self_learning_document_for_doctors,_superintendents_and_administrators

  1. 1. BIO-MEDICAL WASTE MANAGEMENT- SELF LEARNING DOCUMENT FOR DOCTORS, SUPERINTENDENTS AND ADMINISTRATORS Supported By World Health Organization (WHO), India Country Office, New Delhi Prepared ByENVIRONMENT PROTECTION TRAINING AND RESEARCH INSTITUTE Gachibowli, Hyderabad, Andhra Pradesh. www.eptri.com
  2. 2. Environment Protection Training & Research Institute, (EPTRI) AcknowledgmentBio- Medical Waste Management is an essential, fundamental and important activity of allhospital. This document on Bio-Medical Waste Management - Self Learning Documentfor Doctors, Medical Superintendents and Administrators, is an attempt to refresh andenhance the knowledge on bio-medical waste management.Our sincere thanks to Mr. A.K. Sengupta, National Professional Officer, SustainableDevelopment and Environmental Health, World Health Organization (WHO), India CountryOffice, New Delhi for supporting this project and providing guidance at every level.We are grateful to Mr. Indrajit Pal, IAS, Director General, for his encouragement indeveloping this document.We wish to express our thanks and gratitude to everyone who contributed to this document.Dr. Razia SultanaProject Coordinator,Director (Programs) i/c,EPTRI, Hyderabad, Andhra Pradesh i
  3. 3. Environment Protection Training & Research Institute, (EPTRI) Content Page No.1. Introduction………………………………………………………………………….. 2 1.1 Definition of Bio-Medical Waste……………………………………………... 3 1.2 Risk to Personnel Due to Bio –Medical Waste………………………………. 3 1.3 Dangers of Improper Management of Bio-Medical Waste…………………… 42. Regulations on Bio- Medical Waste Management………………………………… 6 2.1 National Legislations Governing Waste Management……………………. ….7 2.2 Excerpts from Bio-Medical Waste (Management and Handling) Rules,1998 and as Amended............................................................................................. …83. Role of Doctors, Medical Superintendent and Administrators of Hospitals In Bio-Medical Waste Management……………………………………………….. 13 3.1 Planning and Designing of Bio- Medical Waste Management…….......... 14 3.1.1 Unit Wise Generation of Bio-Medical Waste……………………………..15 3.1.2 Waste Audit and Waste Minimization……………………………… …....16 3.1.3 Items and Equipments Required for Bio- Medical Waste Management…20 3. 1.4 Placement of Required Items……………………………………………..24 3.1.5 Designing the Movement of Bio-Medical Waste…………………………24 3.1.6 Formation of Committee for Bio-Medical Waste Management…………..24 3.2 Reducing Risk of Disease Transmission and Response to Accidents…….26 3.3 Financial Management…………………………………………………...30 3.3.1 Cost of Bio-Medical Waste Management System Where common Bio-Medical Waste Treatment Facility is Not Available………….31 3.3.2 Cost of Bio-Medical Waste Management System Where Common Bio-Medical Waste Treatment Facility is Not Available………….31 4. Implementation of Bio- Medical Waste Management Plan……………………....33 4.1 Bio-Medical Waste Management in Hospitals Where Common Bio- Medical Waste Treatment Facility is Not Available………………………...34 4.2 Bio-Medical Waste Management in Hospitals Where Common Bio- Medical Waste Treatment Facility is Available……………………………..57 4.3 Bio-Medical Waste Management in PHCs and Small Units………………...695. Do’s and Don’ts ……………………………………………………………………...73Annex 1 Bio-Medical waste (Management and Handling) Rules and Amendment…77 ii
  4. 4. Environment Protection Training and Research Institute (EPTRI) Bio-Medical Waste Management- Self Learning Document For Doctors, Medical Superintendents and AdministratorsAbout the Manual:The concern for bio-medical waste management has been felt globally with the rise ininfectious diseases and indiscriminate disposal of waste. This manual is useful forrefreshing and or up gradation of knowledge of doctors, superintendents andadministrators on bio-medical waste management. This will sensitize the reader aboutthe impacts of improper waste management and acquaint them with laws andpractices in India. The main bottleneck to sound bio-medical waste management islack of training and appropriate skills, insufficient resource allocation and lack ofadequate equipment. This document has been developed to create basic awarenessabout bio-medical waste management practices, equip the readers with enough skillsfor effectively managing bio-medical waste, safe guard themselves and thecommunity against adverse health impact.It is to be understood that management of bio medical waste is an integral part ofhealth care. This manual on “Bio-Medical Waste Management - Self LearningDocument for Doctors, Medical Superintendents and Administrators” contains fivechapters describing introduction, legal provision, role of doctors and other cadres ofstaff in bio-medical waste management. Waste auditing, requirement of items andequipments, financial management, planning, designing and implementation of bio-medical waste management with dos and don’ts has been provided. It covers safe,efficient and environmental friendly waste management options. It also containssafety procedures while handling waste. This will serve as a useful guide in planning,implementation and monitoring of bio-medical waste management program inhospitals. 1
  5. 5. Environment Protection Training and Research Institute (EPTRI) Bio-Medical Waste Management - Self Learning Document for Doctors, Medical Superintendents and Administrators 1. IntroductionAbout this Module -This module focuses upon the importance and the purpose of Bio-medical wastemanagement, definition of bio-medical waste, risks associated and dangers of impropermanagement of bio-medical waste.Learning Objectives: • To define the bio-medical waste. • To understand the importance and purpose of bio- medical waste management. • To get familiarized with the risks involved and dangers of improper management of bio-medical waste.Output: • The reader will be able to define bio-medical waste, understand the risks if not managed properly and importance of bio-medical waste management. Hospitals and other healthcare establishments have a “duty of care” for the environment, public health and have particular responsibilities in relation to the waste they produce (i.e., bio-medical waste). Negligence in terms of bio-medical waste management significantly contributes to polluting the environment andaffects the health of human beings. The waste generated by any hospital / health carefacilities consists of general waste like packaging material, eatables, paper, wrapperetc., hazardous and infectious waste like out dated medicines, cytotoxic drugs, soileddressing, swabs, cotton with blood and body fluid, dissected body organs and tissues,disposable syringes, intravenous fluid bottles, catheters, gloves, injection vials,needles, blades, scalpels etc. Quantity wise around 70 % - 80% is general waste and20% - 30% is hazardous and infectious waste which poses risk to human health and 2
  6. 6. Environment Protection Training and Research Institute (EPTRI)environment. These two basic category of wastes (hazardous and infectious) shouldbe segregated other wise the whole waste, the entire volume of waste will becomeinfectious. 1.1 Definition of Bio-Medical Waste:As per Bio-Medical Waste (Management and Handling) Rules, 1998 andamendments, any waste, which is generated during the diagnosis, treatment orimmunization of human beings or animals or in research activities pertaining there toor in the production of testing of biological and including categories mentioned inschedule 1 of the Rule, is the bio-medical waste.As per WHO norms the health-care waste includes all the waste generated by health-care establishments, research facilities, and laboratories. In addition, it includes thewaste originating from minor or scattered sources such as that produced in the courseof health care undertaken in the home (dialysis, insulin injections, etc.). 1.2 Risks to Personnel Due to Bio-Medical Waste:Poor bio-medical waste management exposes hospital and other health care facilityworkers, waste handlers and community to infection, toxic effects and injuries.Doctors, nurses, paramedical staff, sanitary staff, hospital maintenance personnel,patients receiving treatment, visitors to the hospital, support service personnel,workers in waste disposal facilities, scavengers, general public and more specificallythe children playing with the items they can find in the waste outside the hospitalwhen it is directly accessible to them are potentially at risk of being injured orinfected when they are exposed to bio- medical waste.Risk to all those who generate, collect, segregate, handle, package, store, transport,treat and dispose waste ( an occupational hazard). Occupational exposure to blood canresult from percutaneous injury (needle stick or other sharps injury), mucocutaneousinjury (splash of blood or other body fluids into the eyes, nose or mouth) or bloodcontact with non-intact skin. Over 20 blood born diseases can be transmitted butparticular concern is the threat of spread of infectious and communicable diseases likeAIDS, Hepatitis B & C, Cholera, Tuberculosis, Diphtheria etc. Waste chemicals, 3
