Malabar dental college

1. 1

2. Presented by
Anjali.S
Lecturer
Department of Public Health Dentistry
Malabar dental college
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3.  Introduction
 Definitions
 Classification of biomedical waste
 Regulatory requirements
 Hazards of poor biomedical waste management
 Biomedical waste handling and management
 Waste management protocol for a dental clinic
 Pollution prevention
 Central pollution control board 2016
 Conclusion
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4. INTRODUCTION
 Medical care is vital for our life, health and well being.
 The waste generated from medical activities can be
hazardous, toxic and even lethal because of their high
potential for diseases transmission.
 If these wastes are not treated and disposed according
to the guidelines, they pose grave risk to man,
community and environment.
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5. DEFINITIONS
 BIOMEDICAL WASTE: Waste generated during diagnosis,
treatment and immunization of human beings or animals in
research or in the production and testing of biological products.
 INFECTIOUS WASTE: Wastes which have the potential to
transmit viral, bacterial or parasitic diseases.
 HAZARDOUS WASTE: Waste with a potential to pose threat to
human health and life.
5 Biomedical Waste Management and Handling Rules, The Gazette of India 2011.

6. CLASSIFICATION OF HOSPITAL WASTE
6
Yves Chartier, Jorge Emmanuel, Ute Pieper, Annette Prüss, Philip Rushbrook, Ruth Stringer.
Safe management of waste from health care activities. World Health Organisation, Geneva 2014.

7. 7

8. Statistics of waste generated
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PLACE OF SUDY
BMW
GENERATED
% OF
INFECTIOUS
WASTE
KOLKATA 1.04 - 1.36 Kg 20 – 30%
NEW DELHI 1.5 – 1.8 Kg 45%
MUMBAI 1.13 Kg 46%
PUNJAB 1.05 – 1.5 kg 15 – 30%
MANIPAL 0.775 Kg 16 – 26 %
Sengodan VC. Segregation of biomedical waste in an South Indian tertiary care
hospital. J Nat Sc Biol Med 2014;5:378-82.

9.  In Indian hospitals, 3 million tonnes of waste is generated every
year and is expected to grow 8% annually.
 Out of 4,20,461 kg/day of waste generation, only 2,40,682 kg/day
of waste is treated.
9
Mohan kumar S, Kottaiveeran K. Hospital waste management and environment
problems in India. International Journal of Pharmaceuticals and Biological
Archives2011;2(6):1621-1626.

10. REGULATORY MECHANISMS
 The Water (Prevention and Control of Pollution) Act, 1974
 The Air (Prevention and Control of Pollution) Act, 1981
 The Environment (Protection) Act, 1986
 The Hazardous Wastes (Management and Handling) Rules, 1989
 The Biomedical Wastes (Management and Handling) Rules, 1998
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11. HAZARDS OF POOR BIOMEDICAL
WASTE MANAGEMENT
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12. Who is at risk of poor biomedical
waste management???
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• Doctors, nurses,hospital maintenance personnel
• Patients in health care establishments
• Visitors to health care establishments
• Workers in support services
• Workers in waste disposal
Raman U, Iyer VH, editors. Going Green: A Manual of Waste Management for the
Dental Students. 1 st ed. New Delhi: Jaypee Brothers Publishers; 2007.

13. Segregation at source
 Segregation should occur at the point of origin.
 General waste and biomedical waste should be separated.
 Colour coded and labelled containers should be used.
 Biomedical waste should be segregated into infectious sharps,
infectious non sharps, soiled waste and solid waste.
13
Raman U, Iyer VH, editors. Going Green: A Manual of Waste Management for the
Dental Students. 1 st ed. New Delhi: Jaypee Brothers Publishers; 2007.

14. OPTION WASTE
CATEGORY
TREATMENT &
DISPOSAL
CATEGORY1 Human Anatomical
Waste
Incineration and deep
burial
CATEGORY 2 Animal waste Incineration and deep
burial
CATEGORY 3 Microbiology and
Biotechnology waste
Local
autoclaving/micro
waving/incineration
CATEGORY 4 Waste Sharps Disinfection by
chemical
treatment/autoclaving/
microwaving/mutilati
on/shredding
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15. OPTION WASTE
CATEGORY
TREATMENT &
DISPOSAL
CATEGORY 5 Discarded
medicines and
Cytotoxic drugs
Incineration/destruction
and disposal in secured
landfills.
CATEGORY 6 Soiled Waste Incineration/autoclaving
CATEGORY 7 Solid Waste Disinfection by chemical
treatment
CATEGORY 8 Liquid Waste Disinfection by chemical
treatment
CATEGORY9 Incinerator Ash Landfill
CATEGORY 10 Chemical Waste Chemical treatment15

16. Colour
coding
Type of
container
Waste category Treatment
options
Yellow Plastic bag
Human
waste,animal
waste,microbiology
and laboratory
waste,solid waste
Incineration
/deep burial
Red Disinfected
container/
plastic bag
microbiology and
laboratory
waste,solid waste
Autoclaving/
chemical
treatment
16

