1. Dr. SUMI NANDWANIAssociate Professor, Microbiology,E.S.I.C.-PGIMSR& Hospital, Basaidarapur, New Delhi
2. Points 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, Appeal, Reporting of Accidents BMW Mx Committee Take Home Message
3. What is Biomedical WasteBio-medical waste is defined as waste that isgenerated during the diagnosis, treatment orimmunization of human beings and arecontaminated with patients’ body fluids (suchas syringes, needles, ampoules ,organs andbody parts, placenta, dressings, disposablesplastics and microbiological wastes).
4. NEED FOR BMW MANAGEMENTThe hospital waste, in addition to therisk for patients and personnel whohandle these wastes poses a threat topublic health and environmentHealth hazards of BMW Type of waste Health hazard Human / Animal HIV,HBV,HCV, Hgic fevers, cholera, waste/ Soiled salmonellosis, shigellosis, rabies, waste leptospirosis, anthrax,TB, pneumonia, septicemia Sharps HIV, HBV, HCV, Injuries Cytotoxic/ Cancer, genetic mutation, birth radioactive waste defect Chemical waste Poisonings, dermatitis, conjunctivitis, bronchitis
5. Extent of the problemMost countries of the world, especially the developing nations, are facing the grim situation arising out of environmental pollution due to pathological wasteIn India :three million tonnes of medical wastes generated every year and the amount is expected to grow at eight per cent annually. 4.2 lakh kg of biomedical waste is generated on a daily basis,( CPCB April2011) Only 157 facilities to treat the same. 84,809 hospitals and healthcare facilities in India only 48,183 are using either common biomedical waste treatment facilities or have commissioned private parties to take care of the same.Quantum of BMW Generation & Treatment in Delhi- DPCC: No. of Health Care Establishments in Delhi : About 1900 , 10.125 Tons BMW/day (based on the annual report for the year 2010). There are 10 Incinerators (including 3 CBWTFs), 21 autoclaves(including 3CBWTFs) and 3 microwaves operating in Delhi.
6. Present practice withinHospitals• Around 50% of the hospitals in the country are dumping the BMW with Municipal garbage• Waste is not segregated at the site• 15000 hospitals have been served notice for acting as defaulters of these rules.• No proper treatment options• No regulated disposal sites
7. Present practices withinhospitals1- Mostly dumped in the open space - Rag pickers can collect contaminated syringes, cotton, plastics, etc.2- Burnt at dumpsites in an open environment - Incomplete - Small quantities of many organic and chlorinated organic compounds as well as pathogens survives - dispersal of dangerous diseases.3- Landfills - Designed poorly and can pollute ground-water.
8. BIOMEDICAL WASTE(MANAGEMENT & HANDLING)RULES by Govt. of India , 1998Amended on 2000• Authoritative order to all the hospitals to stop the indiscriminate disposal of waste and ensure that it is treated in such a manner that it does not hamper the environment and human health.• All the BMW to be segregated at the point of generation
9. Application These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste in any form includes a hospital, nursing home, clinic, dispensary, veterinary institutions, and animal house, pathological laboratory, blood bank e.t.c.
10. Duty of Occupier It shall be the duty of every occupier 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.
11. . Segregation, Packing, a. Bio-medical waste shall not be mixed with other wastes b. 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.