  7. 7. Environment Protection Training and Research Institute (EPTRI)radioactive waste and heavy metals also finds its way in waste stream which are alsohazardous to health. 1.3 Dangers of improper Management of Bio-Medical Waste:There is public health hazard due to poor management of bio-medical waste whichcan cause a number of disease. Serious situations are very likely to happen when bio-medical waste is dumped on uncontrolled sites where it can be easily accessed bypublic. Children and rag pickers are particularly at risk to come in contact withinfectious waste. Inappropriate treatment and disposal contributes to environmentalpollution (uncontrolled incineration causes air pollution, dumping in drains, tanks andalong the river bed causes water pollution and unscientific land filling causes soilpollution).In many parts of the country bio-medical waste is neither segregated nor disinfected.It is being indiscriminately dumped into municipal bins, along the roadsides, intowater bodies or is being burnt in the open air. All this is leading to rapid proliferationand spreading of infectious, dangerous and fatal communicable diseases. Theimproper handling and mismanagement of bio- medical waste is posing seriousproblems, few of the problems due to improper disposal are as follows. • The infectious waste which is only 20% – 25% of the entire waste from hospitals is not segregated and is mixed with general waste by doing so the whole of waste may turn up to infectious waste. If the same is dumped into the municipal bin then there are fair chances of the waste in municipal bin to become infectious. • The disposal of sharps will lead to needle stick injuries, cuts, and infections among hospital staff, municipal workers, rag pickers and the general public. This will lead to transmission of diseases like Hepatitis B, C, E and HIV etc. • The needles and syringes which are not mutilated or destroyed are being circulated back through traders who employ the poor and the destitute to collect such waste for repackaging and selling in the market. • One of the reasons for spreading of infection is reuse of disposable items like syringes, needles, catheters, IV and dialysis sets etc. • The dumping of untreated bio-medical waste in municipal bins may increase 4
  8. 8. Environment Protection Training and Research Institute (EPTRI) the possibility of survival, proliferation and mutation of pathogenic microbial population in the municipal waste. This leads to epidemics and increased incidence and prevalence of communicable diseases in the community. • Chances of vectors are high, like cats, rats, mosquitoes, flies and stray dogs getting infected or becoming carriers which also spread diseases among the public.WHO has estimated that, in 2000, injections with It is estimated that approximately 3contaminated syringes caused: million HCWs experience • 21 million hepatitis B virus (HBV) percutaneous exposure to blood infections (32% of all new infections); borne viruses (BBVs) each year. • Two million hepatitis C virus (HCV) This results in an estimated 16,000 infections (40% of all new infections); hepatitis C, 66,000 hepatitis B and • 260 000 HIV infections (5% of all new 200-5000 HIV infections annually. infections). ( Source: Needle stick injuries in aEpidemiological studies indicate that a person who tertiary care hospital by S Texperiences one needle-stick injury from a needle Jayanth et al , Indian Journal ofused on an infected source patient has risks of Medical Microbiology, year 2009 ,30%, 1.8%, and 0.3% respectively to become Vol. 27, Issue 1, page 44-47)infected with HBV, HCV and HIV. In 2002, theresults of a WHO assessment conducted in 22developing countries showed that the proportion ofhealthcare facilities that do not use proper wastedisposal methods ranges from 18% to 64%.(Source: AIDE-MEMOIRE by World HealthOrganization (WHO) Courtesy: Dept. of Protection ofthe Human Environment Water, Sanitation and Health)Questions 1. Define bio-medical waste? 2. Who are at risk if bio-medical waste is not managed properly? 3. What are the effects of improper management of bio-medical waste? 5
  9. 9. Environment Protection Training and Research Institute (EPTRI) 2. Regulations on Bio-medical Waste ManagementAbout this Module -In this module the attention of reader is drawn on various legal provisions governed onwaste management. The salient features of Bio-Medical Waste (Management andHandling) Rules, 1998 and amendments has been provided.Learning Objectives: • To know various rules governing waste management. • To know Bio-Medical Waste (Management and Handling) Rules, 1998 and Amendments.Output: • The reader will be able to understand various regulations which governs the waste management and the salient features of Bio-Medical Waste (Management and Handling) Rules, 1998 and amendments. Establishment of a sustainable bio-medical waste management system gets benefit from a national legal framework that regulates and organizes the different elements of a waste management system. Legislation usuallyplaces obligations and controls on what is permitted and prescribes sanctions on thosethat deviate from accepted practice. In reality, a law will remain ineffective if sources(finance, material and knowledge) are not available in the hospitals or health caresectors to implement it and or if enforcement is weak.The five guiding principles governing in waste-related laws are the “polluter pays”principle, this requires any waste producer to be made legally and financiallyresponsible for the safe and environmentally sound disposal of their waste. Theresponsibility to ensure that the disposal of waste causes no environmental damage isplaced upon each waste generator, the “precautionary” principle, the rationale ofthe principle is that if the outcome of a potential risk is suspected to be serious, butmay not be accurately known, it should be assumed that this risk is high. This has theeffect of obliging health care waste generators to operate a good standard of 6
  10. 10. Environment Protection Training and Research Institute (EPTRI)waste collection and disposal, as well as provide health and safety training, protectiveequipment and clothing for their staff , the “duty of care” principle, this recognizesthat any person managing or handling health care waste, or waste-related equipment,is morally responsible to take good care of the waste while it is under theirresponsibility, the “proximity” principle, the philosophy behind this principle is thattreatment and disposal of hazardous waste (including health care waste) should takeplace at the nearest convenient location to its place of generation, in order to minimizethe risks to the general population. This does not necessarily mean treatment ordisposal has to take place at each health care establishment; instead it could be done ata facility shared locally or at a regional or national location. An extension to thisprinciple is the expectation that every country should make arrangements to disposeof all wastes in an acceptable manner inside its own national borders and priorinformed consent principle / also known as ‘cradle to grave’ control, this principleintroduces the concept that all parties involved in the generation, storage, transport,treatment and disposal of hazardous wastes (including health care waste) should belicensed or registered to receive and handle named categories of waste. In addition,only licensed organizations and sites are allowed to receive and handle these wastes.No hazardous wastes (including health care waste) should leave a place of wastegeneration until the subsequent parties (e.g. transport, treatment and disposaloperators and regulators) are informed that a waste consignment is ready to be moved. 2.1 National Legislations Governing Waste Management:National legislation is the basis for bio-medical waste management practices in thecountry. It establishes control and permits for the disposal. The regulatory frame workwhich governs the management of waste is as follows. • The Water (Prevention and Control of Pollution) Act, 1974 (for liquid waste) • The Air (Prevention and Control of Pollution) Act, 1981( for air quality) • The Environment (Protection) Act, 1986 • Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008 (for hazardous waste). • The Bio- Medical Wastes (Management and Handling) Rules 1998 (for hospital waste) 7
  11. 11. Environment Protection Training and Research Institute (EPTRI) • The Municipal Solid Wastes (Management and Handling) Rules, 2000 (for domestic municipal waste) • Battery (Management and Handling) Rules, 2001 (for used batteries waste). 2.2 Excerpts from Bio- Medical Waste (Management and Handling) Rules 1998 and as Amended:The Bio-Medical Waste Management and Handling Rules regulate bio-medical wastemanagement at local, regional and national level. The rules provides a generalfoundation for improving bio- medical waste management systems by indicating inbroad terms what is regarded as good and acceptable practice in the hospitals or healthcare institutions. The main benefit of a national law covering hospital waste is that itcan give a uniform basis for a country to develop good practices by providing thedefinition of waste, its categories , defined legal obligations of waste producers,requirements for record-keeping and reporting to regulatory agencies, authority for aninspection system, establishment of procedures to permit or prohibit some wastehandling, treatment and disposal practices and the courts with powers to settledisputes and impose penalties on offenders.This rule has 14 sections, 6 schedules and 5 forms and is applied to all persons whogenerate, collect, receive, store, transport, treat, dispose, or handle bio-medical wastein any form. As per the rule "Occupier" means in relation to any institutiongenerating bio-medical waste, which includes a hospital, nursing home, clinicdispensary, veterinary institution, animal house, pathological laboratory, blood bankby whatever name called, means a person who has control over that institution and /or its premises. The duty of every occupier of an institution generating bio-medicalwaste is to take all steps to ensure that such waste is handled without any adverseeffect to human health and the environment.No untreated bio-medical waste shall be kept stored beyond a period of 48 hours,provided that if for any reason it becomes necessary to store the waste beyond suchperiod, the authorized person must take permission from the prescribed authority andtake measures to ensure that the waste does not adversely affect human health and theenvironment. "Authorized Person" means an occupier or operator authorized by the 8
