History of BioWarfare 1346, Caffa, a port on the Black Sea- Tartars suffered an outbreak of plague during a siege, they sent the infected bodies over the walls of city. 1422,Karlstein in Bohemia , attacking forces launched the decaying cadavers of men killed in battle over the castle walls. 1763, Delaware, British Gen. Jeffery Amherst ordered that blankets and handkerchiefs be taken from smallpox patients in the fort's infirmary and given to Indians at a peace-making parley. (Jenner discovered in 1798 that people could be vaccinated against smallpox by using the closely-related cowpox) 1936, Manchuria- Japanese scientists ( Imperial Army Unit 731 ) used scores of human subjects to test the lethality of various disease agents, including anthrax, cholera, typhoid, and plague. As many as 10,000 people were killed (Japanese airplanes dropped paper bags filled with plague-infested fleas over the cities of Ningbo and Quzhou in Zhejiang province)
With clinical waste, the colour of the container can help to identify the type of waste within. Here are some of the container types / colours that you will come across at the University. Black bags should only ever be used for uncontaminated or decontaminated, non-offensive waste. For example, in some areas they are used for autoclaved laboratory plastics. Otherwise, lab plastics will go in orange bags. Carcass / anatomical material will only ever be placed in a yellow container, etc. Other coloured containers or lids may be in use in your laboratory or area. If they are, be certain that you know what they are for.
Biomedical Waste Management
Disposal of Hospital & Bio-Medical Wastes [Bio-Medical Waste Management] Dr. Gunwant Joshi Chief ChemistMadhya Pradesh Pollution Control Board
What Causes wastes from Hospital premises HAZARDOUS? 1. Waste Chemical-medications, Solutions, or 2. Infectious microbes, 3. Chemicals such as formaldehyde, waste anesthetic gases, etc., 4. Used disposables, Wasted equipments and Chemotherapeutic agents, 5. Laser Smoke and aerosolized medications
Apart from HospitalsInfectious wastes are also generated at Dental Chambers Nursing homes Path. Laboratories Blood Banks Veterinary institutions Bio-Medical & Biotech Research centers The work environments similar to Hospital environment.
Recurrence ofOlder infectious deceases& Advent of Newer infectionsPrompted improvementsin Medical technology andCentralized Medicare,Brought huge volumes of Toxic & Hazardous WasteSituation forced a seriousrethinking & necessitedan appropriate Legislation 4
Who’s at Risk ?• Doctors and nurses • Patients • Hospital support staff • Waste collection and disposal staff • General public and • the Environment 5
The Biomedical Waste (Management & Handling) Rules, 1998 The Municipal Solid Waste (Management & Handling) Rules, 2000 6
To minimize the potential for spread of disease from a medical settings to the general public; To reduce the overall amount of infectious medical waste produced. Infectious agents may become toyes of terrorists, as Bioweapons of Mass Destruction
Basic Concepts ofHospital waste management Never mix Infectious Bio waste in to Municipal wastes [The entire waste lot shall become infectious] Segregation and safe containment (packing) of waste at health facility level Processing and storage for terminal disposal 9
Hospital Wastes are dangerous and require more careful attention These are heterogeneous waste, both solid & liquid, primarily from Health Care Facilities The available techno-economic options for the disposal are largely determined by Nature of activity of HCF and volume of the various waste components
Liquid wastesApprox. Quantity : 4 to 250 liters / bed / day1. Domestic Effluents and sewage2. Sewage from isolation wards, ICU’s toilets & urinals, Bed-bath, bathrooms and hospital’s laundry3. Wash waters from laboratories,OPD, Dressing rooms & Operation theaters.
