Oral cancer ranks number one among men and number three among women in India. Oral cancer constitutes 12% of all cancers in men and 8% of all cancers among women.
Adequate medical supplies are already a problem for many developing countries like India, but disposal of biomedical waste is another, more serious matter
Bio-medical waste, if not handled and disposed indiscriminately, may cause adverse effects on human health & environment. According to the available information from the State Pollution Control Boards (2007-08) 52,001 (53.25 %), Health Care Establishments (HCEs) are in operation without obtaining authorization from their respective SPCB/PCC. Approximately 288.20 tons per day (56.87%) out of 506.74 tons per day wastes generated is being treated either through Common Bio-medical Waste Treatment Facilities (159 in number), or captive treatment facilities. There are 602 Bio-medical Waste Incinerators (which include both common and captive incinerators), 2218 autoclaves, 192 microwaves, 151 hydroclaves and 8,038 shredders in the country. About 424 (70.4%) out of 602 incinerators are provided with air pollution control devices and 178 (29.6 %) incinerators are in operation without air pollution control devices.The Ministry of Environment and Forests (MoEF), Government of India, has notified The Bio-Medical Waste Management and Handling Rules, 1998 and The Bio-Medical Waste (Management and Handling) (Amendment) Rules,2003 to provide for statutory and obligatory guidelines for health care waste management.Central Pollution Control Board has also issued guidelines on Central Bio-medical Waste Treatment Facilities (CBWTF) and Design and Construction of Incinerator. However, the implementation of these Rules and guidelines as well as the condition of medical waste management in general, remains grossly unsatisfactory.
Inadequate waste management thus will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles contaminated with human. Although there are no exhaustive documented studies on health hazards associated with poor hospital waste management, some indicators like progressive increase in hospital infection rate, increasing resistance to wide variety of antibiotics are the pointers to the way in which poor hospital waste management can contribute to the ill health plaguing the health care institutions. In addition to health risks associated with the poor management of bio-medical waste, due consideration must be given to the impact on environment, especially to the risks of pollution of water, air and soil. Hence, collection and disposal of waste in the proper manner is of great importance as it can decrease directly and indirectly health risk to people, and damage to flora, fauna and the environment
Commonest infections, which can result from mishandling of hospital/health care waste, are gastro enteric through faeces and/or vomit (Salmonella, Shigella spp., Vibrio Cholera, Helminthes; Hepatitis A), Respiratory through inhaled secretions; saliva (Mycobacterium tuberculosis; measles virus; streptococcus pneumonae), Ocular infections through eye secretions (Herpes virus), Genital infections (Neisseria gonnorrhoeae; herpes virus), Skin infection through pus (Streptococcus spp.), meningitis through Cerebrospinal fluid (neisseria meningitides), AIDS through blood and sexual secretions (HIV), Haemorrhagic fevers through body fluids (Junin, Lassa, Ebola and Marburg viruses), Septicaemia and bacteraemia through blood (staphylococcus aureus, Enterococcus, enterobacter, klebsiella and streptococcus) and Viral Hepatitis B & C through blood and body fluids (hepatitis B and C viruses).
Bio medical waste management 13-1
Bio-Medical Waste ManagementAnji AnuraSchool of Medical Science and TechnologyIIT Kharagpur
My researchOral CancerIndia accounts for 86% of the worlds oral cancer casesPrevalence of oral cancerRanked 1st among male (12% of all cancerRanked 3rd among female (8% of all cancer) CauseThe habit of betel quid chewing incorporating tobaccoHuman papiloma virus (HPV)HistopathologyDiagnosis ofcancerOral lesionsTissue Biopsy
WASTESWastesSolid wasteHouseholdwasteIndustrialwasteBiomedicalwaste orhospital wasteLiquid Waste Gaseous WasteWASTES“Something which isnot put into properusage at a giventime”.
What is Bio-medical waste ??Definition– Anything tested or used on an individual, or any trash frombiological experiments are medical wasteGenerated from– Waste generated by health care facility– Research facility– LaboratoriesHazardous health care waste– 85% waste is non infectious– 10% are infectious– 5% are hazardous
History• In the late 1980’s– Items such as used syringes washed up on several EastCoast beaches USA– HIV and HPV virus infection– Lead to development of Biomedical Waste ManagementLaw in USA.• However in India the seriousness about the managementcame into lime light only after 1990’s.