17. Colour
coding
Type of
container
Waste
category
Treatment
options
Blue/white
translucent
Plastic
bag/puncture
proof
container
Waste sharps,
solid waste
Autoclaving/
chemical
treatment
Black Plastic bag
Discarded
medicine,
incineration
ashes,
chemicals
used in
disinfection
Disposal of
secured
landfill
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18. Storage of Biomedical Waste
 Secure and separate areas should be maintained for storage of
segregated biomedical waste.
 Segregated waste should not be stored for more than 48 hours.
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20. Transportation of biomedical waste
 Closed trolleys or wheeled containers
should be used within hospital.
 Special vehicles with fully enclosed
body lined with stainless steel or
aluminium should be used for off site
transportation.
 There should be a bulk head separating
the drivers compartment from the
loading compartment.
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22. Treatment of biomedical waste
 Treatment of waste is required
1. To disinfect the waste so that it is not infectious.
2. To reduce the volume of waste needing disposal.
3. To make waste unrecognisable to public for aesthetic reasons.
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23. Methods for treatment of biomedical
waste
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TREATMENT METHODS
A. INCINERATION
• Single chamber
furnace
• Double chamber
pyrolytic incinerator
• Rotary kilns
B.NONINCINERATION
•Thermal process
•Chemical process
•Irradiative process
•Biological process
Anantpreet Singh, Sukhjit Kaur. Biomedical waste disposal.1st edi.New delhi:
Jaypee Brothers Publishers;2012.

24. Incineration
 A high temperature dry oxidation process.
 Reduces organic and combustible waste to inorganic
incombustible waste.
 Operate at temperatures of 1800ºF and above.
 All pathogens are completely destroyed at such high
temperatures.
24
Singh VP, Biswas G, Sharma JJ. Biomedicl waste management-An emerging
concern in Indian hospitals. Ind J Foren Med Toxic2007;1(1):7-12.

25. Waste types contraindicated for
Incineration
 Halogenated plastics such as PVC.
 Waste with high Cadmium or Mercury content, e.g. broken
thermometers , used batteries.
 Sealed ampoules or ampoules containing heavy metals.
 Pressurised gas containers.
 Large bulk of reactive chemical wastes.
 Photographic or radiographic wastes and silver salts.
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26. Types of Incinerators
 Double Chamber Pyrolytic Chamber
• In the first chamber waste undergoes combustion in oxygen
deficient conditions at 800ºC.
• Results in production of ashes and gases.
• Gases are burnt in the second chamber at a temperature
ranging from 900-1200ºC.
26
Anantpreet Singh, Sukhjit Kaur. Biomedical waste disposal.1st edi.New delhi:
Jaypee Brothers Publishers;2012.

27.  Rotary Kilns
1. Comprises of a rotating oven and a post combustion
chamber.
2. Indicated for incineration of chemical waste.
• Monitoring of Incinerator to ensure
1. Proper operation and maintenance of the incinerator.
2. Attainment of prescribed temperature in primary and
secondary chambers.
3. Proper maintenance of record book.
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29. Non Incineration Technologies
 Thermal process
 Utilizes thermal or heat energy to destroy pathogens.
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Depending upon
temperature
Low Heat Thermal
Process
93-177ºC
Medium Heat
Thermal Process
177-370ºC
High-Heat
Thermal Process
540-8300ºC
Wet Heat
Treatment
Dry Heat
Treatment
Anantpreet Singh, Sukhjit Kaur. Biomedical waste disposal.1st edi.New delhi:
Jaypee Brothers Publishers;2012.

30. Autoclave
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TEMPERATURE TIME
121ºC 60 minutes
135ºC 45 minutes
149ºC 30 minutes
Biomedical Waste Management and Handling Rules, The Gazette of India 2011.
Gravity Displacement Autoclave

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TEMPERATURE TIME
121C 45 minutes
135C 30 minutes
Prevacuuming Autoclave
Biomedical Waste Management and Handling Rules, The Gazette of India 2011.

33. Hydroclave
 Is a double walled cylindrical, pressurised vessel.
 The vessel is fitted with motor driven shaft.
 When steam is introduced, it transmits the heat to fragmented
waste.
 After sterilisation, the liquid but sterile components of the waste
are steamed out of the vessel, recondensed and drained to sewer.
 Remaining waste is dehydrated, fragmented and self unloaded.
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•Sterilisation time of 15 minutes @ 132ºC or 30 minutes at 121ºC
ensures inactivation of spores

35. Chemical Process
 Chemical based disinfectants were used in the past.
 Non chlorine chemical disinfectants available now are,
peroxyacetic acid, gluteraldehyde, ozone gas, sodium
hydroxide, calcium oxide.
Types of wastes treated
 Cultures and stocks
 Blood and body fluids
 Sharps and surgery waste
 Gauze, bandages, drapes, gowns, bedding.35