Solid wastes Approximate Quantity : 0.3 to 3.5 kg/bed/day1.Garbage 55% (Bulk Density :330 kg/m3,Cal.Value:1000 K.cal / kg, Moisture :40%)2.Bio-medical waste (sensu stricto) 13% A. Wasted body remains 05% (Blood,Cultures,Anotomicals) B. Pharmaceutical & Chemical Wastes. 02% C. Pathological wastes (may be infectious). 06%3.Sharp Objects 20%4.Pressurized Containers & Discarded Instruments 02%5.Radioactive Wastes 0.3%
Key to proper Bio - Medical Waste Management is the segregationas individual categories of wasteare to be treated & disposed offin different specific ways
1. Out rightly send Domestic Effluents to ..the municipal sewers 2. Isolate & Collect the infectious liquid wastes(streams 2 & 3), Disinfect completely and then send to municipal sewers
3. Pack the Segregated Solid Waste according to prescribed mode and
May be Where, The BMW shall be treated using Standard methods such as Incineration, Autoclaving, Micro- waving, and Chemical & Mechanical techniques and the treated waste residue shall be finally disposed off in a secured
Hazardous waste:Only 10-25% of Hospital waste is actuallyhazardous and can be injurious to humans oranimals and deleterious to environment.This may be either A. Infectious Bio-hazard Infectious in nature B. Sharps that may lead to secondary infections C. Toxic Bio-hazard Cytotoxic in nature D. Radiation Bio-hazard Radioactive in nature
Other Potentially Infectious Material Any body fluid with visible blood Amniotic fluid Cerebrospinal fluid Pericardial fluid Peritoneal fluid Pleural fluid Saliva in dental procedures Semen/vaginal secretions Synovial fluid Anywhere body fluids that are indistinguishable
Blood and Fluid Borne Pathogen Exposures may typically occur by one of the following ways: Puncture from contaminated needles, broken glass, or other sharps Contact between non-intact (cut, abraded, acne, or sunburned) skin and infectious body fluids Direct contact between mucous membranes and infectious body fluids Example: A splash in the eyes, nose, or mouth
Under Environment Protection Act,1998BIO-MEDICAL WASTE (Management & handling) RULES 19981st Amendment Rules vide S.O.201(E) Dated 06/03/20002ndAmendment Rules vide S.O.1069(E) Dated 17/09/2003 The Authorization is required for Generation/Collection/Reception/Storage Transportation Treatment/Disposal or any other form of handling.
Classification and management Schedule-I Category Waste Type Treatment and Disposal Method Human WastesCategory 1 (Tissues, organs, body Incineration / deep burial partsCategory 2 Animal Waste Incineration / deep burial Microbiology andCategory 3 Autoclave/microwave/incineration Biotechnology waste Disinfection (chemical treatment)Category 4 Sharps +/autoclaving/microwaving and mutilation shredding Discarded Medicines Incineration/ destruction and drugsCategory 5 and Cytotoxic Drugs disposal in secured landfills
Schedule-I. contd… Classification and management Category Waste Type Treatment and Disposal Method Contaminated solid Incineration/autoclaving /Category 6 waste microwaving Solid waste (disposable Disinfection by chemical treatment+Category 7 items other than microwaving/autoclaving & sharps) mutilation shredding Liquid waste (generated from laboratory washing, Disinfection by chemical treatment+Category 8 cleaning, housekeeping and discharge into the drains and disinfecting activity)Category 9 Incineration ash Disposal in municipal landfill Chemical Treatment + andCategory10 Chemical Wastes discharge in to drain for liquids and secured landfill for solids
Schedule-II Colour coding and Type of Containers for Different Biomedical WastesColour Type of Waste Treatment / coding container category Disposal Incineration/ Plastic Deep Burrial Bags Disinfected Autoclaving, Container / Microwaving and Plastic Chemical Treatment Bags Plastic Autoclaving, Bags Microwaving and /Puncture Chemical Treatment Proof Destruction/ shredding Containers
MANAGEMENT OF HOSPITAL WASTE Yellow Dustbin & BagsFrom OT: Amputated Limbs,Placenta, Intestine, UterusOvary etc.From Labs: Live or Attenuatedvaccines, Infected Samplesand cultures, Culture Plates,Wastes from production ofBiologicals,Toxins.
MANAGEMENT OF HOSPITAL WASTE Red Dustbin & BagsCotton pads, Swabs, GaugePieces, Dressings,Bandages, Cloths, Bedsheetsand Plaster castesSoiled with blood, Pus,Vomits, Sputum and otherBody Fluids.
MANAGEMENT OF HOSPITAL WASTE Black Dustbin & BagsWastes comprising of out dated,contaminated and discardedmedicines, solid chemicals usedfor disinfection in Lab &Hospitals as insecticides
MANAGEMENT OF HOSPITAL WASTE Blue Dustbins & BagsNeedles, Scalples,Blades, Glass ampoulesand Syringes etc. thatmay cause puncture andcuts. This includes bothused and unused sharps
A separate Blue Dustbins & Bags May also be put forAll disposable items likeI.V.Sets, S.V.Sets, Venflon,Catheter, I.V.Fluid BottlesUro-bags, Ryles tube,Drainage Tube and Bags,Empty blood bags and Dialysisand other plastic disposable.