WHO has estimated that• in 2000• injections with contaminated syringes caused:• 21 million hepatitis B virus (HBV)infections (32% of all new infections);• Two million hepatitis C virus (HCV)infections (40% of all new infections);• 260 000 HIV infections (5% of all new)
Laws of Biomedical Waste ManagementOn 20th July 1998• Ministry of Environment and Forests (MoEF), Govt. of India,Framed a rule known as ‘Bio-medical Waste (Management andHandling) Rules, 1998,’• Provides uniform guidelines and code of practice for Bio-medical wastemanagement.According to this rule Bio-Medical Waste“Any waste, which is generated during the diagnosis, treatment orimmunization of human beings or animals or in research activitiespertaining there to or in the production of testing of biological”
Developed Countries- 1-5 kg/bed/day, with variationsamong countries.In India-1-2 kg/bed/day with variation amongGovt. and Private establishments.Approximately 506.74 tons/ day wastes generatedOut of which only 57% waste undergoes properdisposalBiomedical waste Statistics
The exposure to hazardous health care waste canresult in1. Infection2. Genotoxicity and Cytotoxicity3. Chemical toxicity4. Radioactivity hazards.5. Physical injuries6. Public sensitivity.
InfectionThe infectious agents enter in he body through Puncture, Abrasion, Cut in the skin; Through mucous membranes; By inhalation and ingestion.
Most Common Infections1. Gastro enteric through faeces and/or vomite.g. Salmonella, Vibrio Cholera, HelminthesHepatitis A2. Respiratory through inhaled secretionse.g. Mycobacterium tuberculosis; measles virus;streptococcus pneumonae3.Ocular infections through eye secretionse.g. Herpes virus,4. Skin infection through puse.g. Streptococcus spp ,5. Meningitis through Cerebrospinal fluide.g. neisseria meningitides,
Most Common Infection Cont.6. Blood borne diseases• AIDS• Septicaemia and bacteraemia• Viral Hepatitis B & C7. Hemorrhagic fevers through body fluids• Junin, Lassa, Ebola and Marburg viruses
Genotoxicity and CytotoxicityChemical Toxicity• Irritant to skin and eyesE.g. alkylating agent, intercalating agent• Carcinogenic and Mutagenice.g. Secondary neoplasia due to chemotherapy• Many drugs are hazardous• May cause intoxication , burns, poisoning on exposure
Radioactivity HazardsPhysical InjuriesRadioactive waste exposure may causeheadache, dizziness, vomiting, genotoxicity and tissue damageMay result from sharps, chemicals and explosive agentsPublic sensitivityVisual impact of the anatomical waste, recognizablebody parts
Cat- 1 Human Anatomical WastesCat- 2 Animal Anatomical WastesCat- 3 Microbiology and Biotechnology wastesCat- 4 Waste SharpsCat- 5 Discarded medicines and Cytotoxic drugsClassification of Waste Category as perWHO standard
Cat- 6 Sailed WastesCat- 7 Solid WastesCat- 8 Liquid wastesCat- 9 Incineration AshCat- 10 Chemical wastesClassification of Waste Category as perWHO standard cont…
Pharmaceutical WasteBlood bags found in the municipal waste stream in violation ofrules for such waste. 25
27WASTECATEGORYTYPE OF WASTETREATMENT ANDDISPOSAL OPTIONCategory No. 1 Human Anatomical Waste (Human tissues, organs, body parts)Incineration@ / deepburial*Category No. 2Animal Waste(Animal tissues, organs, body parts, carcasses, bleeding parts,fluid, blood and experimental animals used in research, wastegenerated by veterinary hospitals and colleges, discharge fromhospitals, animal houses)Incineration@ / deepburial*Category No. 3Microbiology & Biotechnology Waste (Wastes from laboratorycultures, stocks or specimen of live micro organisms orattenuated vaccines, human and animal cell cultures used inresearch and infectious agents from research and industriallaboratories, wastes from production of biologicals, toxins anddevices used for transfer of cultures)Local autoclaving/microwaving /incineration@Categories of Biomedical Waste Schedule asper WHO Standard
28Category No. 4Waste Sharps (Needles, syringes, scalpels,blades, glass, etc. that may cause puncture andcuts. This includes both used and unusedsharps)Disinfecting (chemicaltreatment@@ / autoclaving /microwaving and mutilation /shreddingCategory No. 5Discarded Medicine and Cytotoxic drugs(Wastes comprising of outdated, contaminatedand discarded medicines)Incineration@ / destruction anddrugs disposal in securedlandfillsCategory No. 6Soiled Waste (Items contaminated with bodyfluids including cotton, dressings, soiled plastercasts, lines, bedding and other materialscontaminated with blood.)Incineration@ / autoclaving /microwavingCategory No. 7Solid Waste (Waste generated from disposableitems other than the waste sharps such astubing, catheters, intravenous sets, etc.)Disinfecting by chemicaltreatment@@ / autoclaving /microwaving and mutilation /shredding# #Categories of Biomedical Waste Schedule asper WHO standards Cont….
