• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Biomedical waste managment  rule 2011
 

Biomedical waste managment rule 2011

on

  • 3,623 views

Biomedical waste managment as per the revised rules2011 promulgated under Environment protection act 1986

Biomedical waste managment as per the revised rules2011 promulgated under Environment protection act 1986

Statistics

Views

Total Views
3,623
Views on SlideShare
3,623
Embed Views
0

Actions

Likes
5
Downloads
357
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • .

Biomedical waste managment  rule 2011 Biomedical waste managment rule 2011 Presentation Transcript

  • BIOMEDICAL WASTEBIOMEDICAL WASTE MANAGEMENTMANAGEMENT Dr. SANJAY SINGH NEGI Assistant Professor, Microbiology AIIMS, Raipur, Chhattisgarh
  • Points to be discussedPoints to be discussed ……………………  Overview : Definition  Extent of Problem , Need, Present practices  BMW Management Rules, application, duty of occupier  Segregation, categories of BMW  Transport & storage  Treatment & Disposal  Authorization, Reporting of Accidents  BMW Mx Committee
  • What is Biomedical Waste?What is Biomedical Waste? Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I; Biologicals" means any preparation made from organisms or micro- organisms or product of metabolism and biochemical reactions intended for use in the diagnosis, immunisation or the treatment of human beings or animals or in research activities pertaining thereto; Specific to hospitals Bio-medical waste is defined as waste that is generated during the diagnosis, treatment or immunization of human beings and are contaminated with patient’s body fluids (such as syringes, needles, ampoules ,organs and body parts, placenta, dressings, disposables plastics and microbiological wastes).
  • What is Biomedical Waste? Waste Sharps eg: Needles Discarded medicines Human anatomical waste Solid waste eg: cotton swabs
  • Who’s at Risk ? • Doctors and nurses • Patients • Hospital support staff • Waste collection and disposal staff • General public and • the Environment
  • NEED FOR BMW MANAGEMENTNEED FOR BMW MANAGEMENT The hospital waste, in addition to the risk for patients and personnel who handle these wastes poses a threat to public health and environment Health hazards of BMW Type of wasteType of waste Health hazardHealth hazard Human / AnimalHuman / Animal waste/ Soiledwaste/ Soiled wastewaste HIV,HBV,HCV, Hgic fevers, cholera,HIV,HBV,HCV, Hgic fevers, cholera, salmonellosis, shigellosis, rabies,salmonellosis, shigellosis, rabies, leptospirosis, anthrax,TB,leptospirosis, anthrax,TB, pneumonia, septicemiapneumonia, septicemia SharpsSharps HIV, HBV, HCV, InjuriesHIV, HBV, HCV, Injuries Cytotoxic/Cytotoxic/ radioactive wasteradioactive waste Cancer, genetic mutation, birthCancer, genetic mutation, birth defectdefect Chemical wasteChemical waste Poisonings, dermatitis, conjunctivitis,Poisonings, dermatitis, conjunctivitis, bronchitisbronchitis
  • NEED FOR BMW MANAGMENT  Nosocomial infections to patients from poor infection control practices and poor waste management.  Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers.  Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.  Risk of infection outside hospital for waste handlers and scavengers, other peoples.
