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New bio medical waste management rules 2016

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Notification of New Bio Medical Waste Management Rules 2016 by MOEF & CC in March 2016 has prompted to launch new presentation on the subject in place of earlier one.

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New bio medical waste management rules 2016

  1. 1. Environmentally safe Disposal of Hospital & Health care Wastes Bio-Medical Waste Management Rules 2016 Dr. Gunwant Joshi Former Chief Chemist Madhya Pradesh Pollution Control Board 8/27/2016 1Dr. Gunwant Joshi
  2. 2.  The Biomedical Waste (Management & Handling) Rules, 1998 as amended up till March2016 2 up till March2016  The Municipal Solid Waste (Management & Handling) Rules, 2000, amended up till 2016 8/27/2016 2Dr. Gunwant Joshi
  3. 3. 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.,waste anesthetic gases, etc., 4. Used disposables, Wasted equipments and Chemotherapeutic agents, 5. Laser Smoke and aerosolized medications 8/27/2016 3Dr. Gunwant Joshi
  4. 4. Apart from Hospitals Infectious wastes are also generated at  Dental Chambers  Nursing homes  Cosmetic clinics  Path. Laboratories  Blood Banks Aayush Hospitals Aayush Hospitals  Veterinary institutions  Bio-Medical & Biotech Research centers  Medical check-up & Surgical camps  Mortuaries & Autopsy centres The work environments similar to Hospital environment. 8/27/2016 4Dr. Gunwant Joshi
  5. 5. Recurrence of Older infectious diseases & Advent of Newer infections Prompted improvements in Medical technology and Centralized Medicare, and 5 Centralized Medicare, and Brought huge volumes of Toxic & Hazardous Waste Situation forced a serious rethinking & necessitated an appropriate refinement in pre-existing Legislation 8/27/2016 5Dr. Gunwant Joshi
  6. 6. Unsafe BMW disposal : Who’s at Risk ? • Doctors and nurses • Other Patients • Hospital support staff • Waste collection and disposal staff• Waste collection and disposal staff • General public in the vicinity and • The Environment 8/27/2016 6Dr. Gunwant Joshi
  7. 7. • Health care Associated infections : 5-10% of admissions in acute care hospitals, 20 times higher in developing world Oct. 2004, World alliance for Patient safety formed, Identified certain challenges w/r to safety of patients. “Clean care is Safer Care” (2005) A formal pledge committing to address health care- associated infection in the country was signed by Government of India. acute care hospitals, 20 times higher in developing world 1.4 million people worldwide suffer from HCAUI, 50% preventable. India contributes to 25%-30% of the global injections [3-6 Billion], nearly two-thirds (62.9%injections) unsafe prevalence rate of blood born disease is on rise- Hepatitis B 38/1000, Hepatitis c also on rise HIV 7/1000 8/27/2016 7Dr. Gunwant Joshi
  8. 8.  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.medical waste produced.  Infectious agents may become toys of terrorists, as Bioweapons of Mass Destruction a tight control over BMW management can reduce the risk & Response time 8/27/2016 8Dr. Gunwant Joshi
  9. 9. Hospital Waste is Hazardous waste: But only a fraction of the Hospital waste is actually hazardous and can be injurious to humans or animals, and is deleterious to the environment. This may be either A. Infectious Bio-hazard Infectious in nature 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 nature8/27/2016 9Dr. Gunwant Joshi
  10. 10. Other Potentially Infectious Material  Any body fluid with visible blood  Amniotic fluid  Cerebrospinal fluid  Pericardial fluid  Peritoneal fluid Peritoneal fluid  Pleural fluid  Saliva in dental procedures  Semen/vaginal secretions  Synovial fluid  Anywhere body fluids that are indistinguishable 8/27/2016 10Dr. Gunwant Joshi
  11. 11. 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 8/27/2016 11Dr. Gunwant Joshi
  12. 12. 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 the Nature of activity of HCF and volume of the various waste components 8/27/2016 13Dr. Gunwant Joshi
  13. 13. Liquid wastes Approx. Quantity : 4 to 250 liters / bed / day 1. Domestic Effluents and sewage 2. Sewage from isolation wards, ICU’s toilets & urinals, Bed-bath, bathrooms and hospital’s laundry 3. Wash waters from laboratories,OPD, Dressing rooms & Operation theaters. 8/27/2016 14Dr. Gunwant Joshi
  14. 14. Solid wastes Approximate Quantity : 0.3 to 3.5 kg/bed/day 1.Garbage 55% (Bulk Density :330 kg/m3,Cal.Value:1000 K.cal / kg, Moisture :40%) 2.Bio-medical waste (sensu stricto) 13%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% 8/27/2016 15Dr. Gunwant Joshi