29Category No. 8Liquid Waste (Waste generated from thelaboratory and washing, cleaning, housekeeping and disinfecting activities)Disinfecting by chemicaltreatment@@ and dischargeinto drainsCategory No. 9Incineration Ash (Ash from incineration ofany biomedical waste)Disposal in municipal landfillCategory No.10Chemical Waste (Chemicals used inproduction of biologicals, chemicals usedin disinfecting, as insecticides, etc.)Chemical treatment @@ anddischarge into drains for liquidsand secured landfill for solids.Categories of Biomedical Waste Schedule asper WHO standards cont….
Color Coding For Segregation ofBMWCOLOR WASTE TREATMENTYellow Human & Animal anatomical waste /Micro-biology waste and soiledcotton/dressings/linen/beddings etc.Incineration / Deep burialRed Tubings, Catheters, IV sets. Autoclaving / Microwaving /Chemical treatmentBlue /WhiteWaste sharps( Needles, Syringes, Scalpels, bladesetc. )Autoclaving / Microwaving /Chemical treatment &Destruction / ShreddingBlack Discarded medicines/cytotoxic drugs,Incineration ash, Chemical waste.Disposal in secured landfill
1. Survey of waste generated.2. Segregation of hospital waste.3. Collection & Categorization of waste.4. Storage of waste.( Not beyond 48 hrs. )5. Transportation of waste.6. Treatment of waste.
5: Managing Medical Waste Slide 32Steps to Manage Hazardous Wastesbefore Disposal1. Know what hazardsyou have2. Purchase smallestquantity needed, anddon’t purchasehazardous materials ifsafe alternative exists**Use mercury-free thermometers
5: Managing Medical Waste Slide 33Steps to Manage Hazardous Wastes(cont..)3. Limit use and accessto trained personswith personalprotective gear
5: Managing Medical Waste Slide 344. Use Engineering Controls such as Ventilation,Hoods for Select Hazards
5: Managing Medical Waste Slide 355. Get Rid of Unnecessary Stuff• Don’t accumulate unneeded products• Don’t let peroxides and oxidising agentsturn into bombsPhoto of bomb robot calledinto hospital to dispose ofpicric acid.
5: Managing Medical Waste Slide 366. Label with Agent, Concentration andHazard Warnings• Examples of hazard labels:
5: Managing Medical Waste Slide 377. Communicate about Workplace Hazards• Job description• Posters on doors• Labels on hazards• Give feedback on use of PPE anddisposal in evaluation• Role model safe use and disposal• Contact point who is responsible
5: Managing Medical Waste Slide 388. Recycle Products When Possible
Source Reduction• Source Reduction - ways to lessen the amountof material– Segregation - keeping noninfectious waste out of theinfectious waste stream– Minimization - reduce or eliminate waste at thesource– Engineering controls - methods to reduce quantityof waste(smaller containers)
Conclusion• Thus refuse disposal cannot be solved without public education.• Individual participation is required.• Municipality and government should pay importance to disposalof waste economically.• Thus educating and motivating oneself first is important andthen preach others about it.•
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