  • India :India :Extent of the problemExtent of the problem CPCB,April,2011 dataCPCB,April,2011 data >95,000 hospitals and healthcare facilities in India . 4.2 lakh kg of biomedical waste is generated on a daily basis. Three million tonnes of medical wastes generated every year. Expected to grow 8% annually. 2,91,983 kg/day BMW is disposed. which means that almost 28% of the wastes is left untreated and not disposed finding its way in dumps or water bodies and re-enters our system. Karnataka tops the chart with 62,241 kg/day of BMW.  Only 179 CTF to treat the BMW in the country. No. of HCF/CBWTF violated BMW rules 5472 No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 3585
  • Extent of the problem-Continued CHHATTISGARH(Annual report on BMW, 2011, CPCB) No. of HCE- 740 No. of Bed- 14678 Total quantity of BMW generated(Kg/day) approximately 4492Kg/Day BMW treated 4492Kg/Day No. of HCF/CBWTF violated BMW rules 20 No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 20 No. CBWTF 06 No. of HCE using CBWTF/ Private agencies 446 No. of HCE having own treatment facility & Disposal facility 181 No. of HCE applied for authorization 478 No. of HCE granted authorization 425 No. of treatment equipments INCINERATOR’S 14 AUTOCLAVES 305 OVEN 7 SHREDDERS 358
  • Present practice within many of the HospitalsPresent practice within many of the Hospitals •Around 40% of the hospitals in the country are dumping the BMW with Municipal garbage •Waste is not segregated at the site • 3585 hospitals have been served notice for acting as defaulters of these rules. •No proper treatment options •No regulated disposal plan/sites
  • BIOMEDICAL RULES 1998 The Government of India as contemplated under Section 6,8 and 25 of the Environment (Protection) Act,1986, has made the Biomedical Wastes (Management & Handling) Rules, 1998. The rules are applicable to every institution generating biomedical waste which includes hospitals, nursing homes, clinic, dispensary, veterinary institutions, animal houses, laboratory, blood bank. The rules are applicable to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form.
  • BIOMEDICAL WASTE(MANAGEMENT & HANDLING)BIOMEDICAL WASTE(MANAGEMENT & HANDLING) RULES by Govt. of India, 1998RULES by Govt. of India, 1998 Revised in 2011Revised in 2011 Now known as BMW Rules, 2011Now known as BMW Rules, 2011 2011 1998 Every occupiergenerating BMW, irrespective of the quantumof wastes comes under the BMWRules and requires to obtain authorisation Occupiers with more than 1000 beds required to obtain authorisation Duties of the operatorlisted Operatorduties absent Treatment and disposal of BMWmade mandatory forall the HCEs Rules restricted to HCEs with more than 1000 beds A format forannual report appended with the Rules No format forAnnual Report FormVI i.e. the report of the operator on HCEs not handing overthe BMW added to the Rules FormVI absent
  • Duty of the Occupier It is the duty of every occupier i.e. head of an institution generating bio-medical waste, to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment. Provides training to HCW engaged in handling BMW
  • Duty of the Operator The operators now have to ensure that the BMWis collected from all the HCEs and is transported, handled, stored, treated and disposedin anenvironmentallysoundmanner. Theoperators also haveto informtheprescribedauthorityin formVIif anyHCEs are not handing the segregated BMWas per the guidelines prescribed intherules. 
  • Setting up BMW treatment facility Occupier set up adequate treatment facilities like autoclave / microwave / incinerator / hydroclave, shredder prior to commencement of its operation or ensure that the wastes are treated at a common bio medical waste treatment facility or an authorized waste treatment facility. The new Rules have omitted incinerator as one of the pre requisites for on-site treatment of BMW. The omission is owing to the various environmental impacts of incineration. Promotion of new technologies for treatment and disposal of waste Deep burial for disposal of BMW has also been removed from the Rules. The Rules says it can be an option only in rural areas with no access to CTF with prior approval from the prescribed authority.
  • Health waste CharacterizationHealth waste Characterization Hospital waste Non Hazardous (≈ 75-90%) Hazardous waste (≈ 10-25%) Infectious Others ( Radioactive, Cytotoxic )
  • Liquid wastesLiquid wastes Approx. Quantity : 4 to 250 liters / bed / day Sewage from isolation wards, ICU’s toilets & urinals, Bed-bath, bathrooms and hospital’s laundry Wash waters from laboratories,OPD, Dressing rooms & Operation theaters.
