The document defines biomedical waste and discusses its management according to Indian rules. It notes that biomedical waste includes waste generated from healthcare facilities like hospitals and can be infectious, pathological or hazardous. The rules categorize different types of biomedical waste and their treatment and disposal methods like incineration or autoclaving. The document also provides some statistics on biomedical waste generation rates in developed and developing countries.

2. BIO-MEDICAL WASTE MANAGEMENT

4. Definition : A cc to bio medical waste rules ,1998 of India “ bio-medical waste” means any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of bio medicals. Any unwanted residual material which cannot be discharged directly, or after suitable treatment can be discharged in the atmosphere or to a receiving water source, or used for landfill is waste. ( Wilson, 1981)

5. Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use Medical waste : refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals

6. Infectious waste: are the portion of medical waste that could transmit an ‘infectious disease’. Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.

7. Reduce the impact waste management . Reduction in the incidence of infection and accidental injuries to hospital staff. Cost-effective disposal of hospital waste.

8. GLOBALLY - Developed countries generate 1 to 5 kg/bed/day Developing countries : meager data, but figures are lower. 1-2kg/pt./day WHO Report: 85% non hazardous waste : 10% infective waste : 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive) INDIA :-No national level study - local or regional level study shows hospitals generate roughly 1-2 kg/bed/day

9. The Ministry of Environment and Forest has drafted certain rules in exercise of powers conferred by sections 6,8 and 25 of the environment (protection) act, 1986 The Gazette of India extraordinary , part II –section 3- subsection (ii) On 20 th July 1998

10. CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOSAL OPTION Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep burial* Category No. 2 Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals and colleges, discharge from hospitals, animal houses) Incineration@ / deep burial* Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal cell cultures used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures) Local autoclaving/ microwaving / incineration@

11. Category No. 4 Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding## Category No. 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Incineration@ / destruction and drugs disposal in secured landfills Category No. 6 Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.) Incineration@ / autoclaving / microwaving Category No. 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# #

12. Category No. 8 Liquid Waste (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities) Disinfecting by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Category No.10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfecting, as insecticides, etc.) Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids.

14. Waste category Infectious waste Pathological waste Description And Examples Lab cultures Waste from isolation wards Tissues(swabs) Materials/equipments of infected patients Excreta Human tissues/fluids Body parts Blood or body fluids

15. Pathological waste

16. Blood bags found in the municipal waste stream in violation of rules for such waste.

17. Sharp waste Pharmaceutical waste Genotoxic waste Needles Infusion Sets Scalpels Knives Blades Broken Glass Expired Pharmaceuticals Contaminated Pharmaceuticals Banned Pharmaceuticals Waste Containing Cytotoxic Drugs(often Used In Cancer Theraphy) Genotoxic Chemicals

18. Pharmaceutical Waste Sharp Waste

19. Chemical waste Waste with high content of heavy metals Pressurized containers Radioactive waste Lab reagents Film developer Expired disinfectants Expired solvents Batteries Broken thermometers Blood pressure guages etc Gas cylinders Gas catridges Aerosol cans Radiotherapy/lab research liquids Contaminated glass wares, packages, absorbent papers

20. Cytotoxic drugs Lab reagents Genotoxic waste Chemical waste

21. Waste with high content of heavy metals Worn out batteries Blood pressure guages

22. Gas cartridges Gas cylinders Aerosol cans PRESSURISED CONTAINERS

23. Radioactive waste

24. Government/private hospitals Nursing homes Physician/dentist office or clinic Dispensaries Primary health care centers Medical research and training centers animal./slaughter houses labs/research organizations Vaccinating centers Bio tech institutions/production units

26. 1. Know what hazards you have 2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists **Use mercury-free thermometers

27. 3. Limit use and access to trained persons with personal protective gear

29. Don’t accumulate unneeded products Don’t let peroxides and oxidising agents turn into bombs Photo of bomb robot called into hospital to dispose of picric acid.