  12. 12. Environment Protection Training and Research Institute (EPTRI)prescribed authority to generate, collect, receive, store, transport, treat, dispose and orhandle bio-medical waste in accordance with these rules and any guidelines issued bythe Central Government. The “Prescribed Authority” for the enforcement ofprovisions of these rules shall be the State Pollution Control Boards in respect ofstates and the Pollution Control Committees in respect of the Union territories. The“Prescribed Authority” for the health care establishments of Armed Forces underthe Ministry of Defence shall be the Director General, Armed Forces MedicalServices.Every occupier of an institution generating, collecting, receiving, storing,transporting, treating, disposing and / or handling bio-medical waste in any othermanner, shall make an application in form 1 to the prescribed authority for grant ofauthorization. Occupier of clinics, dispensaries, pathological labs, blood banksproviding treatment / services to less than 1000 patients per month are exempted fortaking authorization. Every authorized person shall maintain records related to thegeneration, collection, reception, storage, transportation, treatment, disposal and orany form of handling of bio-medical waste in accordance with these rules and anyguidelines issued. All these records can be subjected to inspection and verification bythe prescribed authority at any time. When any accident occurs at any institution orfacility or any other site where bio-medical waste is handled or during transportationof such waste, the authorized person shall report the accident to the prescribedauthority. The Segregation, Packaging, Transportation and Storage is as follows. • Bio-medical waste shall not be mixed with other wastes. • Bio-medical waste shall be segregated into containers / bags at the point of generation in accordance with Schedule II prior to its storage, transportation, treatment and disposal. • The containers shall be duly labeled as per schedule III. • If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV. The schedule IV describes the type of waste where it is generated and to where it is being transferred. 9
  13. 13. Environment Protection Training and Research Institute (EPTRI)The Treatment and Disposal of bio-medical waste shall be in accordance withSchedule I and in compliance with Schedule V. The schedule 1 describes categorywise treatment and disposal methodology and schedule V presents the standards forincinerators, autoclave, liquid waste, microwave and deep burial. The schedule I, IIand III are as follows. Schedule 1: Categories of Bio-Medical WasteWaste Waste Category Type Treatment andCategory Disposal Option+Category No. 1 Human Anatomical Waste (body parts, organs, Incineration @ / human tissues etc.). deep burial*Category No. 2 Animal Waste (animal tissues, organs, body parts Incineration @ / carcasses, bleeding parts, fluid, blood and deep burial* experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses).Category No. 3 Microbiology & Biotechnology Waste (Wastes Local autoclaving / from laboratory cultures, stocks or micro-organisms micro waving / live or vaccines, human and animal cell culture used incineration @ in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures).Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, Disinfection glass, etc. that may cause puncture and cuts. This (chemical treatment includes both used and unused sharps). @ @ / autoclaving / micro waving and mutilation / shredding ##Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste Incineration @ / comprising of outdated, contaminated and discarded destruction and medicines). drugs disposal in secured landfillsCategory No. 6 Soiled Waste (items contaminated with blood, and Local autoclaving / body fluids including cotton, dressings, soiled micro waving / plaster casts, lines, bedding, other material incineration @ contaminated with blood).Category No. 7 Solid Waste (Waste generated from disposal items Disinfection by other than the sharps such a tubings, catheters, chemical treatment intravenous sets etc.). @ @ autoclaving / micro waving and mutilation/ shredding ##Category No. 8 Liquid Waste (Waste generated from laboratory Disinfection by and washing, cleaning, housekeeping and chemical treatment disinfecting activities). @ @ and discharge into drains 10
  14. 14. Environment Protection Training and Research Institute (EPTRI)Category No. 9 Incineration Ash (Ash from incineration of any Disposal in bio-medical waste). municipal landfillCategoryNo.10 Chemical Waste (Chemicals used in production of Disinfection by biologicals, chemicals used in disinfection, as chemical treatment insecticides, etc.). @ @ and discharge into drains for liquids and secured land fill for solidsNote@ There will be no chemical pretreatment before incineration. Chlorinated plastics shall notbe incinerated.*Deep burial shall be an option available only in towns with population less than five lakhsand in rural areas.@@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalentchemical reagent. It must be ensured that chemical treatment ensures disinfection.## Mutilation / shredding must be such so as to prevent un authorized reuse.+ Options given above are based on available technologies. Occupier / operator wishing touse other state of the art technologies shall approach the Central Pollution Control Board toget the standards laid down to enable the prescribed authority to consider grant ofauthorization. Schedule II: Color Coding and Type of Container for sposal of Bio-Medical WasteColor Type of Waste Category Treatment options as perCoding Container Schedule IYellow Plastic bag. Cat. 1, Cat. 2, and Incineration/deep burial Cat. 3, Cat. 6Red Disinfected Cat. 3, Cat.6, Autoclaving / Micro waving / container / plastic Cat.7. Chemical Treatment bagBlue / White Plastic bag / Cat. 4, Cat. 7. Autoclaving / Micro waving /Translucent puncture proof Chemical Treatment and Container Destruction / shreddingBlack Plastic bag Cat. 5 and Cat. 9 Disposal in secured landfill and Cat. 10. (Solid)Notes:1.Colour coding of waste categories with multiple treatment options as defined in Schedule I,shall be selected depending on treatment option chosen, which shall be as specified inSchedule I.2.Waste collection bags for waste types needing incineration shall not be made of chlorinatedplastics.3.Categories 8 and 10 (liquid) do not require containers / bags.4.Category 3 if disinfected locally need not be put in containers / bags. 11
  15. 15. Environment Protection Training and Research Institute (EPTRI) Schedule IIILabel for Bio-Medical Waste Containers/ Bags BIOHAZARD CYTOTOXIC C CYTOTOXIC CYTOTOXIQUE HANDLE WITH CARE Note: Label shall be non-washable and prominently visible.Questions 1. Name Acts and Rules which governs waste management. 2. Categorize the bio-medical waste as per Bio-Medical Waste (Management and Handling) Rules, 1998 and amendments. 3. How many colors of waste bags or bins have been mentioned in the Rule and for what purpose? 12
  16. 16. Environment Protection Training and Research Institute (EPTRI) 3. Role of Doctors, Medical Superintendent and Administrators In Bio- Medical Waste ManagementAbout this Module -This module deals with the role of Doctors, Medical Superintendents andAdministrators of hospitals in panning and designing of Bio- Medical WasteManagement. Unit wise generation of waste, its audit and minimization techniques,items and equipments required to manage the waste and their placement has beenmentioned. Financial management as per methodology adopted for disposal isexplained.Learning Objectives: • To enhance knowledge and skills on waste audit, waste minimization, financial management. • To understand unit wise generation of waste. • To know items required to manage waste and their placement in each unit.Output: • The reader will be able to understand unit wise generation of waste, perform waste audit and waste minimization techniques and will be able to do financial management in bio-medical waste disposal. Dealing bio-medical waste in safe manner is the responsibility of all medical staff. Every person including Doctors and Medical Superintendents producing waste items are responsible for ensuring itssafe segregation at the point of generation itself.Bio-medical waste is poorly managed in manyhospitals not only in India, worldwide. Identifyingthe causes and then supporting improvements in thesystem are key skills that doctors, medicalsuperintendents and administrators of hospitals need to develop. Assess the wastehandling and treatment system of bio-medical waste and its mandatory compliance 13