  • Solid wastesSolid wastes Approximate Quantity : 0.3 to 3.5 kg/bed/day 1.Garbage 55% (Bulk Density :330 kg/m3 ,Cal.Value:1000 K.cal / kg, Moisture :40%) 2.Bio-medical waste (sensu stricto) 13% A. Wasted body remains 05% (Blood,Cultures,Anotomicals) B. Pharmaceutical & Chemical Wastes 02% C. Pathological wastes (may be infectious) 06% 3.Sharp Objects 20% 4.Pressurized Containers & Discarded Instruments 02% 5.Radioactive Wastes 0.3%
  • WASTEWASTE CATEGORYCATEGORY WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL CategoryCategory 11 Human Anatomical waste (human tissues,Human Anatomical waste (human tissues, organs, body partsorgans, body parts Incineration/deep burialIncineration/deep burial CategoryCategory 22 Animal Waste: Animal tissues, organs, bodyAnimal Waste: Animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood andparts carcasses, bleeding parts, fluid, blood and experimental animals used in research, wasteexperimental animals used in research, waste generated by veterinary hospitals, colleges,generated by veterinary hospitals, colleges, discharge from hospitals, animal housesdischarge from hospitals, animal houses Incineration/deep burialIncineration/deep burial CategoryCategory 33 Microbiology & Biotechnology Wastes: WastesMicrobiology & Biotechnology Wastes: Wastes from clinical samples, pathology, biochemistry,from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures,hematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live orstocks specimens of micro-organisms, live or attenuated vaccines human and animal cellattenuated vaccines human and animal cell culture used in research and infectious agentculture used in research and infectious agent from research and industrial laboratories,from research and industrial laboratories, waste from production of biologicals, toxins,waste from production of biologicals, toxins, dishes and devices used for transfer of culturesdishes and devices used for transfer of cultures Disinfection at source byDisinfection at source by chemical treatment or bychemical treatment or by Autoclaving /Autoclaving / Microwaving / followed byMicrowaving / followed by Mutilation / shredding andMutilation / shredding and after treatment finalafter treatment final disposal in secured landfillsdisposal in secured landfills or disposal of recyclableor disposal of recyclable waste (plastic or glass )waste (plastic or glass ) through registered orthrough registered or authorized recyclerauthorized recycler SCHEDULE I: CATEGORIES OF BIO-MEDICAL WASTE
  • WASTEWASTE CATEGORYCATEGORY WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL CategoryCategory No. 4No. 4 Waste Sharps (needles, glass syringesWaste Sharps (needles, glass syringes or syringes with fixed needles,or syringes with fixed needles, scalpels ,blades, glass etc.) that mayscalpels ,blades, glass etc.) that may cause puncture and cuts(Includes bothcause puncture and cuts(Includes both used and unused sharps).used and unused sharps). Disinfection (chemicalDisinfection (chemical treatment / destruction bytreatment / destruction by needle & tip cutter,needle & tip cutter, autoclaving/microwave andautoclaving/microwave and mutilation/shredding andmutilation/shredding and final disposal throughfinal disposal through CBWTF / landfillsCBWTF / landfills CategoryCategory No. 5No. 5 Discarded Medicines & CytotoxicDiscarded Medicines & Cytotoxic drugs (Wastes comprising of outdated,drugs (Wastes comprising of outdated, contaminated and discardedcontaminated and discarded medicines)medicines) Disposal in secured landfillsDisposal in secured landfills or Incinerationor Incineration CategoryCategory No. 6No. 6 Soiled Waste (Items contaminated withSoiled Waste (Items contaminated with blood, & body fluids including cotton,blood, & body fluids including cotton, dressings, soiled plaster casts, linens,dressings, soiled plaster casts, linens, beddings, other material contaminatedbeddings, other material contaminated with blood)with blood) IncinerationIncineration
  • WASTEWASTE CATEGORYCATEGORY WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL CategoryCategory No.7No.7 Infectious Solid Waste (wasteInfectious Solid Waste (waste generated from disposablegenerated from disposable items other than the wasteitems other than the waste sharps such as tubing's, handsharps such as tubing's, hand gloves, saline bottles with IVgloves, saline bottles with IV tubes, catheters, glass,tubes, catheters, glass, intravenous sets etc.intravenous sets etc. Disinfection by chemicalDisinfection by chemical Treatment /Treatment / autoclavingautoclaving /Microwaving followed/Microwaving followed by mutilation /by mutilation / shredding & finalshredding & final disposal throughdisposal through registered recyclerregistered recycler CategoryCategory No.8No.8 Chemical Waste ( ChemicalsChemical Waste ( Chemicals used in production ofused in production of biologicals, chemicals used inbiologicals, chemicals used in disinfection as insecticides etc.)disinfection as insecticides etc.) Chemical treatment andChemical treatment and discharge into drains fordischarge into drains for liquids and securedliquids and secured landfill for solidslandfill for solids
  • NOTE 1.Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. 2. Mutilation/shredding must be such so as to prevent unauthorized reuse. 3. There will be no chemical pretreatment before incineration. Chlorinated plastics should not be incinerated.