36. WASTE MANAGEMENT PROTOCOL
FOR A DENTAL CLINIC
 Mercury containing wastes
• Elemental mercury
• Scrap amalgam
 Silver containing wastes
• Spent X-ray fixer
• Undeveloped film
 Lead containing wastes
• Lead foil packets
• Lead aprons
 Anatomical, Non-anatomical wastes and sharps
 Chemicals, disinfectants and sterilizing agents
36

37. Sources of Mercury in Dental Office
 Dental amalgam
 Thermometers
 Sphygmomanometers
 Batteries
 Fluorescent tubes
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38. Handling of mercury containing
wastes
 Remove all ornaments while dealing with mercury/mercury
spills.
 Clear the area around the spill and use thick cardboard sheets to
limit the spread.
 Suck up mercury with a syringe.
 Disposable chair side traps are preferred over reusable traps.
 Amalgam separators can remove amalgam from the dental waste
water more effectively than filters and traps used in chair side.
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Amalgam Separator
Amalgam Trap

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41. Mercury Containment Kit
 Face mask
 Protective eye wear
 Nitrile gloves
 Scotch tape
 10cc syringe
 Covered plastic container with water
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Anantpreet Singh, Sukhjit Kaur. Biomedical waste disposal.1st edi.New delhi:
Jaypee Brothers Publishers;2012.

42. Waste Sharps from Dental Office
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43. Encapsulation
 Filling containers with waste, adding an immobilizing material,
and sealing the containers.
 The containers or boxes are filled up with a medium such as
plastic foam, bituminous sand, cement mortar, or clay material.
 After the medium has dried, the containers are sealed and placed
into landfill sites.
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44. Inertisation
 The following are typical proportions (by weight) for the
mixture:
1. 65% pharmaceutical waste
2. 15% lime
3. 5% water.
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45. Advantages and disadvantages
of treatment and disposal options
Treatment and
disposal methods
Advantages Disadvantages
Rotary kiln
Adequate for all
infectious
waste,pharmaceutical
waste
High investment and
operating cost
Single chamber
incineration
Good disinfection
efficiency,drastic
reduction in the
weight and volume of
waste
Significant
emmissions of
atmospheric
pollutants
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46. Chemical
disinfection
Highly efficient disinfection
under good operating
conditions
Requires qualified
technicians for
operation of the
process
Microwave
irradiation
Good disinfection efficiency
under appropriate operating
conditions
Relatively high
investment and
operating costs
Encapsulation Simple ,low cost and safe Not recommended for
non sharp infectious
waste
Inertization Relatively inexpensive Not applicable to
infectious waste
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53.  WATER QUALITY
 Central Pollution Control Board (CPCB) is monitoring
the water quality of Global Environmental Monitoring
System (GEMS), Monitoring of Indian National Aquatic
Resources System (MINARS) and Yamuna Action Plan
(YAP).
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57.  DEPARTMENT WISE COMPLIANCE –WASTE
DISPOSAL BY CAPTIVE/COMMON FACILITY
Karnataka
 • Bruhath Bengaluru Mahangara palike 100%
 • Health and Family Welfare 100%
 • Animal and Husbandry and Fisheries 99.56%
 • Ayurveda, Yoga, Unani, Siddha, Homeopathy 58%
 • Department of medical Education 100%
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58.  Karnataka in 21.01.2013
 United Nations Industrial Development Organisation
(UNIDO) has come out with a new venture in association
with Ministry of environment and forest (MoEF, )
government of karnataka and Karnataka state pollution
control board(KSPCB )under the name of “Environmental
Sound Management of MedicalWaste in India”.
 In this project they are going to adopt new technologies to
support the hospital and Common biomedical waste
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59.  Government of TamilNadu, has implemented health care waste
management plan through Health Systems Development Project
(HSDP) with the World Bank assistance in 2008 through a
“Project for Upgrading Safety in Healthcare” (PUSH) to train
150 health care providers.
 They inturn will train 40,000 health care providers.
59
Sengodan VC. Segregation of biomedical waste in an South Indian tertiary care
hospital. J Nat Sc Biol Med 2014;5:378-82.

60. REFERENCES
 Sengodan VC. Segregation of biomedical waste in an South Indian tertiary care
hospital. J Nat Sc Biol Med 2014;5:378-82.
 Mohan kumar S, Kottaiveeran K. Hospital waste management and environment
problems in India. International Journal of Pharmaceuticals and Biological
Archives2011;2(6):1621-1626.
 Bio-medical waste management: situational analysis & predictors of
performances in 25 districts across 20 Indian States. INCLEN Program
Evaluation Network (IPEN) study group, New Delhi, India. Indian J Med
Res2014;139:141-153
 Biomedical Waste Management and Handling Rules, The Gazette of India
2011.
60

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Ruth Stringer. Safe management of waste from health care activities. World
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Jaypee Brothers Publishers;2012.
 Singh VP, Biswas G, Sharma JJ. Biomedicl waste management-An emerging
concern in Indian hospitals. Ind J Foren Med Toxic2007;1(1):7-12.
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