  17. 17. Environment Protection Training and Research Institute (EPTRI)with regulatory notifications. Estimate the amount of non-infectious and infectiouswaste, preferably category wise, generated in different wards or sections. Analyze thebio-medical waste management system, including policy, practice, storage, collection,transportation, treatment, disposal and compliance with the standards prescribedunder the regulatory framework. In order to develop a model bio-medical wastemanagement system in the hospital, create awareness among all the stakeholdersabout the importance of bio-medical waste management, related regulations and howto dispose off the waste. The doctors, Medical Superintendents and the Administratorsshould have ‘will’ to improve waste management from a poor standard ofperformance to a better one. To improve the performance, develop policy, plan, lookfor waste minimization options, provide the required materials for waste managementand implement sustainable waste management system. Arrange for regular trainingfor all the staff and organize refresher courses, monitor and over see bio-medicalwaste management system regularly. While monitoring care should be taken that it isnecessary to ensure that each type of segregated waste are kept intact in separatespecific containers and disposed off in separate specific ways, other wise medicalstaff will loose confidence in the benefit of waste segregation if all wastes are remixedin subsequent handling and disposal. Doctors, Superintendents and Administratorsare responsible, have to play a vital role in planning, designing and implementing bio-medical waste management system, reducing risk of disease transmission by takingappropriate measures, response to accidental spillage and financial management. 3.1 Planning and Designing of Bio- Medical Waste Management:All the medical staff should realize that it is part of their duty to tackle bio-medicalwaste management problems. To plan and design bio-medical waste management oneshould know how much and what type of waste is generated and from which unit. Iswaste minimization possible if so in which unit and for what type of waste. What allitems and equipments and their quantities are required for managing the waste. Whattype of disposal methodology is to be adopted to suit to their facility. Ascertainwhether common bio-medical waste facility is available in the area or not. Forming awaste management committee will enhance the waste management practice. Forplanning and designing of bio-medical waste management, unit wise generation ofwaste, its audit and minimization, items and equipments required for managing the 14
  18. 18. Environment Protection Training and Research Institute (EPTRI)waste and its appropriate placement , defining route of movement of waste andfinance management needs to be taken into consideration. 3.1.1 Unit Wise Generation of Bio- Medical Waste:Depending on the services offered by hospitals or health care establishments, thereexist the type of facilities or units in the hospitals. Activities in each unit and numberof units should be identified along with the generation of type of bio-medical wasteexpected. A preliminary study should be taken up before attempting to waste auditand its minimization. In general various types of units available in any hospitals areout patient, injection room, general ward, labour room, operation theater, intensivecare unit, casualty or emergency , laboratory and pharmacy etc. Observe wastegeneration in each unit, segregate the waste as per rule at its generation place, weigh itdaily for one week, aggregate it and then predict for monthly waste generation. If thesegregation is not good then take the total weight of waste unit wise and 10 % to 25%will be the infectious waste. Depending on the activities performed in each unit,different types of waste is generated. The expected type of waste generated unit wiseis as follows.Unit Waste GenerationOut Patient Soiled Waste,(gauze, bandages etc.), Solid waste (Plastic) and SharpsInjection Room Soiled Waste, Sharps and Solid wasteGeneral Ward Sharps waste, Solid waste and Soiled wasteLabour Room Body part (placenta etc.) ,Sharps waste, Solid waste and Soiled wasteOperation Theater Body parts, Sharps waste, Solid waste and Soiled wasteIntensive Care Unit Sharps waste, Solid waste, Soiled wasteCasualty/ Emergency Sharps waste, Solid waste and Soiled wasteLaboratory Sharps waste, Solid waste, Soiled waste, Biologicals (culture / media)Pharmacy Discarded medicines 15
  19. 19. Environment Protection Training and Research Institute (EPTRI) General Units in Hospitals 3.1.2 Waste Audit and Waste Minimization:After knowing the waste generation in all units in a hospital, perform waste audit andthen minimize the generation of waste. This is one of the main step in planning anddesigning of bio-medical waste management. The audit will give the clear picture ofwhat type of waste, how much and from where it is generated. This information willbe helpful to opt for waste minimization, items and equipments required forsegregation and treatment of waste and their placement in different units. To knowhow much and what type of waste is generated in each medical area, segregate thewaste at the point of generation category wise in specific color codes as per Bio-Medical Waste (Management and Handling) Rules. The following steps will help infinding the waste generated quantity wise/ category wise and unit wise. • Ascertain how many medical areas produce bio-medical waste. List all the departments and study on its activities, production of waste and quantity. • Find the composition of the waste in each place. Segregate waste category wise, weigh 16
  20. 20. Environment Protection Training and Research Institute (EPTRI) it daily at least for one week and then average to monthly. The waste generated is not same in all the areas producing waste. • Keenly look for waste minimization options in all the departments. • Along with the solid waste generation assessment, liquid waste assessment is also necessary.Waste minimization benefits the waste producers. The costs for the purchase ofgoods, waste treatment and disposal are reduced and the liabilities associated with thedisposal of waste are lessened. By implementing policies and practices such aspurchasing restrictions to ensure the selection of methods or supplies that are lesswasteful or generate less hazardous waste can lead to source reduction. Use suchmaterials which can be recycled either on-site or off-site. Careful segregation(separation) of waste into the ten categories (solid and liquid) as per rule helps tominimize the quantities of hazardous / harmful waste. Careful management of storeswill prevent the accumulation of large quantities of outdated chemicals orpharmaceuticals and limit the waste to the packaging (boxes, bottles, etc.) plusresidues of the products remaining in the containers. These small amounts of chemicalor pharmaceutical waste can be disposed of easily and relatively cheaply, whereasdisposing of larger amounts requires costly and specialized treatment, whichunderlines the importance of waste minimization. Suppliers of chemicals andpharmaceuticals can also become responsible partners in waste minimization. Thehealth service can encourage this by ordering only from suppliers who provide rapiddelivery of small orders, who accept the return of unopened stock, and who offer off-site waste management facilities for hazardous wastes.Medical and other equipment used in a hospital may be reused provided that it isdesigned for the purpose and will withstand the sterilization process. Reusable itemsmay include certain sharps, such as scalpels and hypodermic needles, syringes, glassbottles and containers, etc. After use, these should be collected separately from nonreusable items, carefully washed (particularly in the case of hypodermic needles, inwhich infectious droplets could be trapped), and may then be sterilized. Althoughreuse of hypodermic needles is not recommended, it may be necessary inestablishments that cannot afford disposable syringes and needles. Plastic syringesand catheters should not be thermally or chemically sterilized, they should be 17
  21. 21. Environment Protection Training and Research Institute (EPTRI)discarded for recycling industries. Long-term radionuclides conditioned as pins,needles, or seeds and used for radiotherapy may be reused after sterilization. Specialmeasures must be applied in the case of potential or proven contamination with thecausative agents of transmissible diseases.Care should be taken while opting for recycle or reuse of materials, medical and otherequipments. Ensure that effective sterilization is attained. Sterilization can beachieved by thermal sterilization and chemical sterilization. Dry sterilization is anexposure to 160 °C for 120 minutes or 170 °C for 60 minutes in an oven. Wetsterilization is an exposure to saturated steam at 121°C for 30 minutes in an autoclave.Sterilization by ethylene oxide is done by exposing to an atmosphere saturated with itfor 3–8 hours, at 50°– 60°C, in a reactor tank “gas-sterilizer”, the tank should be drybefore injection of the ethylene oxide. Ethylene oxide is a very hazardous chemical,this process should therefore be undertaken only by highly trained and adequatelyprotected technical personnel. Exposure to a glutaraldehyde solution for 30 minuteswill sterilize the material and this process is safer for the operators than the use ofethylene oxide but is microbiologically less efficient. The effectiveness of thermalsterilization may be checked by the Bacillus stearothermophilus test and for chemicalsterilization by the Bacillus subtilis test. 18