13. CATEGORIES OF BIO-MEDICAL WASTES.N WASTE WASTE TYPE TREATMENT CATEGORY & DISPOSAL1 Category No.1 Human Anatomical waste (human tissues, Incineration/deep organs, body parts burial2 Category No.2 Animal Waste: Animal tissues, organs, body Incineration/deep parts carcasses, bleeding parts, fluid, blood burial and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses3 Category No.3 Microbiology & Biotechnology Wastes: Autoclave/ Wastes from laboratory cultures, stocks of Microwave/ specimens of micro-organisms live or Incineration attenuated vaccines etc.4 Category No.4 Waste Sharps (needles, syringes, scalpels Disinfection ,blades, glass etc.) that may cause (chemical puncture and cuts. treatment/autoclavE/ microwavE and mutilation/shredding
14. S.N WASTE WASTE TYPE TREATMENT CATEGORY AND DISPOSAL5 Category No.5 Discarded Medicines and Cytotoxic Incineration/destruction drugs Wastes comprising of outdated, and drugs disposal in contaminated and discarded medicines secured landfills6 Category No.6 Soiled Waste (Items contaminated with Incineration blood, and body fluids including cotton, autoclaving/ dressings, soiled plaster casts, linens, microwaving beddings, other material contaminated with blood)7 Category No.7 Solid Waste (waste generated from Disinfection by chemical disposable items other than the waste treatment/autoclaving/ (sharps) such as tubings, catheters, Microwaving & intravenous sets etc. mutilation/shredding8 Category No.8 Liquid Waste generated from laboratory Disinfection by chemical and washing, cleaning, house keeping and treatment and disinfecting activities discharge into drains
15. S.N WASTE WASTE TYPE TREATMENT AND CATEGORY DISPOSAL9 Category No.9 Incineration Ash: Ash from Disposal in municipal landfill incineration of any bio-medical waste10 Category No.10 Chemical Waste Chemical treatment and Chemicals used in production of discharge biologicals, chemicals used in into drains for liquids and disinfection as insecticides etc. secured landfill 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. 4. Deep burial shall be an option available only in towns with population less than five lakhs and in rural area.
16. COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTEColor Type of Waste TreatmentCoding Container Category options as per Schedule IYellow Plastic bag Cat.1, 2,3,6 Incineration/deep burialRed Disinfected Cat 3,6,7 Autoclave/Microwave/ container/Plastic Chemical Treatment bagBlue/White Puncture proof Cat.4,7 Autoclave/Microwave/translucent container Chemical Treatment & destruction/shreddingBlack Plastic bag Cat 5,9,10 Disposal in secured landfill
17. Proper labeling of bins The bins and bags should carry the biohazard symbol indicating the nature of waste to the patients and public. Schedule III (Rule 6) of Bio- medical Waste (Management and Handling) Rules, 1998 specifies the Label for Bio-Medical Waste Containers / Bags as: Label shall be non-washable and prominently visible
18. WASTE DISPOSAL PAPER WRAPPERSKITCHEN WASTE/FOOD BLACK BIN
20. WASTE DISPOSAL Pathology waste soiled linen, contaminated W ABS gowns, S drapesSwab stick- centa icaldecontaminated wast n anatom e-pla a Hum Dressing Bandages YELLOW BIN
21. Human/Animal tissue organs or body parts Animal carcasses Any non plastic soiled waste( contaminated with blood/ body fluids ) Cotton dressings, bandages Linen beddings Soiled plaster casts, Soiled paper Used/ removed sutures
22. WASTE DISPOSAL All infectious, non sharp plastic waste Urine bag Plastic culture plates & tubes I/V setsDrains RED BIN
23. Infectious Plastic and rubber waste such as Gloves i. v tubings and I. V sets Catheters Urine bags, Blood bags Syringes Suction tips Infected plastic containers Rubber base materials Retraction cords
24. DISPOSAL OF SHARPS Destroy needleCut syringetip Decontaminate in twin bucket having 1% bleach SHARPS including catheter guide wires
25. Sharp edged or pointed metallic sharps Needles Scalpel blades Suture needle Intracath LP needle Bone screws ( sharps), Arch bars, Burs Lancets Glass sharps such as broken ampoules,injection vials Glass slides, coverslip Injection vials Broken test tubes/ Broken pippettes
26. Segregated incinerable wastes kept in Yellowbag
27. Segregated Autoclavable waste inBlue/ red bag
28. General wastes of health care unit in Black bag
29. Sharps in sharp container
30. Personnel safety devicesThe use of protective gears should be made mandatoryfor all the personnel handling waste.
31. Storage 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
32. Transport 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 and open, Chutes:
33. Transportation and Storage c. 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.
34. Treatment and Disposal a. Bio-medical waste shall be treated and disposal of in accordance with Schedule 1, and in compliance with the standards prescribed in Schedule V b. Every occupier, where required, shall set up requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or, ensure requisite treatment of waste at a common waste treatment facility or any other waste treatment facility.
