Biomedicalwastemanagementesimc 121211225450-phpapp02


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  • Virex – didecyl dimethyl ammonium chloride
  • Biomedicalwastemanagementesimc 121211225450-phpapp02

    1. 1. Dr. SUMI NANDWANI Associate Professor, Microbiology, E.S.I.C.-PGIMSR& Hospital, Basaidarapur, New Delhi
    2. 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. 3. What is Biomedical Waste Bio-medical waste is defined as waste that is generated during the diagnosis, treatment or immunization of human beings and are contaminated with patients’ body fluids (such as syringes, needles, ampoules ,organs and body parts, placenta, dressings, disposables plastics and microbiological wastes).
    4. 4. NEED 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
    5. 5. Extent of the problem Most countries of the world, especially the developing nations, are facing the grim situation arising out of environmental pollution due to pathological waste In 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. 6. Present practice within Hospitals • 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. 7. Present practices within hospitals 1- 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. 8. BIOMEDICAL WASTE(MANAGEMENT & HANDLING) RULES by Govt. of India , 1998 Amended 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. 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. 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. 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.
    12. 12. Health waste Characterization Hospital waste Non Hazardous (≈ 75-90%) Hazardous waste (≈ 10-25%) Infectious Others (sharps, radioactive, Cytotoxic )
    13. 13. S.NS.N WASTEWASTE CATEGORYCATEGORY WASTE TYPEWASTE TYPE TREATMENTTREATMENT & DISPOSAL& DISPOSAL 11 Category No.1Category No.1 Human Anatomical wasteHuman Anatomical waste (human tissues,(human tissues, organs, body partsorgans, body parts Incineration/deepIncineration/deep burialburial 22 Category No.2Category No.2 Animal WasteAnimal Waste: Animal tissues, organs, body: Animal tissues, organs, body parts carcasses, bleeding parts, fluid, bloodparts carcasses, bleeding parts, fluid, blood and experimental animals used in research,and experimental animals used in research, waste generated by veterinary hospitals,waste generated by veterinary hospitals, colleges, discharge from hospitals, animalcolleges, discharge from hospitals, animal houseshouses Incineration/deepIncineration/deep burialburial 33 Category No.3Category No.3 Microbiology & BiotechnologyMicrobiology & Biotechnology Wastes:Wastes: Wastes from laboratory cultures, stocks ofWastes from laboratory cultures, stocks of specimens of micro-organisms live orspecimens of micro-organisms live or attenuated vaccines etc.attenuated vaccines etc. Autoclave/Autoclave/ Microwave/Microwave/ IncinerationIncineration 44 Category No.4Category No.4 Waste SharpsWaste Sharps (needles, syringes, scalpels(needles, syringes, scalpels ,blades, glass etc.) that may cause,blades, glass etc.) that may cause puncture and cuts.puncture and cuts. DisinfectionDisinfection (chemical(chemical treatment/autoclavE/treatment/autoclavE/ microwavE andmicrowavE and mutilation/shreddingmutilation/shredding CATEGORIES OF BIO-MEDICAL WASTE
    14. 14. S.NS.N WASTEWASTE CATEGORYCATEGORY WASTE TYPEWASTE TYPE TREATMENTTREATMENT AND DISPOSALAND DISPOSAL 55 Category No.5Category No.5 Discarded Medicines and CytotoxicDiscarded Medicines and Cytotoxic drugs Wastesdrugs Wastes comprising of outdated,comprising of outdated, contaminated and discarded medicinescontaminated and discarded medicines Incineration/destructionIncineration/destruction and drugs disposal inand drugs disposal in secured landfillssecured landfills 66 Category No.6Category No.6 Soiled WasteSoiled Waste (Items contaminated with(Items contaminated with blood, and body fluids including cotton,blood, and 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 autoclaving/autoclaving/ microwavingmicrowaving 77 Category No.7Category No.7 Solid WasteSolid Waste (waste generated from(waste generated from disposable items other than the wastedisposable items other than the waste (sharps) such as tubing's, catheters,(sharps) such as tubing's, catheters, intravenous sets etc.intravenous sets etc. Disinfection by chemicalDisinfection by chemical treatment/autoclaving/treatment/autoclaving/ Microwaving &Microwaving & mutilation/shreddingmutilation/shredding 88 Category No.8Category No.8 Liquid WasteLiquid Waste generated from laboratorygenerated from laboratory and washing, cleaning, house keeping andand washing, cleaning, house keeping and disinfecting activitiesdisinfecting activities Disinfection by chemicalDisinfection by chemical treatment andtreatment and discharge into drainsdischarge into drains