  22. 22. Environment Protection Training and Research Institute (EPTRI)Units in Hospitals - Assessment of Waste Generation and Waste Audit 19
  23. 23. Environment Protection Training and Research Institute (EPTRI) 3.1.3 Items and Equipments Required for Bio- Medical Waste Management:The items and facilities required for managing the bio-medical waste are as follows.• Protective aids like gloves, boots, over garment/ apron etc (for self protection against infection / injury).• Colored bins and bags (yellow, red / blue & white puncture proof translucent, black and green). The Bio Hazard Label should be on all bins and bags except on black and green. The Cytotoxic Label should be on black bin and bag. The green color bin should be used for general waste which is like domestic waste ( for segregation of waste).• Big blue or red container (for storing mutilated and disinfected plastic waste).• Temporary central storage room (to keep all categories of waste after segregation before disposal).• Trolley (to carry the waste to temporary central storage place).• Needle cutter or Needle burner (for destroying injection needle).• Scissors or knife (for destroying plastic waste).• Incinerator where Common Bio-Medical waste Treatment Facility is not available (for incinerating waste, but having individual incinerator is discouraged).• Deep burial pit where population is less than 5,00,000 and in rural areas where Common Bio- Medical Waste Treatment Facility is not available (for burial of waste category 1 and 2 ).• Sharp pit where Common Bio-Medical waste Treatment Facility is not available (for encapsulating disinfected mutilated sharps).• Autoclave / Microwave (for disinfection).• Sodium hypo Chlorite solution (for disinfection).• Soap (to wash hands).• Secured landfill• Waste water treatment plant [ for chemical (liquid) and liquid (lab and washing etc.) waste] 20
  24. 24. Environment Protection Training and Research Institute (EPTRI) Items And Equipments Required For Bio-Medical Waste Management. Mask Cap Gloves Boots or closed-toe Shoes Over garment / Apron Waste Segregation Bags and Bins 21
  25. 25. Environment Protection Training and Research Institute (EPTRI)Weighing Machine Needle Cutter Dedicated Trolley Scissors and Disinfection Solution Temporary Central Storage Room 22
  26. 26. Environment Protection Training and Research Institute (EPTRI)Deep Burial Incinerator Sharp Pit Autoclave Shredder Waste Water Treatment Plant 23
  27. 27. Environment Protection Training and Research Institute (EPTRI) 3.1.4 Placement of Required Items:Waste will be generated depending on the activity of each individual unit. Afterensuring the category and quantity of waste generation, required items to manage thebio-medical waste should be placed appropriately. In general the requirement of bio-medical waste management items and its placement in each unit is as follows. Unit Requirement and Placement in UnitsOut Patient Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical.Injection Room Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical.General Ward Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical.Labor Room Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical.Operation Yellow / red , blue and white puncture proof translucent bag & bin /Theater container, needle cutter, scissor and disinfection chemical.Intensive Care Yellow / red , blue and white puncture proof translucent bag & bin /Unit container, needle cutter, scissor and disinfection chemical.Casualty/ Yellow / red , blue and white puncture proof translucent bag & bin /Emergency container, needle cutter, scissor and disinfection chemical.Laboratory Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical.Pharmacy Black bin or bag. 3.1.5 Designing the Movement of Bio- Medical Waste:The movement of waste should be such that after segregating thewaste in specific color coded bags from individual units, it shouldbe placed in dedicated trolleys to transport the waste to temporarystorage place for onward transmission to final disposal place. Theroute should be pre defined, that is it should neither be throughinter units nor from crowded places. Care should be taken that thereshould not be any spillages from bins / bags/ trolleys whilemovement or transporting the bio-medical waste. Dedicated Trolley 3.1.6 Formation of Committee for Bio- Medical Waste Management:A committee to be constituted with representative members drawn from all thedepartments of hospital ( doctor/ specialist doctor, nurse, paramedical staff etc.) 24
  28. 28. Environment Protection Training and Research Institute (EPTRI)representative from each cadre and one from Common Bio-Medical Waste TreatmentFacility if available. The committee should meet once in a week to discuss oncontinual improvement of bio-medical waste management and its minimization. Thecoordinator will be on turn wise basis for a period of one month from eachdepartment who will be in charge for bio-medical waste management and allocatesresources to support the system and ensures arrangements are in place to deal withemergencies and investigates any waste-related accidents. Heads of medicaldepartments ensure that all their staff are aware of the waste segregation and localstorage procedures, encourage good practices and enforce compliance. Matron orhead nurse will be responsible for a continual training and also to new nurses and newrecruits on good bio-medical waste handling practices. They should over see thehandling of bio-medical waste by class IV employees, like there should not be anyspillage along the way, should carry the waste through predefined routes etc., andensures that supplies of consumable items are available (e.g. waste bags, etc.).The committee should ensure technically feasible, environmentally sound,economically viable and socially acceptable system for management of bio-medical 25
  29. 29. Environment Protection Training and Research Institute (EPTRI)waste. The committee members should guide the staff in assessing the wastegeneration in hospital with frequent intervals of time, details of assessment shouldinclude minimum weight of bio-medical waste in each unit of hospital andcomposition of which to be determined by segregating the waste at the point ofgeneration itself. A person to be designated to assess the level of scavenging if any orrecycling taking place inside the hospital, along transportation routes and at finaldisposal sites , also determine social issues in relation to scavenging taking place.The committee to meet once in fortnight and review and analyze existing bio-medicalwaste generation, storage, collection and its frequency and disposal system with dueregards to level of segregation. Review existing awareness on bio-medical wastemanagement among all cadres of staff and prepare training need analysis (TNA) andorganize programs. Committee should also over see the whether consent of operationhas been obtained or not and other regulatory parameters. 3.2 Reducing Risk of Disease Transmission and Response to Accidents:Diseases can be transmitted from Doctors and Nurses to patient (due to unwashedhands, contaminated sharps, or improperly cleaned reusable equipment). Patient toHealth Worker (due to being accidentally needle stick or sharps that have been usedon patients. Also due to blood or body fluids accidentally splashing onto or coming incontact with broken skin). Health Worker to Family and Community (healthworkers with unclean hands or contaminated clothing or shoes can carry infectionhome to family members). Health Facility to Community (improper disposal of bio-medical waste can lead to transmission of disease to community members due toneedle stick injury or needle reuse, droplet infection, respiratory route, skin contactsetc). The risk can be reduced by following the guidelines mentioned below. • Handle all sharps with care to minimize needle stick injury. • Instruct the staff that while handling waste they should wear appropriate protective clothing, including a water resistant apron, thick gloves, boots or closed-toe shoes, and eye protection. • Do not allow to sort waste or open waste containers to sort waste. • Educate the staff to wash hands after working with waste or infected material. • Before and after examining patient or in between two patients wash hands. 26