35. Incineration Burning of waste material in the presence of oxygen. Waste volume reduction, destroying some harmful constituents. Works at temperature (~ 400–700°C). Drawback toxic products like furanes and dioxins - can cause air pollution
36. Non-incineration methods 1 - THERMAL PROCESSESA - Low-Heat Thermal Processes (93°C-177°C) Wet heat (steam) disinfection - autoclave ,Dry heat (hot air) disinfection - infrared heaters.B - Medium-Heat Thermal Processes (177°C-370°C) Chemical breakdown of organic material. Reverse polymerization using high-intensity microwaveC - High-Heat Thermal Processes (540°C-8,300°C) or higher Electrical resistance, induction, natural gas, and/or plasma energy provide the intense heat ,total destruction of the waste Significant change in the mass and volume
37. Non-incineration methods2 - 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.3 - IRRADIATIVE PROCESSES Electron beams,Cobalt-60, or UV irradiation.
38. Common waste treatment facility( CWTF)Operators auth. by Delhi Pollution Cont. Commit. Biotic Waste Solutions Pvt. Ltd., 46, SSI Industrial Area, G.T. Karnal Road, Delhi 33 Phone (O) : 011 -47528106, 47528107 Metro Bio Care Technological Services (P). Ltd., 55, Railway Road, Samaipur Industrial Area, Delhi-42 Phone No. 27898011, 27898033, 278661422. Synergy Waste Management (P) Ltd., Near Compost Plant, Okhla Tank Mathura Road New Delhi - 110020, Phone No. 26933371, 26933372
39. Waste Generation survey •Return outdated Waste Segregation drugs/ chemicals •Recycling/ reuse Waste Storage Waste transport WasteWaste treatment Cycle Waste disposal Municipal ,sanitary lan drain in sewer
40. Authorization Every occupier of an institution generating, handling BM W should make an application in Form 1 to the prescribed authority for grant of authorization. Every operator of a bio-medical waste facility shall make an application in Form 1 to the prescribed authority for grant of authorization.
41. Annual 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.
42. Maintenance of Records& .Accident Reportinga. 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. When any accidents the authorized person shall report the accident in Form III to the prescribed authority forth with
43. Dos and Don’tsDo’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 bagsDo 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
44. BMW 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
45. Responsibility of WMO 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
46. Responsibility of WMO (Contd…..) 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 CPWD Deptt. (Civil & Electrical) Send monthly & annual report to DPCC
47. • Check Segregation • Check segregation• Monitoring disinfection of waste • Check labeling on site • Weigh the waste• Availability of basic items for • Monitor final disposal of theBMWM waste• Monitoring compliance of usage • Ensure the working ofof facilities by HCW incinerator• Monitor level of awareness • Provide monthly data of• Prepare waste audit waste generated by both• Liason between HOD’s, CNO’s Hospitals& WMO Feedback to WMO Assist in training programme
48. BMW 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!)
49. Hand 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 Compliance
50. Steps to EffectiveHandwashingUse soap & warmwater. Scrub 10-15 Rinse well with fingersseconds pointed downward.After drying hands,turn off water using apaper towel. Discard towel in trash.
51. It is TIME to ACT, toprevent an epidemic waitingto happen. 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.
52. Conclusion 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.
53. THANK YOU Presented By Dr Sumi NandwaniMD,DNB, PGCHM,MNAMS Associate ProfessorDepartment of Microbiology