  15. 15. Key to proper Bio - Medical Waste Management is the segregation as individual categories of waste are to be treated & disposed off in different specific ways 8/27/2016 16Dr. Gunwant Joshi
  16. 16. 1. Out rightly send Domestic Effluents to ETP or..the municipal sewers 2. Isolate & Collect the possibly infectious liquid wastes (from Path Labs,OTs,Laundry ,etc.), Disinfect completely and then send to ETP, municipal sewers or as per terms of Consentmunicipal sewers or as per terms of Consent 3. Send the pre segregated Solid Waste that is packed according to prescribed mode and 8/27/2016 17Dr. Gunwant Joshi
  17. 17. May be Where, The BMW shall be treated using prescribed Standard methods such asprescribed 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 Landfill 8/27/2016 18Dr. Gunwant Joshi
  18. 18. Under Environment Protection Act,1998 BIO-MEDICAL WASTE (Management & handling) RULES 1998 1st Amendment Rules vide S.O.201(E) Dated 06/03/2000 2ndAmendment Rules vide S.O.1069(E) Dated 17/09/2003 BIO – MEDICAL WASTE MANAGEMENT RULES, 2016 The Authorization is required for Generation/Collection/Reception/StorageGeneration/Collection/Reception/Storage Transportation/Treatment/Disposal or any other form of handling of BMW Exclussions: Municipal Solid Waste, Lead acid batteries wastes, hazardous wastes, e-Waste, Radioactive wastes, Hazardous micro organisms, GEMS & cells and Haz Chem [MSIHC Rules’89] 8/27/2016 19Dr. Gunwant Joshi
  19. 19.  Never mix Infectious Bio waste in to Municipal wastes. [The entire waste lot shall become infectious] Basic Concepts of Hospital waste management 20  Segregation and safe containment (packing) of waste at Generator level. [Health care facility]  Processing & storage for the final or terminal disposal. 8/27/2016 Dr. Gunwant Joshi
  20. 20. Genesis of the Rules 2016 (Draft Rules3rd June,2015 ) The Bio Medical Waste Management Rules, 2016 CONTAINS 18 RULES, 4 SCHEDULES & 5 FORMS.  BMW categories, Segregation, Colour coding, Collection ,Treatment & Disposal - Schedule I  Standards for Treatment & Disposal - Schedule II  Prescribed Authorities & Responsibilities - Schedule III Labels for BMW containers & Bags - Schedule IV Labels for BMW containers & Bags - Schedule IV  Accident Reporting - Form - I  Application & Authorization Document - Form II & III  Annual Reporting - Form IV  APPEAL - Form V
  21. 21. The Bio Medical Waste Management Rules, 2016 1. Date of enforcement : Date of publication: 28/03/2016 2. Application & Exclussions, 3. Definition (a to p), 4. Duties of the occupier [Generator] - (a to t), 5. Duties of the occupier [Operator of CTDF] - (a to q), 6. Duties of the Authorities[Operator of CTDF] - (a to q), 7. Treatment & Disposal - (1 to 11), 8. Segregation, packaging, Transportation & storage - (1 to 8), 9. Prescribed authority (1 to 7),9. Prescribed authority (1 to 7), 10. Procedure for Authorization (1 to 4), 11. Advisory committee (1 to 4), 12. Monitoring & Implementation (1 to 6), 13. Annual report, (1 to 4), 14. Maintenance of records (1 to 2), 15. Accident Reporting (1 to 2), 16. Appeal (1 to 4), 17. Site for CBMWTDF (1 to 2), 18. Liability of the Occupier[Generator/Operator] (1 to 2)
  22. 22. 8/27/2016 23Dr. Gunwant Joshi
  23. 23. Classification & Management as per BMW rules,2016 Schedule-I . Category-1: YELLOW, 2:RED Category 1 YELLOW (a) Human Anatomical Waste: (b)Animal Anatomical Waste : (c) Soiled Waste: (d) Expired or Discarded Medicines: (e) Chemical Waste: (f) Chemical Liquid Waste : (g) Discarded linen, (h) Microbiology, Bio-technology & Clinical Laboratory Waste: Treatment & Disposal Options Incineration/Plasma Pyrolysis/ deep burial* In absence of above autoclaving/ micro-waving/ hydroclaving followed by shredding/mutilation or combination of sterilization and shredding. Treated waste to be sent for energy recovery. & Clinical Laboratory Waste: recovery. Category 2 RED Contaminated Waste (Recyclable) (a) Wastes generated from disposable items such as tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (withoutneedles and fixed needle syringes) vaccutainers with their needles cut)/ gloves Autoclaving or micro-waving/ hydroclaving followed by shredding /mutilation or combination of sterilization & shredding. Treated waste to be sent to registered or authorized recyclers or for energy recovery or plastics to diesel or fuel oil or for road making, whichever is possible. Plastic waste should not be sent to landfill sites. 8/27/2016 24Dr. Gunwant Joshi