  30. 30. Environment Protection Training and Research Institute (EPTRI) • Be aware of procedures for treatment of injuries, cleaning of contaminated areas and reporting sharps injuries or accidents. • Report sharps injuries to the appropriate personnel. • Injuries should be followed up by post-exposure prevention treatment. • Head nurse should maintain a log of all accidents. • A full course of hepatitis B and tetanus vaccination will protect from the hepatitis -B virus and tetanus.Health workers are at risk of accidental needle stick or other injuries from sharps.World health Organization (WHO) recommends the following steps after a needlestick injury. • Wounds and skin sites exposed to blood or body fluids should be washed with soap and water; and mucous membranes flushed with water. • If blood or body fluids have gotten into eyes, splash eyes with clean water. • Immediately report the incident to a designated person or head nurse. • Retain, if possible, the item involved in the incident, get details of its source for identification of possible infection. • Seek additional medical attention in an emergency health department as soon as infection identified (based on body substance and severity of exposure). • Get blood tests or other tests and counseling, if indicated. • Record the incident. • Investigate the incident and identify and implement remedial action to prevent similar incidents in the future.Health workers need to protect themselves by establishing a barrier betweenthemselves and the infective agent. The type of protection needed depends on theworker’s activities. Protective clothing must be worn at all times when handling bio-medical waste. It must be properly maintained and kept clean. The clothing should notbe taken home, must remain at the health facility to avoid possible contamination ofthe community. Protective clothing includes: • Gloves-always wear gloves when contaminated items are handled. Puncture- Resistant gloves should be used when handling sharps containers or bags with unknown contents. 27
  31. 31. Environment Protection Training and Research Institute (EPTRI) • Boots or closed-toe shoes- rubber boots or leather shoes provide extra protection to the feet from injury by sharps or heavy items that may accidentally fall. They must be kept clean. When possible, avoid wearing sandals or shoes made of soft materials. • Aprons- rubber or plastic aprons provide a protective, waterproof barrier to the body. • Goggles- plastic goggles can protect the eyes from accidental splashes. • Hand washing- Wash with soap and antiseptic detergent. Protective AidsThe measures that could / should be taken in case of accidental spillages in hospitalsis as follows. 1. Evacuate the contaminated area. 2. Decontaminate the eyes and skin of exposed personnel immediately. 3. Inform the designated person who should coordinate the necessary actions. 4. Determine the nature of the spill. 5. Evacuate all the people not involved in cleaning up. Spillage 28
  32. 32. Environment Protection Training and Research Institute (EPTRI) 6. Provide first aid and medical care to injured individuals. 7. Secure the area to prevent exposure of additional individuals. 8. Provide adequate protective clothing to personnel involved in cleaning-up. 9. Limit the spread of the spill. 10. Neutralize or disinfect the spilled or contaminated material if indicated. 11. Collect all spilled and contaminated material. Sharps should never be picked up by hand, brushes and pans or other suitable tools should be used. Spilled material and disposable contaminated items used for cleaning should be placed in the appropriate waste bags or containers. 12. Decontaminate or disinfect the area, wiping up with absorbent cloth. The decontamination should be carried out by working from the least to the most contaminated part, with a change of cloth at each stage. Dry cloths should be used in the case of liquid spillage, for spillages of solids, cloth impregnated with water (acidic, basic, or neutral as appropriate) should be used. 13. Rinse the area, and wipe dry with absorbent cloths. 14. Decontaminate or disinfect any tools that were used. 15. Remove protective clothing and decontaminate or disinfect it if necessary. 16. Seek medical attention if exposure to hazardous material has occurred during the operation.If the spillage of mercury occurs then collection of mercury spill and storage aspectis as follows. 1. Remove everyone from the area that has been contaminated with mercury. Keep the heat below 20°C and ventilate the area if possible. 2. Put on face mask in order to prevent breathing of mercury vapor. 3. Remove all jewelry from hands and wrists so that the mercury cannot combine (amalgamate) with the precious metals. 4. Appropriate personal protective equipment (rubber gloves, goggles / face shields and clothing) should be used while handling mercury. 5. Locate all mercury beads carefully. Cardboard sheets should be used to push the spilled beads of mercury together. Mercury should be placed carefully in a container with some water. 6. Never use a broom or a vacuum cleaner. 29
  33. 33. Environment Protection Training and Research Institute (EPTRI)7. It should not be swept down the drain and wherever possible, it should be disposedoff at a hazardous waste facility or given to a mercury-based equipment manufacture. Collection of Mercury Beads 3.3 Financial Management:According to the “polluter pays principle”, all organizations are financially liable forthe safe management of any waste it generates. The costs of separate collection,appropriate packaging, and on-site handling are internal to the establishment and paidas labor and supplies costs. The costs of off-site transport, treatment, and finaldisposal are external and paid to the contractors who provide the service (commonbio-medical waste treatment facilitator). Where common bio- medical waste treatmentfacility is not available, the costs of construction, operation, and maintenance ofsystems for managing the waste can represent a significant part of the overall budgetof a hospital. They should be covered by a specific allotment from the hospitalbudget. Certain basic principles should always be respected in order to minimize thesecosts. Waste minimization, segregation, and recycling are recommended which cangreatly reduce disposal costs. The benefits of producing less waste are evident, andsegregation prevents the unnecessary treatment of general waste by the costlymethods necessary for waste management.For government-owned hospitals, the government may use general revenues to paythe cost of the waste management system. For private organizations, they need toimplement waste management system from their own resources. Since few years 30
  34. 34. Environment Protection Training and Research Institute (EPTRI)privatization of waste management system ( common bio-medical waste treatmentfacility) is gaining importance and it should be encouraged to reduce environmentalpollution in the vicinity of hospitals. For cost estimation all hospitals need to establishaccounting procedures to document the costs they incur in managing waste. Accuraterecord keeping and cost analysis must be undertaken which helps to reducemanagement cost. All the activities of bio-medical waste management should beobserved with out compromise in its cost involved. The requirement of items andequipments and placement of these has been discussed in 3.4 and 3.5, hencedepending on the waste management plan budget should be allocated. 3.3.1 Costs of Waste Management System Where Common bio- Medical Waste Treatment Facility is Not Available:An Initial capital investment is necessary for management of bio medical waste. Coston the following items has to be taken into account. Plant and equipment ( sterilizer,shredder, incinerator / deep burial where population is less than 5000 population inrural areas), utility requirements (fuel, electricity, water, etc.), operation andmaintenance, consumables, incinerator building, waste storage room, offices, wastecollection trucks, bins/containers / bags for transporting waste from hospitals toincinerator site, trolleys for collecting waste bags from wards, bag holders to belocated at all sources of waste in hospitals, weighing machines for weighing wastebags, protective clothing, disinfecting solution, soap to wash hands and mutilatingagents. The indirect operating costs involves training, replacement of parts,consumables, vehicle maintenance, uniforms and safety equipment, ash disposal,compliance monitoring of flue-gas emissions, project management and administrativecosts for the organization responsible for the execution and long-term operation of theproject. 3.3.2 Costs of Waste Management System Where Common bio- Medical Waste Treatment Facility is Available:When the common bio-medical waste treatment facility is available, the cost ofcolored bags / bins / containers, trolley for transporting the waste to temporary storageplace, mutilating agents, protective clothing, disinfecting solution, soap to wash handsneeds to be considered. The treatment like autoclave , shredding etc. will be taken 31
  35. 35. Environment Protection Training and Research Institute (EPTRI)care by common bio-medical waste treatment facility along with final disposal ofwaste. Questions 1. How to perform waste audit? What is waste minimization? 2. Name protective aids. 3. What measures should be taken in case of accidental spillages in a hospital? 4. How mercury is to be picked up when there is spillage of mercury? 32