  • Schedule-IISchedule-II Colour coding and Type of Containers forColour coding and Type of Containers for Different Biomedical WastesDifferent Biomedical Wastes ColourColour codingcoding Type ofType of containercontainer WasteWaste categorycategory Treatment /Treatment / DisposalDisposal Non chlorinatedNon chlorinated Plastic BagsPlastic Bags Incineration/Incineration/ Deep BurrialDeep Burrial Non chlorinatedNon chlorinated plastic bag /plastic bag / puncture proofpuncture proof Container forContainer for sharpssharps Chemical Treatment /Chemical Treatment / Autoclaving /Autoclaving / Microwaving and followedMicrowaving and followed by Mutilation & shreddingby Mutilation & shredding and disposal in landfills orand disposal in landfills or disposal of recyclabledisposal of recyclable wastewaste Non chlorinatedNon chlorinated Plastic Bags /Plastic Bags / ContainersContainers Chemical TreatmentChemical Treatment and discharge into drainsand discharge into drains for liquids and securedfor liquids and secured landfill for solidslandfill for solids Non chlorinatedNon chlorinated Plastic BagsPlastic Bags MunicipalMunicipal wastewaste Disposed as per the Municipal Solid Waste
  • BIOHAZARD SYMBOL CYTOTOXIC HAZARD SYMBOL BIOHAZARD CYTOTOXIC HANDLE WITH CARE Note : Lable shall be non-washable and Schedule-III LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS
  • Segregation, Packing,Segregation, Packing, 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 The containers shall be labeled according to Schedule III.
  • Black Dustbin & Bags Paper waste, food waste and other non infectious wastes generated from the hospitals should be stored in black coloured bags / containers & Disposed as per MSW management rules, 2000 MANAGEMENT OF HOSPITAL WASTE
  • KITCHEN WASTE/FOOD PAPER/ plastic WASTE DISPOSAL WRAPPERS Outer packing/ Cardboard General/Kitchen waste BLACK BIN For Noninfectious Solid waste
  • Bandages Humananatomical waste-placenta Swab stick- decontaminated WASTE DISPOSAL SWABS Dressing soiled linen, contaminated gowns, drapes Animal waste Discarded medicine/cytotoxic drugs YELLOW BIN Category 1,2, 5,6
  • Human/Animal tissue organs or body partsHuman/Animal tissue organs or body parts Animal carcassesAnimal carcasses Any non plastic soiled waste( contaminated withAny non plastic soiled waste( contaminated with blood/ body fluids )blood/ body fluids ) Cotton dressings, bandagesCotton dressings, bandages Linen beddingsLinen beddings Soiled plaster casts, Soiled paperSoiled plaster casts, Soiled paper Used/ removed suturesUsed/ removed sutures
  • Red Dustbin & BagsRed Dustbin & Bags Cotton pads, Swabs, Gauge Pieces, Dressings,Bandages, Cloths, Bedsheets and Plaster castes Soiled with blood, Pus, Vomits, Sputum and other Body Fluids. MANAGEMENT OF HOSPITAL WASTE
  • RED BINDrains Plastic culture plates & tubes I/V sets Urine bag WASTE DISPOSAL All infectious waste sharp, non sharp & sharps plastic waste Category 3, 4, 7 Pathology waste
  • Microbiology & laboratory waste , Waste sharps, infectious solid waste(Category3,4,7)  Wastes from clinical samples, pathology, biochemistry,Wastes from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures, stockshematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live or attenuated vaccinesspecimens of micro-organisms, live or attenuated vaccines human and animal cell culture used in research andhuman and animal cell culture used in research and infectious agent from research and industrial laboratories,infectious agent from research and industrial laboratories, waste from production of biologicals, toxins, dishes andwaste from production of biologicals, toxins, dishes and devices used for transfer of culturesdevices used for transfer of cultures  Waste Sharps (needles, glass syringes or syringes with fixedWaste Sharps (needles, glass syringes or syringes with fixed needles, scalpels ,blades, glass etc.) that may cause punctureneedles, scalpels ,blades, glass etc.) that may cause puncture and cuts(Includes both used and unused sharps).and cuts(Includes both used and unused sharps).