  24. 24. Category 3 Trans- luscent Waste sharps including Metals: Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal Sharps . Treatment & Disposal Options Autoclaving or Dry Heat Sterilization followed by shredding/mutilation or encapsulation in the metal container or cement concrete; Combination of shredding cum autoclaving. sent for final disposal to iron foundries (having consent to operate from PCB) or sanitary landfill or designated concrete Classification & Management as per BMW rules,2016 Schedule-I . 3:WHITE and 4: BLUE discarded and contaminated metal Sharps . or sanitary landfill or designated concrete waste sharp pit. Category 4 BLUE (a) Glassware: Broken /discarded & contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes. (b) Metallic Body Implants Disinfection (by soaking the washed glass waste after cleaning with detergent & Sodium Hypochlorite treatment) or through autoclaving or microwaving or hydroclaving and then sent for recycling. Disinfection followed by recycling 8/27/2016 25Dr. Gunwant Joshi
  25. 25. B M Waste categories segregation, collection, treatment, processing & disposal options B M Waste categories Container and Pre Treatment Treatment & Disposal (a) Human Anatomical Waste: Human tissues, organs,body parts and fetus below the viability period (as per MTPAct’71, amended up to date). Yellow coloured non-chlorinated plastic bags Incineration or Plasma Pyrolysis or deep burial* (b)Animal Anatomical Waste : Experimental animal carcasses, body parts, organs, tissues, including the waste generated from animals used in experiments or testing in veterinary hospitals or colleges or animal houses. (c) Soiled Waste: Items contaminated with blood, body fluids like dressings, plaster casts, cotton swabs and bags containing residual or Incineration/Plasma Pyrolysis/deep burial* In absence of above autoclaving/ micro-waving/ hydroclaving followedcotton swabs and bags containing residual or discarded blood and blood components. micro-waving/ hydroclaving followed by shredding/mutilation or combination of sterilization and shredding. Treated waste to be sent for energy recovery. (d) Expired or Discarded Medicines: Pharmaceutical waste like antibiotics, cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc. Yellow coloured non-chlorinated plastic bags or containers Expired `cytotoxic drugs & items contaminated with them to be sent back to Manufacturer/supplier for incineration at >1200 C, or to CBMWTF or HWTSDF for incineration at >1200C, Or Encapsulation or Plasma Pyrolysis at >1200C. All other discarded medicines shall be either sent back to manufacturer or disposed by incineration. 8/27/2016 26Dr. Gunwant Joshi
  26. 26. B M Waste categories segregation, collection, treatment, processing & disposal options B M Waste categories Container and Pre Treatment Treatment & Disposal (e) Chemical Waste: Chemicals used in production of biological and used or discarded disinfectants. (f) Chemical Liquid Waste : Liquid waste generated due to use of chemicals in production of biological and used ordiscarded disinfectants, Silver X-ray film developing liquid, discarded Formalin, infected secretions,aspirated body fluids, liquid from laboratories and floor washings, cleaning, house-keeping and disinfecting Separate collection system leading to effluent treatment system. After resource recovery, the chemical liquid waste shall be pre-treated before mixing with other wastewater. The combined discharge shall conform to the discharge norms given in Schedule-III.washings, cleaning, house-keeping and disinfecting activities etc. norms given in Schedule-III. (g) Discarded linen, mattresses, beddings contaminated with blood or body fluid. Non-chlorinated yellow plastic bags or suitable packing material Non- chlorinated chemical disinfection followed by incineration or Plazma Pyrolysis or for energy recovery. In absence of above shredding/mutilation or combination of sterilization and shredding. Treated waste to be sent for energy recovery or incineration or Plazma Pyrolysis. (h) Microbiology, Biotechnology and Clinical Laboratory Waste: Blood bags, Laboratory cultures, stocks or specimens of microorganisms, live or attenuated vaccines, human & animal cell cultures used in research, industrial laboratories, production of biological, residual toxins, dishes and devices used for cultures. Yellow coloured containers or non-chlorinated safe plastic bags Autoclave /Pre-treat to sterilize with nonchlorinated chemicals on-site as per NACO or WHO guidelines thereafter for Incineration. 8/27/2016 27Dr. Gunwant Joshi