  36. 36. Environment Protection Training and Research Institute (EPTRI) 4. Implementation of Bio- Medical Waste Management PlanAbout this Module –This module explains the implementation of bio-medical waste management plan inhospitals where common bio-medical waste treatment facility is not available and oravailable, in primary health centers and in small hospitals situated in rural areas.Learning Objectives: • To understand the various steps involved in management of bio-medical waste in the absence of common bio-medical waste treatment facility. • To understand the various steps involved in management of bio-medical waste in the presence of common bio-medical waste treatment facility. • To get familiarized with management of bio-medical waste in primary health centers and in small hospitals in the rural areas.Output: • The readers will be able to implement bio-medical waste management plan properly in their hospitals. The bio-medical waste management is a crucial one which starts from point of generation and ends at point of disposal. Policy on bio-medical waste management needs to be evolved on the feasibility option and optimal sustainable treatment technologies. There are various optionsavailable for managing bio-medical waste and the selection of treatment and disposaldepends on the availability and non availability of common bio-medical wastetreatment facility, nature of hospital ( large scale or small scale) place where it issituated etc. The implementation plan for bio-medical waste management withvarious options is as follows. 33
  37. 37. Environment Protection Training and Research Institute (EPTRI) 4.1 Bio- Medical Waste Management in Hospitals Where Common Bio- Medical Waste Treatment Facility is Not Available:The bio-medical waste management starts from the point of generation. Wasteminimization options should be considered and adopted. After the waste is generatedthe immediate step is segregation followed by collection, storage, transportation,treatment and disposal. The path between the two points (cradle to grave) can besegmented schematically as • Identification of areas of waste generation • Categorization, quantification of waste and minimization • Segregation, handling and storage • Treatment, destruction and disposalThe detailed implementation of bio-medical waste management plan where commonbio-medical waste treatment facility is not available is as follows.Identification of Areas of Waste Generation:To identify areas of waste generation, list out units available in the hospital and asurvey of all the units will help to identify waste generation. In almost all the units(out patient, wards, operation theater, labour room, laboratories, intensive care unitsetc.), waste is generated, only difference will be in quantity and category.Categorization, Quantification of Waste and Minimization:Categorize the waste according to Bio-Medical Waste (Management and Handling)Rules. The quantification will help in placing the bins / bags of appropriate size,quantity and at appropriate places as close to the source of waste generation. Wasteminimization helps in reducing the burden of waste management in special way.Waste minimization practice should be adopted at source of generation ( reuse,recycle and reduction). Reuse of chemicals, medical equipments etc. translates intocost saving. Recycling of specific materials like disinfected and shredded plastic helpsa secondary industry. Reduction in waste generation decreases waste disposal costs.All the categories of bio-medical waste have been mentioned in chapter two,quantification and waste minimization has been explained in chapter three. The tencategories of bio-medical waste mentioned above are as follows. 34
  38. 38. Environment Protection Training and Research Institute (EPTRI)• Category 1: Human Anatomical Waste (body parts, organs, human tissues etc.).• Category 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).• Category 3: Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micro-organisms live or attenuated 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).• Category 4: Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps).•• Category 5: Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines).• Category 6: Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, beddings, other material contaminated with blood).• Category 7: Solid Waste (Waste generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc.).• Category 8: Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities).• Category 9: Incineration Ash (Ash from incineration of any bio-medical waste).• Category 10: Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfection, as insecticides, etc.). 35
  39. 39. Environment Protection Training and Research Institute (EPTRI) Categories of Bio-medical Waste Category 1 : Human Anatomical Waste Category 2: Animal Waste Category 3: Micro Category 4: Waste Category 5: Discarded & Biotech Waste Sharp Medicine & Cytotoxic DrugsCategory 6: Soiled Waste Category 7: Solid Waste Category 8: Liquid WasteCategory 9: Category 10: ChemicalIncineration Ash Waste Solid and Liquid 36
  40. 40. Environment Protection Training and Research Institute (EPTRI)Segregation, Handling and Storage:Segregation is a very important factor in waste management system. Depending uponthe treatment and disposal option for various categories of wastes, specific coloredcontainers are required to segregate and store it at temporary central storage place tillit is disposed off. The disposal should be with in 48 hours. The waste which goes forincinerator or deep burial, should be collected in yellow plastic bag or bin. The wastewhich is planed for autoclaving ormicrowaving or chemical treatment andfinally to find its way in secured landfill orfor recycling, should be collected in red orblue bin or bag. The waste sharps such asneedles, blades etc. which is for disinfection,destruction or shredding should be collected inwhite puncture proof translucent container, which will be encapsulated or can go forrecycling as final disposal. The chemical waste (solid), out dated medicines andcytotoxic drugs which goes for disposal in secured land fill should be collected inblack bin or bag with Cytotoxic label. All the bins and bags should have biohazardlabel except on black colored bin or bag on which cytotoxic label to be inserted. Thedetails of segregation of waste into specific color coded bags or bins, as per treatmentand disposal option planned is presented below. Maximizing segregation is veryeffective in reducing waste management costs, environmental impacts and alsocomplexity of management.Handling of waste needs attention. As soon as the waste is generated it should besegregated into specific color coded containers or bags. When these are 3/4th filledthen it should be picked up from the neck and placed so that bags can be picked up bythe neck again for further handling. While handling care should be taken to reduce therisk of needle prick injury and infection. No other forms of waste should be mixedwith bio-medical waste. The waste should not be over loaded while transporting. Themovement of waste in the wheeled trolleys, containers or carts should be through predefined route within the hospital till it reaches central temporary storage place. Thesetrolleys should not be used for any other purpose and need to be cleaned daily. 37
  41. 41. Environment Protection Training and Research Institute (EPTRI) Segregation of Waste in Specific Colored Bins Depending on Treatment and Disposal Technology Yellow Plastic Bag – Non Chlorinated Cat -1 Human Anatomical Waste , Cat -2 Animal Waste, Cat -3 Microbiology & Biotechnology Waste, Cat-6 Soiled Waste Treatment & Disposal- Incineration or Deep Burial Blue Plastic Bag Cat -7 Solid Waste Treatment & Disposal- Autoclaving or Microwave or Chemical Treatment and Destruction or Shredding- Recycling White Translucent Puncture Proof Container Cat – 4 Sharps WasteTreatment & Disposal- Autoclaving or Microwave or Chemical Treatment and Destruction or Shredding- Encapsulation on Secured Landfill Red Disinfected container / plastic bag Cat-3 Microbiology & Biotechnology Waste, Cat – 6 Soiled Waste, Cat-7 Solid WasteTreatment & Disposal- Autoclaving or Microwave or Chemical Treatment– Secured Landfill and Cat. 7 Recycle Black Plastic bag Cat-5 Discarded Medicine & Cytotoxic Drugs, Cat – 9 Incineration Ash Cat – 10 Chemical Waste (solid) Treatment & Disposal- Disposal in Secured LandfillStorage location for hospitals / health-care waste should be designated inside itspremises. The waste in the bags or containers should be stored in central storage placein an area or room of a size appropriate to the quantities of waste produced and thefrequency of collection. Recommendation for storage facilities with in the hospitals isas follows. • The storage area should have an impermeable, hard-standing floor with good drainage; it should be easy to clean and disinfect. • There should be a water supply for cleaning purposes. 38
  42. 42. Environment Protection Training and Research Institute (EPTRI) • The storage area should afford easy access for staff in charge of handling the waste. • It should be possible to lock the store to prevent access by unauthorized persons. • Easy access for waste-collection vehicles is essential. • There should be protection from the sun. • The storage area should be inaccessible for animals, insects, and birds. • There should be good lighting and at least passive ventilation. • The storage area should not be situated in the proximity of fresh food stores or food preparation areas. • A supply of cleaning equipment, protective clothing, and waste bags or containers should be located conveniently close to the storage area.Cytotoxic waste should be stored separately from other health-care waste in adesignated secure location. Central Storage PlaceTreatment, Destruction and Disposal:The various treatment, destruction and disposal methods for each category of waste asper bio-medical waste management and handling rules are mentioned below.Category 1 Human Anatomical Waste (human tissues, organs, body parts):As soon as it is segregated in yellow colored bin or bag, before 48 hours it should beincinerated or deep burial. The deep burial option is for towns where population isless than five lakh and in rural areas. 39