30. Examples of hazard labels:

31. Job description Posters on doors Labels on hazards Give feedback on use of PPE and disposal in evaluation Role model safe use and disposal Contact point who is responsible

33. Slide

34. Separate sharps and infectious waste where they are used This prevents injuries that can occur when people sort the trash after it is disposed Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members

36. Treatment and Disposal Methods of Hospital Waste

37. Waste minimization & recycling of waste Identification of points of generation of waste Waste segregation at source Compiling the inventory of waste Waste treatment (disinfection etc.) at the site Waste collection and transportation, on-site and off-site Waste treatment , on-site & off the site Final disposal of waste Occupational safety Continuous monitoring of the system Training of the staff.

38. TREATMENT/DISPOSAL METHOD ADVANTAGES DISADVANTAGES Rotary kiln Adequate –all infect waste most Chemical waste Pharmaceutical waste High investment and operating costs Pyrolytic incineration Adequate –all infect waste Most pharmaceutical waste Chemical waste Incomplete destruction of cytotoxics Relative high investment

39. ROTARY KILN PYROLYTIC INCINERATOR

40. Single-chamber incinerator Good dis infection efficiency Drastic reduction of wt & volume of waste Residues disposed in landfills No need of high trained operators Low investment/operating cost Significant emissions of atmos pollutants Need for periodic removal of slag &soot Inefficient in destroying thermally resistant chem /drugs Drum/ brick incinerator Drastic reduction of wt &volume of waste Very low investment & operation Massive emission of black smoke, ash toxic flue gas

41. SINGLE CHAMBER INCINERATOR DRUM/BRICK INCINERATION

42. Chemical disinfection Highly efficient disinfection under good operating conditions Chemical disinfectants are relatively inexpensive Requires highly qualified technicians for operating of the process Uses hazardous substances that requires comprehensive safety measures Wet thermal treatment Environmentally sound Relatively low investment/operating costs Shredders are subject to frequent breakdowns Poor functioning

43. CHEMICAL DISINFECTION

44. WET THERMAL TREATMENT Off-site wet thermal (or "steam autoclave") treatment facility

45. Operating requires qualified technicians Inadequate for anatomical, pharmaceutical,chemical waste ,waste that is not steam permeable Micro- wave irradiation Good disinfection efficiency under appropriate conditions Drastic reduction in waste volume Environmentally sound High investment& operating costs Potential operation Maintenance problems

46. MICROWAVE IRRADIATION

47. Encapsulation Simple Low cost Safe Not recommended for non sharp infectious waste Safe burying Low cost Relatively safe if access to site is restricted Safe only if access to site is limited and certain precautions are taken inertisation Relatively inexpensive Not applicable to infectious waste

48. ENCAPSULATION

49. Inertisation, Immobilisation

50. Biomedical waste (management &handling) rule 1998, prescribed by The Ministry of Environment and Forests, Govt of India, came into force on 20th July 1998 . This rule applies to those who generate, collect, receive, store, dispose, treat or handle bio medical waste in any manner. Thus bio medical waste should be segregated into containers/bags at the point of generation of waste. Thus Colour Coding & type of containers used for disposal of waste is came into existence which is shown as follows

51. Colour coding Type of container Waste category Treatment options Yellow Plastic bag Human anatomical waste Animal waste Microbiology &biotech waste, solid waste Incineration/deep burial Red Dis infected container/plastic bag Micro&biotech waste Solid waste Solid waste Autoclaving Microwaving Chem Rx

52. Black Plastic bag Discarded medicines Cytotoxic drugs Incineration ash chemicals Disposal in secured landfills Blue/white translucent Plastic bag Puncture proof container Sharp waste Solid waste Autoclaving Microwaving Chem Rx Destruction/ shredding

53. Thus refuse disposal cannot be solved without public education. Individual participation is required. Municipality and government should pay importance to disposal of waste economically. Thus educating and motivating oneself first is important and then preach others about it. Start disposing waste first from within your home, then outside home, then neighborhood ,then your street, your area ,city and then the nation and the world. Lets make this world a better place to live in .

54. This World belongs to me. And to you. And to your children. It's ours. HCRW Management.ppt 7/03 Slide