  27. 27. B M Waste categories segregation, collection, treatment, processing & disposal options B M Waste categories Container and Pre Treatment Treatment & Disposal Contaminated Waste(Recyclable) (a) Wastes generated from disposable items such as tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles and fixed needle syringes) and vaccutainers with their needles cut) and gloves. Red, non- chlorinated plasticbags or containers Autoclaving / micro-waving/ hydroclaving followed by shredding / mutilation or combination of sterilization & shredding. Treated waste be sent to registered or authorized recyclers or for energy recovery or plastics to diesel or fuel oil or for road making, whichever is possible. Plastic waste should not be sent to landfill sites. Waste sharps including Metals White Autoclaving or Dry Heat SterilizationWaste sharps including Metals: Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal sharps White (Translucent) PunctureProof Leak proof, tamper proof containers Autoclaving or Dry Heat Sterilization followed by shredding/mutilation or encapsulation in metal container or cement concrete; combination of shredding cum autoclaving; and sent for final disposal to iron foundries (having consent to operate from PCB or sanitary landfill or designated concrete waste sharp pit. (a) Glassware: Broken/discarded & contaminated glass including medicine vials & ampoules except those contaminated with cytotoxics (b) Metallic Body Implants Cardboard boxes with blue colour marking Disinfection (by soaking the washed glass waste after cleaning with detergent and Sodium Hypochlorite treatment) or through autoclaving or microwaving or hydroclaving and then sent for recycling. 8/27/2016 28Dr. Gunwant Joshi
  28. 28. Category Yellow MANAGEMENT OF HOSPITAL WASTE (a) Human Anatomical Waste: Human tissues, organs, body parts and fetus below the viability period (as per MTPAct’71, amended up to date) (b)Animal Anatomical Waste : Experimental animal carcasses, body parts, organs, tissues, including the waste generated from animals used in experiments or testing in veterinary hospitals or colleges or animal houses.colleges or animal houses. (c) Soiled Waste: Items contaminated with blood, body fluids like dressings, plaster casts, cotton swabs and bags containing residual or discarded blood and blood components. (d) Expired or Discarded Medicines: Pharmaceutical waste like antibiotics, cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc.8/27/2016 29Dr. Gunwant Joshi
  29. 29. Category Yellow MANAGEMENT OF HOSPITAL WASTE (e) Chemical Waste: Chemicals used in production of biological and used or discarded disinfectants. (f) Chemical Liquid Waste : Liquid waste generated due to use of chemicals in production of biological, used or discarded disinfectants, Silver X-ray film developing liquid, discarded Formalin, infected secretions, aspirated body fluids, liquids from the Laboratory floor washings, cleaning, house-keepingLaboratory floor washings, cleaning, house-keeping and disinfecting activities etc. (g) Discarded linen: Clothing, Mattresses, beddings contaminated with blood or body fluid. (h) Microbiology, Biotechnology & Clinical Lab Waste: Blood bags, Lab. cultures, Stocks or specimens of microorganisms, live or attenuated vaccines, human & animal cell cultures used in Research, Industrial labs production of biologicals, Residual toxins, dishes & devices used for cultures.8/27/2016 30Dr. Gunwant Joshi
  30. 30. Category RedContaminated Waste (Recyclable) Wastes generated from disposable items such as tubing, bottles, intravenous tubes and sets, catheters, MANAGEMENT OF HOSPITAL WASTE tubes and sets, catheters, urine bags, syringes (without needles and fixed needle syringes) and vaccutainers with their needles cut and the gloves.8/27/2016 31Dr. Gunwant Joshi
  31. 31. Waste sharps including Metals: Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, White Dustbin with Puncture/ Leak/Temper proof Container MANAGEMENT OF HOSPITAL WASTE Category WHITE cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal sharps 8/27/2016 32Dr. Gunwant Joshi
  32. 32. Blue Dustbins or Cardboard boxes with blue colour marking MANAGEMENT OF HOSPITAL WASTE (a) Glassware: Category BLUE (a) Glassware: Broken /discarded & contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes. (b) Metallic Body Implants 8/27/2016 33Dr. Gunwant Joshi
  33. 33. Colour-Coded Bins & well ventilated storage space for Segregated BMW 8/27/2016 34Dr. Gunwant Joshi
  34. 34. Schedule-II Operational standards, Emission standards and Testing & Recording protocole for Treatment Technology Options  Incinerstor [Stack height/emission std]  Plasma Pyrolysis/Gasification system  Autoclaving  Microwaving 8/27/2016 35Dr. Gunwant Joshi  Microwaving  Deep Burrial  Sterilization  Chemical disinfection  Liquid waste Routine test and validation by spore strip/Vials or Chemical vials