  43. 43. Environment Protection Training and Research Institute (EPTRI)Category 2 Animal Waste (animal tissues, organs, body parts, bleeding partsetc.):As soon as it is segregated in yellow colored bin or bag, before 48 hours it should beincinerated or deep burial. The deep burial option is for towns where population isless than five lakh and in rural areas.Category 3 Microbiology and Biotechnology Waste (waste from Lab, cultures,stocks or specimens human and animal cells etc.):As soon as it is segregated before 48 hours it should be incinerated or deep burial. Thedeep burial option is for towns where population is less than five lakh and in ruralareas. Other option is disinfect and put it in secured landfill.Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that maycause puncture and cuts. This includes both used and unused sharps):After the injection is administered the needles should be cut from the hub by a needlecutter, both the needle and the syringe become useless and can’t be reused. The cutneedle gets segregated in the pot which is fixed to the needle cutter. The cut syringegoes in the plastic bucket with sieve, which has 1% sodium hypochlorite solution orany other equivalent chemical agent. Metal needle from the pot can be stored in thepuncture proof translucent container having 1% sodium hypochlorite solution or anyother equivalent chemical agent. It must be ensured that chemical treatment ensuresdisinfection. The disinfected needle can be encapsulated for disposal into municipalsecured landfill or can be given to authorized metal recycler. If auto disabledsyringes are provided it prevents the reuse of non sterile syringes as it self locks aftersingle use. The waste syringes will follow the same route of management of sharpswaste.Category 5 Discarded medicines and Cytotoxic drugs (waste comprising ofoutdated, contaminated and discarded medicines.):Either directly incinerate or after destruction put it in secured landfill. 40
  44. 44. Environment Protection Training and Research Institute (EPTRI)Category 6 Soiled waste (items contaminated with blood, and body fluidsincluding cotton, dressings, soiled plaster casts, lines, beddings, other materialcontaminated with blood.):Either incinerate or disinfect by autoclaving / microwaving and put it in securedlandfill.Category 7 Solid waste (waste generated from disposable items other than wastesharps such as tubings, catheters, intravenous sets etc.):Destroy the plastic waste to ensure prevention of reuse and disinfect by keeping in 1%sodium hypochlorite solution or any other equivalent chemical agent. It must beensured that chemical treatment ensures disinfection. If recycling of plastic waste isplanned, care should be taken to give to authorized recycler only after disinfection andshredding.Category 8 Liquid waste (waste generated from laboratory and washing,cleaning, house-keeping and disinfection activities):The liquid waste generated from labs and washing, cleaning and house keeping needto be treated to the standards prescribed and flush in the drains. The standard forliquid waste is as follows.Standards for liquid waste:The effluent generated from the hospital should conform to the following limits: PH -63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD -250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.These limits are applicable to those, hospitals which are either connected with sewerswithout terminal sewage treatment plant or not connected to public sewers. Fordischarge into public sewers with terminal facilities, the general standards as notifiedunder the Environment (Protection) Act, 1986 shall be applicable.Category 10 Chemical waste (chemical used in production of biological,chemicals used in disinfection, as insecticides, etc.):Chemical waste that is chemical used in production of biological, chemicals used in 41
  45. 45. Environment Protection Training and Research Institute (EPTRI)disinfection, as insecticides, etc. should be treated by using 1% sodium hypochloritesolution or any other equivalent chemical agent. It must be ensured that chemicaltreatment ensures disinfection. After treatment discharge into drains for liquids andsecured landfill for solid.As per the guidelines issued by Central Pollution Control Board disposal of bio-medical waste by individual hospitals is discouraged and common bio-medical wastetreatment facilities are encouraged. Pictorial representation of detail implementationplan of action with various technological options category wise is presented below.Provision of Common Bio-Medical Waste Treatment Facility (CBMWTF) if incourse of time comes up has also been considered and provided in the implementationplan. 42
  46. 46. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 1: HUMAN ANATOMICAL WASTE BODY PART YELLOW BIN CENTRAL STORAGE PLACEINCINERATIOR DEEP BURIAL CBMWTF 43
  47. 47. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 2: ANIMAL WASTE EXPERIMENTAL ANIMAL YELLOW BININCINERATIOR DEEP BURIAL CBMWTF 44
  48. 48. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 3: SOILED WASTE MICROBIOLOGY AND RED BINBIOTECHNOLOGY WASTE CENTRAL STORAGE PLACEAUTOCLAVE CBMWTF MUNICIPAL SECURED LANDFILL 45
  49. 49. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 4: WASTE SHARPWASTE SHARPS MUTILATION DISINFECTION CENTRAL STORAGE METAL RECYCLER CBMWTF SHARP PIT GLASS WASTE BLUE BIN GLASS RECYCLER 46
  50. 50. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 5: DISCARDED DRUGS AND MEDICINES DISCARDED DRUGS AND MEDICINES BLACK BIN SEPARATE STORAGE PLACEMUNICIPAL SECURED CBMWTF LANDFILL 47
  51. 51. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 6: SOILED WASTE SOLIED WASTE YELLOW BIN CENTRAL STORAGEINCINERATOR DEEP BURIAL CBMWTF 48
  52. 52. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 6: SOILED WASTE SOILED WASTE RED BIN CENTRAL STORAGEAUTOCLAVE CBMWTF MUNICIPAL SECURED LANDFILL 49
  53. 53. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 7: SOLID WASTE ( PLASTIC) PLASTIC WASTE MUTILATECENTRAL STORAGE CBMWTF PLACE 50
  54. 54. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 7: SOLID WASTEPLASTIC WASTE MUTILATE RED BIN CENTRAL STORAGE AUTOCLAVE PLASTIC RECYCLER 51
  55. 55. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 8: LIQUID WASTE )LIQUID WASTE EFFLUENT TREATMENT PLANT DISCHARGE INTO DRAIN 52
  56. 56. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 9: INCINERATOR ASHINCINERATOR ASH BLACK BIN MUNICIPAL SECURED LANDFILL 53
  57. 57. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 10: CHEMICAL WASTE BLACK BINCHEMICAL SOLID WASTEMUNICIPAL SECURED CBMWTF LANDFILL 54
  58. 58. Environment Protection Training and Research Institute (EPTRI) BIO-MEDICAL WASTE MANAGEMENT CATEGORY 10: CHEMICAL WASTECHEMICAL LIQUID WASTE EFFLUENT TREATMENT PLANTDISCARGE INTO DRAIN 55
  59. 59. Environment Protection Training and Research Institute (EPTRI)The details of category wise treatment and disposal methods are presented in thefollowing table. Category Wise Treatment and Disposal Category Treatment and Disposal1.Human anatomical waste No treatment required, incineration@/ deep burial*2.Animal Waste No treatment required, incineration @/ deep burial*3.Microbiology and No treatment required, incineration @Biotechnology Waste Autoclaving / microwaving, municipal secured landfill4.Waste Sharps Mutilating / shredding / disinfection and encapsulation municipal secured landfill Mutilating / shredding / disinfection and non- encapsulation, possibility of recycling shall be explored5.Discarded medicines and No treatment required, incineration @Cytotoxic Destruction, municipal secured landfill6.Soiled waste (Cotton No treatment required, incineration @dressings etc.) Autoclaving / microwaving, municipal secured land fill7.Solid waste ( Tubing , Disinfection @@ / autoclaving / microwaving /Catheters etc) mutilating / shredding##, recycling or municipal secured land fill8.Liquid waste Disinfection by chemical treatment @@ ,discharge into drain9.Incineration ash No treatment required, disposal in municipal land fill / Secured Landfill10. Chemical waste Chemical treatment @@ ,discharge into drains for(Chemicals used in production liquids and secured landfill for solids.of biological, Chemicals usedin disinfection etc.)@@ Chemical treatment using at least 1 % hypochlorite solution or any otherequivalent chemical reagent. It must be ensured that chemical treatment ensuresdisinfection.# # Mutilation/shredding must be such so as to prevent unauthorized re-use@ There will be no chemical pre-treatment before incineration. Chlorinated plasticshall not be incinerated.* Deep burial shall not be an opinion available only in towns with population lessthan five lakhs and rural areas.Occupier / Operator wishing to use other state of the art technologies shall approachthe Central Pollution Control Board to get the standards laid down to enable theprescribed authority to consider grant of authorization. 56

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