    15. 15. S.NS.N WASTEWASTE CATEGORYCATEGORY WASTE TYPEWASTE TYPE TREATMENT ANDTREATMENT AND DISPOSALDISPOSAL 99 Category No.9Category No.9 Incineration Ash:Incineration Ash: Ash fromAsh from incineration of any bio-medicalincineration of any bio-medical wastewaste Disposal in municipal landfillDisposal in municipal landfill 1010 Category No.10Category No.10 Chemical WasteChemical Waste Chemicals used in production ofChemicals used in production of biologicals, chemicals used inbiologicals, chemicals used in disinfection as insecticides etc.disinfection as insecticides etc. Chemical treatment andChemical treatment and dischargedischarge into drains for liquids andinto drains for liquids and secured landfill for solidssecured 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. 16. COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTE ColorColor CodingCoding Type ofType of ContainerContainer WasteWaste CategoryCategory TreatmentTreatment options as peroptions as per Schedule ISchedule I YellowYellow Plastic bagPlastic bag Cat.1, 2,3,6Cat.1, 2,3,6 Incineration/deep burialIncineration/deep burial RedRed DisinfectedDisinfected container/Plasticcontainer/Plastic bagbag Cat 3,6,7Cat 3,6,7 Autoclave/Microwave/Autoclave/Microwave/ Chemical TreatmentChemical Treatment Blue/WhiteBlue/White translucenttranslucent Puncture proofPuncture proof containercontainer Cat.4,7Cat.4,7 Autoclave/Microwave/Autoclave/Microwave/ Chemical Treatment &Chemical Treatment & destruction/shreddingdestruction/shredding BlackBlack Plastic bagPlastic bag Cat 5,9,10Cat 5,9,10 Disposal in securedDisposal in secured landfilllandfill
    17. 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- medicalWaste (Management and Handling) Rules, 1998 specifies the Label for Bio-MedicalWaste Containers / Bags as:  Label shall be non-washable and prominently visible
    19. 19.  General wasteGeneral waste  Paper, plasticsPaper, plastics  WrappersWrappers  CardboardsCardboards  Outer packagingOuter packaging  Kitchen wasteKitchen waste  Unsoiled plaster castUnsoiled plaster cast
    20. 20. YELLOW BIN Bandages Pathology waste Humananatomical waste-placenta Swab stick- decontaminated WASTE DISPOSAL SWABS Dressing soiled linen, contaminated gowns, drapes
    21. 21.  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
    22. 22. RED BINDrains Plastic culture plates & tubes I/V sets Urine bag WASTE DISPOSAL All infectious, non sharp plastic waste
    23. 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. 24. DISPOSAL OF SHARPS Destroy needle Cut syringe tip Decontaminate in twin bucket having 1% bleach SHARPS including catheter guide wires
    25. 25.  Sharp edged or pointed metallic sharpsSharp edged or pointed metallic sharps  NeedlesNeedles  Scalpel bladesScalpel blades  Suture needleSuture needle  IntracathIntracath  LP needleLP needle  Bone screws ( sharps), Arch bars, BursBone screws ( sharps), Arch bars, Burs  LancetsLancets  Glass sharps such as broken ampoules,injection vialsGlass sharps such as broken ampoules,injection vials  Glass slides, coverslipGlass slides, coverslip  Injection vialsInjection vials  Broken test tubes/ Broken pippettesBroken test tubes/ Broken pippettes
    26. 26. Segregated incinerable wastes kept in Yellow bag
    27. 27. Segregated Autoclavable waste in Blue/ red bag
    28. 28. General wastes of health care unit in Black bag
    29. 29. Sharps in sharp container
    30. 30. Personnel safety devices The use of protective gears should be made mandatory for all the personnel handling waste.
    31. 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. 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. 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. 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. 35. Incineration  Burning of waste material in the presence of oxygen.  Waste volume reduction, destroying some harmful constituents.  Works at temperature (~ 400–700°C). DrawbackDrawback toxic products like furanes and dioxins - can cause air pollution
    36. 36. Non-incineration methods 1 - THERMAL PROCESSES A - 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 microwave C - 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. 37. Non-incineration methods 2 - 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. 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. 39. Waste Cycle Waste Generation survey Waste Segregation Waste Storage Waste transport Waste disposal Municipal ,sanitary lan drain in sewer Waste treatment •Return outdated drugs/ chemicals •Recycling/ reuse
    40. 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. 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. 42. Maintenance 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. When any accidents the authorized person  shall report the accident in Form III to the  prescribed authority forth with
    43. 43. Dos and Don’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
    44. 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. 45. Responsibility of WMOResponsibility 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. 46. Responsibility of WMO (Contd…..)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. 47. • Check Segregation • Monitoring disinfection of waste on site • Availability of basic items for BMWM • Monitoring compliance of usage of facilities by HCW • Monitor level of awareness • Prepare waste audit • Liason between HOD’s, CNO’s & WMO • Check segregation • Check labeling • Weigh the waste • Monitor final disposal of the waste • Ensure the working of incinerator • Provide monthly data of waste generated by both Hospitals Feedback to WMO Assist in training programme
    48. 48.  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!) BMW Spills & Surface Disinfection
    49. 49.  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 Hand Washing
    50. 50. Steps to Effective Handwashing Use soap & warm water. Scrub 10-15 seconds Rinse well with fingers pointed downward. After drying hands, turn off water using a paper towel. Discard towel in trash.
    51. 51. It is TIME to ACT, to prevent an epidemic waiting to 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. 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. 53. THANK YOU  Presented By Dr Sumi Nandwani  MD,DNB, PGCHM,MNAMS Associate Professor Department of Microbiology