  35. 35. Schedule-III Prescribed Authorities & Duties MOEF & CC [Policy making/Training/Assistance/Monitoring Hearing Appeals/specify Stds. & op. Parameters] MOHFWF [Liscenceing/Listing/Coordinating PCB/ Monitoring/ Operational Research/Training & Awareness ] MOD [Authorization/Treatment & disposal/ Training/Reiew/ Advisory committee/ submission of reports to CPCB] CPCB[Guide lines/Coordination with SPCB & MOD/Training/ Lay standards/Random inspections & Monitoring/ Research] CPCB[Guide lines/Coordination with SPCB & MOD/Training/ Lay standards/Random inspections & Monitoring/ Research] State MOHFF & Administration [Insure implementation/ allocation of Funds/procurement of equipments/ constitute State & District Advisory Committee/Advise SPCB ] PCB[Inventorisation of Occupiers/ Authorization & Consent/ Training / Monitoring and Action for violation/ Compilation & Reporting to CPCB/ Implementation of Advisory committee Issues/Publish List of registered Occupiers] Municipal bodies[provide suitable land/Collect & ManageMSW]8/27/2016 36Dr. Gunwant Joshi
  36. 36. Schedule-IV: Container’s Colour/Markings/Label 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 containers 8/27/2016 37Dr. Gunwant Joshi
  37. 37. 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.COD 250 mg/l. Bio assay 90 % Survival of fish after 96 hours in 100% effluent Send Domestic Effluents to municipal sewers Disinfect the infectious liquid waste and then send it to municipal sewers 8/27/2016 38Dr. Gunwant Joshi
  38. 38. Bio Medical Liquid Wastes Disinfection by Sodium Hypochlorite 8/27/2016 39Dr. Gunwant Joshi
  39. 39. Bio Medical Liquid Wastes Treatment by an Effluent Treatment Plant 8/27/2016 40Dr. Gunwant Joshi
  40. 40. Garbage Wastes Collection &Transport 8/27/2016 41Dr. Gunwant Joshi
  41. 41. Sharp Management Always Remember Not to recap the Needle and cut it Immediately after the useafter the use 80 % Reduction in Secondary Infection in a SuperSpeciality Hospital Sharp Sign 8/27/2016 42Dr. Gunwant Joshi
  42. 42. 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 Use/Reuse Unsafe collection Unsafe disposal 8/27/2016 43Dr. Gunwant Joshi
  43. 43. Sharp Encapsulation : Sharp Pit • MUTILATE & DISTROY •DISINFECT:- Chemically/Autoclave/Microwave •DISPOSE IN SHARP PIT •SEAL PIT WHEN 2/3 FULL•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 8/27/2016 44Dr. Gunwant Joshi
  44. 44. 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 8/27/2016 45Dr. Gunwant Joshi
  45. 45. Bio Medical Wastes: Segregate and Pack it right at the point of Generationpoint of Generation only to 75% capacity 8/27/2016 46Dr. Gunwant Joshi
  46. 46. Bio Medical Wastes Collection, Labelling &Transport 8/27/2016 47Dr. Gunwant Joshi
  47. 47. Bio Medical Wastes Collection &Transport 8/27/2016 48Dr. Gunwant Joshi
  48. 48. BMW CTDF at Bhopal Bio Medical Wastes Collection &Transport by Common Treatment & Disposal Facility Govindpura Industrial Area8/27/2016 49Dr. Gunwant Joshi
  49. 49. Inspection & Re-Segregation issues It requires to segregate again to ensure the final disposal of BMW as per BMW Rules 1998 (M & H) 8/27/2016 50Dr. Gunwant Joshi
  50. 50. Autoclave Validation test : Spot testing by Bacillus stearo- thermophilus spores on a spores strip with at leastwith at least 1 x 104 Spores/ml. Routine test : Chemical indicator strip/tape 8/27/2016 51Dr. Gunwant Joshi
  51. 51. Sharp Storage & Disposal 8/27/2016 52Dr. Gunwant Joshi
  52. 52. Bio Medical Plastic Wastes Disinfection by Sodium Hypochlorite 8/27/2016 53Dr. Gunwant Joshi
  53. 53. Bio Medical Wastes Destruction by Double Chambered Incinerator 8/27/2016 54Dr. Gunwant Joshi
  54. 54. Details of Double Chambered Incinerator 8/27/2016 55Dr. Gunwant Joshi
  55. 55. New Double Chambered Incinerator 8/27/2016 56Dr. Gunwant Joshi
  56. 56. Incinerator Ash Disposal 8/27/2016 57Dr. Gunwant Joshi
  57. 57. Schedule -V DEEP BURIAL PIT for BMW 8/27/2016 58Dr. Gunwant Joshi
  58. 58. 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.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 pits8/27/2016 59Dr. Gunwant Joshi
  59. 59. Land Disposal Facility for Rural & Remote areas with population less than 5 lacs 8/27/2016 60Dr. Gunwant Joshi
  60. 60. Other Bio Medical Wastes Treatment Options 8/27/2016 61Dr. Gunwant Joshi
  61. 61. Other Bio Medical Wastes Treatment Options Microwaveing8/27/2016 62Dr. Gunwant Joshi
  62. 62. Other Bio Medical Wastes Treatment Options Plasma Pyrolysis 8/27/2016 63Dr. Gunwant Joshi
  63. 63. Duties of the Occupier "occupier" means a person having administrative control over the institution and the premises generating biomedical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathology laboratory, blood bank, health care facility and clinical establishment, irrespective of their system of medicine and by whatever name they clinical establishment, irrespective of their system of medicine and by whatever name they are called Occupier / institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling Bio-medical waste to ensure that bio-medical waste is handled without any adverse effect to human health & the environment and in accordance with rules; 8/27/2016 64Dr. Gunwant Joshi