  • Microbiology & laboratory waste , Waste sharps, infectious solid waste(Category3,4,7)--- Continued Infectious Solid Waste (waste generated fromInfectious Solid Waste (waste generated from disposable items other than the waste sharps such asdisposable items other than the waste sharps such as Gloves,tubing, saline bottles with i. v tubes, I. V sets ,Catheters, Urine bags, Blood bags, Syringes, Suction tips, Infected plastic containers, Rubber base materials, Retraction cords
  • In Blue Nonchlorinated bags Chemical waste Chemical TreatmentChemical Treatment and dischargeand discharge into drains for liquids and securedinto drains for liquids and secured landfill for solidslandfill for solids
  • Segregated incinerable wastes kept in Yellow bagSegregated incinerable wastes kept in Yellow bag
  • Segregated Autoclavable waste in red bagSegregated Autoclavable waste in red bag
  • General wastes of health care unit in Black bagGeneral wastes of health care unit in Black bag
  • Sharps in sharp containerSharps in sharp container
  • Personnel safety devicesPersonnel safety devices The use of protective gears should be made mandatory forThe use of protective gears should be made mandatory for all the personnel handling waste.all the personnel handling waste.
  • StorageStorage In an area away from general traffic and accessible only to authorized personnel DO NOT store for more than 48 hours If for any reason it becomes necessary to store the waste beyond such period take measures to ensure that the waste does not adversely affect human health and environment
  • TransportTransport  Transport by wheeled trolleys/containers /carts only in vehicles authorized for the purpose  They should be  Easy to load and unload  No sharp edges  Easy to clean  Disinfect daily  Trolleys ,Wheelbarrows: covered
  • Transportation and StorageTransportation and Storage  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.
  • Schedule-IVSchedule-IV Label for Transportation of Bio-Medical Waste Containers /Label for Transportation of Bio-Medical Waste Containers / BagsBags  Waste category No. Day -------- Month --------  Waste class Year --------  Waste description Date of generation----------- Sender's Name & Address Receiver's Name & Address  Phone No. ........................... Phone No. ...........................  Telex No. ............................ Telex No. ............................  Fax No. ............................... Fax No. ...............................  Contact Person ................... Contact Person ................... In Case of Emergency, Please Contact:  Name & Address  Phone No.
  • Treatment and DisposalTreatment and Disposal SCHEDULE V STANDARD FOR TREATMENT AND DISPOSAL OF BMW STANDRAD for Incinerator STANDARD for Autoclave STANDARD for Microwave 
  • IncinerationIncineration  Combustion efficiency (CE) shall be at least 99.00%.  The Combustion efficiency is computed as follows:  %C02  C.E. = ------------ X 100  %C02 + % CO  The temperature of the primary chamber shall be 800 +/-500 C  The secondary chamber gas residence time shall be at least 1 (one) second at 1050 +/- 500 C DrawbackDrawback toxic products like furanes and dioxins - can cause air pollution
  • Bio Medical Wastes Destruction byBio Medical Wastes Destruction by Double Chambered IncineratorDouble Chambered Incinerator
  • Details of Double Chambered IncineratorDetails of Double Chambered Incinerator
  • Incinerator Ash DisposalIncinerator Ash Disposal
  • Emission Standards Parameters Concentration mg/Nm3 at (12%CO2 correction) Particulate matters 150 Nitrogen Oxide 450 HCl 50 Minimum stack height shall be 30 metres above ground Volatile organic compounds in ash shall not be more than 0.01%
  • AutoclaveAutoclave A temperature of not less than 121 0 C and pressure of 15 pounds per square inch (psi)for an autoclave residence time of not less than 60 minutes Validation test : Spot testing by Bacillus stearo-thermophilus spores on a spores strip with at least 1 x 104 Spores/ml. Routine test : Chemical indicator strip/tape
  • STANDARD FOR MICROWAVING SHOULD KILL BACTERIA AND OTHER PATHOGENIC ORGANISM BIOLOGICAL INDICATOR Bacillus Subtilis CHEMICAL PROCESSES Dissolved chlorine dioxide, bleach (sodium hypochlorite), peracetic acid, or dry inorganic chemicals. To enhance exposure of the waste to the chemical agent, chemical processes often involve shredding, grinding, or mixing.