Containers Colour Tells other staff what is in the container Tells the contractor what to do with the waste Can apply to both sacks and rigid containersSafe for Disposal to Sharps General Waste Carcass, anatomical Cytotoxic
Colour-Coded Bins for Segregation of Bio Medical Waste
Schedule-IIILabel for Containers of Bio-Medical WasteBio Hazard Cyto-Toxic Substance
Schedule-IV Label for Transportation of Bio-Medical Waste Containers / Bags Waste category No. Day -------- Month -------- Waste class Year -------- Waste description Date of generation-----------Senders Name & Address Receivers Name & Address Phone No. ........................... Phone No. ........................... Telex No. ............................ Telex No. ............................ Fax No. ............................... Fax No. ............................... Contact Person ................... Contact Person ................... In Case of Emergency, Please Contact: Name & Address Phone No.
Schedule -V a - STANDARD FOR LIQUID WASTE pH 6.5 to 9.0 Suspended Solids 100 mg/l. Oil & grease 10 mg/l. BOD 30 mg/l. COD 250 mg/l. Bio assay 90 % Survival of fish after 96 hours in 100% effluentSend Domestic Effluents to municipal sewersDisinfect the infectious liquid waste and then send it to municipal sewers
Bio Medical Liquid Wastes Disinfection by Sodium Hypochlorite
Bio Medical Liquid Wastes Treatment by an Effluent Treatment Plant
Sharp Management Always Remember Not to recap the Needle and cut it Immediately after the useSharp Sign
Sharps Issues Must be collected at the point of generation, in a leak-proof and puncture-resistant container Containers must bear the international biohazard symbol and appropriate wording Containers should never be completely filled, nor filled above the full line indicated on box. Unauthorised Unsafe collection Unsafe disposal Use/Reuse
Sharp Encapsulation : Sharp Pit • MUTILATE & DISTROY •DISINFECT:- Chemically/Autoclave/Microwave •DISPOSE IN SHARP PIT •SEAL PIT WHEN 2/3 FULL •START DISPOSAL IN NEW PIT. •Alternatively, after Destruction/ Mutilation and Disinfection the Stored Sharps can be sold as Scrap
Waste Sharp & Syringe Destruction The Shredded Needles, Sharps and Plastics may be kept in the secured containers and could be sent to Plastic / Metal Recycling Plants
Bio Medical Wastes: Segregate andPack it right at thepoint of Generation
Schedule -V D - STANDARD FOR DEEP BURIAL Entry of scavengers to the burial site be prevented may be by using covers of galvanized iron/wire mash. After every burial in the same secured pit a layer of 10 cm. soil be added .Burial must be performed under close and dedicated supervision.Deep burial site should be relatively impermeable and distant from habitat.There should be no well, lake, river etc. close to the site to avoid contamination of surface water or ground water.Location of the deep burial site to be authorized by the Prescribed Authority.The occupier shall maintain record for all the pits
Land Disposal Facility for Cities & Towns with population less than 5 lacs
Other Bio Medical Wastes Treatment Options Microwaveing
Other Bio Medical Wastes Treatment Options Plasma Pyrolysis
Duties of the OccupierOccupier / institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling Bio-medical waste To apply for Grant of Authorization in form –I to MPPCB which is the Prescribed Authority.Operator of the Bio - medical Waste Treatment Facility to apply for Grant of Authorization in form –I to MPPCB (The Prescribed Authority).
Duties of the OccupierBio-medical Waste shall be treated and disposed of in accordance with the Schedule -I and in compliance with the standards prescribed in Schedule –V.Every Occupier, shall set- up the requisite Bio-medical Waste Treatment Facilities like incinerator, Autoclave, Microwave system for treatment of waste,or, ensure requisite treatment of waste at common or any other waste treatment facility
Duties of the OccupierTo submit an annual report to in form –I I by 31st June Every year about the categories and quantities of Bio-medical Waste handling during the preceding yearTo maintain records related to Generation, collection,reception, storage, transportation, treatment,disposal and/or handling of Bio- medical waste according the rules & guidelines.
Duties of the OccupierAll records subject to the inspection & verification by the MPPCBAccident during handling & Transportation of BMW needs to be reported by the authorized person in Form – III to MPPCB forthwith.