  64. 64. Duties of the Occupier[Generator]  to ensure that there shall be no secondary handling, pilferage of recyclables or inadvertent scattering or spillage by animals and bio-medical waste from such place or premises shall be directly transported in the manner as prescribed in these rules to CBMWTF or for appropriate treatment & disposal, in manner prescribed in Schedule I;in Schedule I;  Phase out use of chlorinated plastic bags, gloves and blood bags within 2 yrs from the date of notification that is 28th March’ 2018.  Provide within the premises a safe, ventilated & secured location for storage of Segregated biomedical waste in colored bags or containers in the manner as specified in Schedule I, 8/27/2016 65Dr. Gunwant Joshi
  65. 65. Duties of the Occupier[Generator]  Pre-treat the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilisation on-site in the manner as prescribed by (WHO)/(NACO) guidelines & then sent CBMWTF for final disposal  Dispose of solid waste other than bio-medical waste in accordance with the provisions of respective waste management rules made under the relevant laws andmanagement rules made under the relevant laws and amended from time to time;  Provide training to all its health care workers & others, involved in handling of BMW at the time of induction and thereafter at least once every year and the details of training programmes conducted, number of personnel trained and number of personnel not undergone any training shall be provided in the Annual Report; 8/27/2016 66Dr. Gunwant Joshi
  66. 66. Duties of the Occupier[Generator]  Not to give treated BM waste or mix with MS waste;  Immunise all its health care workers & others, involved in handling of bio-medical waste for protection against diseases including Hepatitis B and Tetanus that are likely to be transmitted by handling of BMW, in the manner as prescribed in the National Immunisation Policy or the guidelines of the Ministry of Health and Family Welfareguidelines of the Ministry of Health and Family Welfare issued from time to time;  Establish a Bar- Code System for bags or containers containing bio-medical waste to be sent out of the premises or place for any purpose within one year from the date of the notification of these rules; 8/27/2016 67Dr. Gunwant Joshi
  67. 67. Duties of the Occupier[Generator]  Ensure segregation of liquid chemical waste at source and ensure pre-treatment/neutralisation prior to mixing with other effluent generated from health care facilities;  Ensure treatment and disposal of liquid waste in accordance with the Water (Prevention and Controlaccordance with the Water (Prevention and Control of Pollution) Act, 1974 ( 6 of 1974);  Ensure occupational safety of all its health care workers and others involved in handling of bio- medical waste by providing appropriate and adequate personal protective equipments; 8/27/2016 68Dr. Gunwant Joshi
  68. 68. Duties of the Occupier[Generator]  Conduct health check up at the time of induction and at least once in a year for all its health care workers and others involved in handling of bio- medical waste and maintain the records for the same;  maintain and update, on day to day basis, the BMW management register and display the monthly record on its website according to the bio-medical waste management register and display the monthly record on its website according to the bio-medical waste generated in terms of category and colour coding as specified in Schedule I;  report major accidents including accidents caused by fire hazards, blasts during handling of BMW, the remedial action taken & the records relevant thereto, (including nil report) in Form I to the prescribed authority and also along with the annual report;  8/27/2016 69Dr. Gunwant Joshi
  69. 69. Duties of the Occupier[Generator]  make available the annual report on its web-site and all the health care facilities shall make own website within two years from the date of notification of these rules;  inform the prescribed authority immediately in case the operator of a facility does not collect the bio- medical waste within the intended time or as per themedical waste within the intended time or as per the agreed time;  Establish a system to review and monitor activities related to BMW management, either through an existing committee or by forming a new committee to meet once in every six months  record of the minutes of the meetings of this committee shall be submitted along with the annual report to the prescribed authority8/27/2016 70Dr. Gunwant Joshi