  • Common waste treatment facility( CWTF)
  • AuthorizationAuthorization Every occupier of an institution generating, collecting, receiving, storing, transporting, treating and /or handling Biomedical Waste shall apply on Form 1 for Authorization to the Board.  The State Pollution Control Board are declared as prescribed Authority for grant of Authorization. The Board grants authorizations after satisfying itself.
  • APPLICATION FOR AUTHORISATION (To be submitted in duplicate.) To The Prescribed Authority (Name of the State Govt/UT Administration) Address. 1. Particulars of Applicant (i) Name of the Applicant (In block letters & in full) (ii) Name of the Institution: Address: Tele No., Fax No. Telex No. 2. Activity for which authorisation is sought: (i) Generation (ii) Collection (iii) Reception (iv) Storage (v) Transportation (vi) Treatment (vii) Disposal (viii) Any other form of handling 3. Please state whether applying for resh authorisation or for renewal: (In case of renewal previous authorisation-number and date)
  • Form 1- Continued 4. (i) Address of the institution handling bio-medical wastes: (ii) Address of the place of the treatment facility: (iii) Address of the place of disposal of the waste: 5. (i) Mode of transportation (in any) of bio-medical waste: (ii) Mode(s) of treatment: 6. Brief description of method of treatment and disposal (attach details): 7. (i) Category (see Schedule 1) of waste to be handled (ii) Quantity of waste (category-wise) to be handled per month 8. Declaration I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information. I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority. Date : Signature of the Applicant Place : Designation of the Applicant
  • Annual ReportAnnual Report   Every occupier/operator submit an annual report to  the  prescribed  authority  in  Form  II  by  31  January  every  year,  to  include  information  about  the  categories  and  quantities  of  bio-medical  wastes  handled  during  the  preceding  year.  The  prescribed  authority shall send this information in a compiled  form to the Central Pollution Control Board by 31  March every year.
  • Maintenance of Records & Accident ReportingMaintenance of Records & Accident Reporting  a.  Every  authorized  person  shall  maintain  records  related to BMW. b.  All  records  shall  be  subjected  to  inspection  and  verification by the prescribed authority at any time. c. In any accidents, the authorized person shall report  the  accident  in  Form  III  along  with  the  remedial  action taken to the prescribed authority forth with
  • Setting up a CELL or UNIT for BMW management. The BMW 2011, Rules have also made mandatory for all the HCEs with 30 or more beds to set up a cell or unit to deal with the BMW management. The cell has to meet every six months and minutes of the meeting have to be submitted along with the Annual Report to the prescribed authority
  • Dos and DonDos and Don’ts’ts Do’s  The used product should be segregated  The used product should be mutilated. The used product is treated prior to disposal.  Use protective gear when handling waste  Collect waste when the bin is 3/4 the full  Clean spills with disinfectant  Use trolleys & do not drag waste bags Do not  Reuse plastic equipment.  Mix plastic equipment with other wastes.  Burn plastic waste.  Avoid needle stick injuries  Avoid using common lift to move waste  Avoid spillage
  • BMW management committeeBMW management committee  Head of the hospital : chairman  Waste Mx officer (dev. and implementation plan) Members:  HOD’s of all department  Nursing superintendent,  Head nurse,  Sanitary inspector  Chief pharmacist,  Radiation officer  Supply officer,  financial officer
  • Responsibility of WMCResponsibility of WMC  Day to day control of segregation, transport & disposal of BMW  Co-ordinate with the store officer for continuous supply of basic  items for BMWM  Prepare guidelines for BMWM & distribute to all department  Prepare BMW posters to raise awareness  Arrange training programmes on BMWM & safety measures for all  categories of HCW  Co-ordinate with HOD/In-charge of Deptt. where deficiencies are  pointed out  Co-ordinate with Chhattisgarh Environment Conservation Board ) 
  • BMW Spills & Surface DisinfectionBMW Spills & Surface Disinfection  Proper spill handling: –Notify people in the area –Don appropriate PPE –Place absorbent material on spill –Apply appropriate disinfectant – allow sufficient contact time (30  min) –Pick up material (watch for glass – use tongs or dust pan); dispose  of material into biomedical waste –Reapply disinfectant and wipe –For large/high hazard spills use 10% hypochlorite   For routine disinfection of surfaces where BMW is handled, use  a 1:10 solution of freshly diluted bleach or 1% hypochlorite  (ethanol evaporates too quickly!)