Please Remember! The Primary responsibility of the disposal of the Bio-Medical Waste lies with the Generator
And also do not forget that Bio-medical waste shall not be mixed with other Wastes such as Municipal Waste Segregate the Bio-medical Waste in separate containers at point of generation (schedule-II) and label as prescribed (schedule-III)
And also do not forget that Biomedical waste that are to be transported, must be securely packed, and Labeled as per (schedule-IV). Transportation of BM Waste is allowed only in vehicles authorized by the prescribed Authority A day -to -day record of the Quantity under different categories of the Bio – Medical Waste generated in premises must be maintained
And also do not forget that No untreated Bio-medical Waste shall be kept stored beyond 48 Hrs. if for any reason, the Bio-Medical Waste is required to be stored beyond this time limit, the Authorized person must seek a permission from Prescribed Authority and take adequate measures to ensure that waste does not affect the human life & environment adversely.
The contravention of the Act ,Rules, Orders & directions may lead to legal actionThe punishment may lead to the imprisonment up to 5 years with fine up to Rs. 1 lakh.For failure or continued contravention a fine @ Rs.5000 /Day may be charged.If the failure or the contravention continues beyond one year, the imprisonment may be extended up to 7 years.
Liquid Infectious Medical WastesLiquid Infectious Medical Waste, i.e., the contents ofsuction canisters, may be disposed as follows Placed directly in the Biohazardous waste, Autoclaved & the poured down a sanitary sewer, Solidified using an approved disinfectant solidifier and discarded in the solid waste
Disposal Procedure – Plastics Laboratory plastics Render safe first If non-identifiable following autoclave then non- clinical disposal [Black Bag and label “Safe for Disposal”] If identifiable still then possibly “offensive” - Orange Bag and label as for Clinical Waste
Disposal Procedure Glassware Render safe first Designated boxes – clearly labelled “Broken Glassware – Safe for Disposal” Except if contains hazardous chemicals – special disposal route via Chemistry Mercury -Collect through spill kit and send for recycling
Biomedical Waste Management - Issues• Not considered important – Lack of interest from senior management – No ownership of the process – Awareness of problems – Appreciate the need for constant monitoring
Biomedical Waste Management - Issues–Segregation of waste not taken seriously at user level–Non compliance with color coding–Monitoring segregation at source – low budgets allocated –costs are not always known/nor worked out properly–Cost of color coding, staff, transport and disposal is a major deterrent–Quantification of waste generated is not accurately done 73
Biomedical Waste Management - Issues–Protection of healthcare workers not givenadequate thought–Clinical waste dumped with non infectious waste -Risk for healthcare workers and public–Residual Waste disposal not effective, oftendumped in open landfills 74
Over Classification makes it complex The disposal of solid wastes that are not infectious medical waste, is often done as if they were infectious It is the most commonly cited violation It increases the financial burden on patients and taxpayers in the form of increased disposal costs for health care facilities
Problems When large volumes of plastics, common in medical waste, are incinerated there is an increased potential for atmospheric release of reformed gaseous carcinogenic agents such as Dioxins & Furans Increased medical waste generation increases the risk of costly accidents and spills due to the increased number of trucks required to haul the waste
When infectious waste and regular solid waste mixes together, it can not be permitted to separate them Once combined, the entire contents are considered infectious waste!
ChallengesEstablishing robust waste management policies within theHealth Care Facility/organization Organization wide awareness about the health hazards Sufficient financial and Trained human resources needed Monitoring and control of waste disposal Clear responsibility and tracebility for appropriate handlingand disposal of waste. 78
ADRESSING THE ISSUES1. Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal2. This is a long-term process, sustained by gradual improvements.3. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital.4. Man power needs and other resources for the BMWM of hospital to be addressed.5. Quality assessment of bio-medical waste management should be done from time to time. 79
ADRESSING THE ISSUES- continued6. Segregated collection and transportation – need for Non- ambiguous color coding and labeling of wastes.7. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages.8. Safety of handlers is a big concern that is still not addressed adequately.9. Raising Awareness about risks related to health-care waste; training staff & Waste handlers on safe practices.10.Selection of safer & environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing waste. 80
ADRESSING THE ISSUES11.Issue of all protective clothing such as, gloves, aprons, masks etc. to all HCW & Waste handlers.12.Regular medical check-up (half-yearly) of staff associated with BMWM.13.Maintenance of Record registers for this purpose.14.Containers should be robust and leak proof15.Tracking of Bio Medical Waste up to point of Disposal.16.Proper treatment and final disposal. 81