  70. 70. Duties of the Occupier[Generator]  healthcare establishments with less than 30 beds shall designate a qualified person to review and monitor the activities relating to bio-medical waste management within that establishment and submit the annual report;  maintain all record for operation of incineration, hydro or autoclaving etc., for a period of 05 years;hydro or autoclaving etc., for a period of 05 years;  existing incinerators to achieve the standards for treatment and disposal of bio-medical waste as specified inSchedule II for retention time in secondary chamber and Dioxin and Furans within two years from the date of this notification 8/27/2016 71Dr. Gunwant Joshi
  71. 71. Duties of the Operator[CBMWTDF] (a)take all necessary steps to ensure that the bio-medical waste collected from the occupier is transported, handled, stored, treated and disposed of, without any adverse effect to the human health and the environment, in accordance with these rules and guidelines issued by the Central Government or, as the case may be, CPCB/SPCB from time to time; (b)ensure timely collection of bio-medical waste from the occupier as prescribed under these rules; (c)establish bar coding and global positioning system for handling of bio- medical waste within one year; (d)inform the prescribed authority immediately regarding the occupiers which are not handing over the segregated bio-medical waste in accordance with these rules; 8/27/2016 72Dr. Gunwant Joshi
  72. 72. Duties of the Operator[CBMWTDF]  (e) provide training for all its workers involved in handling of Bio-medical waste at the time of induction and at least once a year thereafter;  (f) assist the occupier in training conducted by them for Bio-medical waste management;Bio-medical waste management;  (g) undertake appropriate medical examination at the time of induction and at least once in a year and immunise all its workers involved in handling of bio-medical waste for protection against diseases, including Hepatitis B and Tetanus, that are likely to be transmitted while handling Bio-medical waste & maintain the records for the same;8/27/2016 73Dr. Gunwant Joshi
  73. 73. Duties of the Operator[CBMWTDF]  (h) ensure occupational safety of all its workers involved in handling of Bio-medical waste by providing appropriate and adequate personal protective equipment;  (i) report major accidents including accidents caused by fire hazards, blasts during handling of Bio-medical waste and the remedial action taken & records relevant thereto,and the remedial action taken & records relevant thereto, (including nil report) in Form- I to the prescribed authority and also along with the annual report;  (j) maintain a log book for each of its treatment equipment according to weight of batch; categories of waste treated; time, date and duration of treatment cycle & total hours of operation; 8/27/2016 74Dr. Gunwant Joshi
  74. 74. Duties of the Operator[CBMWTDF]  (k) allow occupier , who are giving waste for treatment to the operator, to see whether the treatment is carried out as per the rules;  (l) shall display details of authorisation, treatment, annual report etc on its web-site;  (m) after ensuring treatment by autoclaving or microwaving (m) after ensuring treatment by autoclaving or microwaving followed by mutilation or shredding, whichever is applicable, the recyclables from the treated bio-medical wastes such as plastics and glass, shall be given to recyclers having valid consent or authorisation or registration from the respective State Pollution Control Board or Pollution Control Committee; 8/27/2016 75Dr. Gunwant Joshi
  75. 75. Duties of the Operator[CBMWTDF]  (n) supply non-chlorinated plastic coloured bags to the occupier on chargeable basis, if required;  (o) common bio-medical waste treatment facility shall ensure collection of biomedical waste on holidays also;  (p) maintain all record for operation of incineration, hydroor autoclaving for a period of five years; andautoclaving for a period of five years; and  (q) upgrade existing incinerators to achieve the standards for retention time in secondary chamber and Dioxin and Furans within two years from the date of this notification. 8/27/2016 76Dr. Gunwant Joshi
  76. 76. BMW Treatment & Disposal  (1) Bio-medical waste shall be treated and disposed of in accordance with Schedule I, and in compliance with the standards provided in Schedule-II by the health care facilities and common bio-medical waste treatment facility.  (2) Occupier shall hand over segregated waste as per the Schedule-I to common bio-medical waste treatment facility for treatment, processing and final disposal:  Provided that the lab and highly infectious bio-medical Provided that the lab and highly infectious bio-medical waste generated shall be pre-treated by equipment like autoclave or microwave.  (3) No occupier shall establish on-site treatment and disposal facility, if a service of common bio-medical waste treatment facility is available at a distance of seventy-five kilometer. 8/27/2016 77Dr. Gunwant Joshi