  • Hand WashingHand Washing  Handwashing is the single most effective way to stop the spread of disease.  Make certain that jewelry is limited to wedding rings, certain areas such as OR< C-section,Cath Lab and NBN allow no jewelry. Nails should be kept short and clean.  Gloves do not replace handwashing. Hand sanitizer may be used if no visible soiling is present and the sinks cannot be readily accessed. This is in every patient room. It can also be used when the water is out of service.  Inspect your hands each time they are washed. Only use hospital approved soaps and lotions, do not bring in any from home  Alcohol based hand rubs at point of care  Sinks and clean running water  Training
  • Steps to Effective HandwashingSteps to Effective Handwashing  Thorough hand washing after any procedure involving nursing care or close contact with the patient is essential.  Alchol based hand antiseptics gaining importance where washing with water and soap are not practicable.
  • Biomedical Waste Management - IssuesBiomedical Waste Management - Issues • Not considered importantNot considered important – Lack of interest from senior managementLack of interest from senior management – No ownership of the processNo ownership of the process – Awareness of problemsAwareness of problems – Appreciate the need for constant monitoringAppreciate the need for constant monitoring – Segregation of waste not taken seriously at user levelSegregation of waste not taken seriously at user level – Non compliance with color codingNon compliance with color coding – Monitoring segregation at source – low budgets allocatedMonitoring segregation at source – low budgets allocated – costs are not always known/nor worked out properly– costs are not always known/nor worked out properly – Cost of color coding, staff, transport and disposal is aCost of color coding, staff, transport and disposal is a majormajor deterrentdeterrent – Quantification of waste generated is not accurately doneQuantification of waste generated is not accurately done
  • 69 ChallengesChallenges Establishing robust waste management policies within theEstablishing robust waste management policies within the Health Care Facility/organizationHealth Care Facility/organization  Organization wide awareness about the health hazardsOrganization wide awareness about the health hazards  Sufficient financial and Trained human resources neededSufficient financial and Trained human resources needed  Monitoring and control of waste disposalMonitoring and control of waste disposal  Clear responsibility and tracebility for appropriate handling andClear responsibility and tracebility for appropriate handling and disposal of waste.disposal of waste.
  • 7070 ADRESSING THE ISSUES 1. Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal 2. This is a long-term process, sustained by gradual improvements. 3. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital. 4. Man power needs and other resources for the BMWM of hospital to be addressed. 5. Quality assessment of bio-medical waste management should be done from time to time.
  • 71 ADRESSING THE ISSUES- continued 6. Segregated collection and transportation – need for Non- ambiguous color coding and labeling of wastes. 7. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages. 8. Safety of handlers is a big concern that is still not addressed adequately. 9. Raising Awareness about risks related to health-care waste; training staff & Waste handlers on safe practices. 10.Selection of safer & environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing waste.
  • 7272 ADRESSING THE ISSUES 11.Issue of all protective clothing such as, gloves, aprons, masks etc. to all HCW & Waste handlers. 12.Regular medical check-up (half-yearly) of staff associated with BMWM. 13.Maintenance of Record registers for this purpose. 14.Containers should be robust and leak proof 15.Tracking of Bio Medical Waste up to point of Disposal. 16.Proper treatment and final disposal.
  • ConclusionConclusion Bio-medical waste programme cannot be successfully implemented without the willingness, self-motivation, and co-operation from all sections of employees of any health care setting. If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community.
  • Dr. SANJAY SINGH NEGI Assistant Professor, Microbiology, AIIMS, Raipur, Chhattisgarh