  77. 77. BMW Treatment & Disposal  (4) In cases where service of the common bio-medical waste treatment facility is not available, the Occupiers shall set up requisite biomedical waste treatment equipment like incinerator, autoclave or microwave, shredder prior to commencement of its operation, as per the authorisation given by the prescribed authority.  (5) Any person including an occupier or operator of a common bio medical waste treatment facility, intending tocommon bio medical waste treatment facility, intending to use new technologies for treatment of bio medical waste other than those listed in Schedule I shall request the Central Government for laying down the standards or operating parameters.  (6) On receipt of a request referred to in sub-rule (5), the Central Government may determine the standards and operating parameters for new technology which may be published in Gazette by the Central Government. 8/27/2016 78Dr. Gunwant Joshi
  78. 78. BMW Treatment & Disposal  (7) Every operator of common bio-medical waste treatment facility shall set up requisite biomedical waste treatment equipments like incinerator, autoclave or microwave, shredder and effluent treatment plant as a part of treatment, prior to commencement of its operation.  (8) Every occupier shall phase out use of non-chlorinated plastic bags within two years from the date of publication of these rules and after two years from such publication ofthese rules and after two years from such publication of these rules, the chlorinated plastic bags shall not be used for storing and transporting of bio-medical waste and the occupier or operator of a common bio-medical waste treatment facility shall not dispose of such plastics by incineration and the bags used for storing and transporting biomedical waste shall be in compliance with the Bureau of Indian Standards. Till the Standards are published, the carry bags shall be as per the Plastic Waste Management Rules, 2011. 8/27/2016 79Dr. Gunwant Joshi
  79. 79. BMW Treatment & Disposal  (9) After ensuring treatment by autoclaving or microwaving followed by mutilation or shredding, whichever is applicable, the recyclables from the treated bio-medical wastes such as plastics and glass shall be given to such recyclers having valid authorisation or registration from the respective prescribed authority.  (10) The Occupier or Operator of a common bio-medical waste treatment facility shall maintain a record of recyclablewaste treatment facility shall maintain a record of recyclable wastes referred to in sub-rule (9) which are auctioned or sold and the same shall be submitted to the prescribed authority as part of its annual report. The record shall be open for inspection by the prescribed authorities.  (11) The handling and disposal of all the mercury waste and lead waste shall be in accordance with the respective rules and regulations. 8/27/2016 80Dr. Gunwant Joshi
  80. 80. Segregation, packaging, transportation & storage (1) No untreated BM waste shall be mixed with other wastes. (2) BMW shall be segregated into containers or bags at the point of generation in accordance with Schedule I prior to its storage, transportation, treatment and disposal. (3) These containers / bags to be labelled as per Schedule IV.(3) These containers / bags to be labelled as per Schedule IV. (4) Bar code & global positioning system (GPS)to be installed by the Occupier & CBMWTF in 01 yrs time.(up till 28March 2017) (5) The operator of CBMWTF to transport BMW from occupier’s premises to any off-site CBMWTF only in specified vehicles labelled as per part ‘A’ of the Schedule IV along with necessary information as specified in part ‘B’ of the Schedule IV. 8/27/2016 81Dr. Gunwant Joshi
  81. 81. Segregation, packaging, transportation & storage (6) The vehicles used for transportation of BMW to comply with conditions specified by the MPPCB in addition to requirement of the Motor Vehicles Act, 1988 (59 of 1988), if any or the rules made there under for transportation of such infectious waste. (7) Untreated human anatomical waste, animal anatomical waste, soiled waste & biotechnology waste not be stored beyond a period of forty –eight hours: in case the condition can not beperiod of forty –eight hours: in case the condition can not be met, the occupier shall take appropriate measures to ensure that the waste does not adversely affect human health and the environment and inform the prescribed authority along with the reasons for doing so. 8/27/2016 82Dr. Gunwant Joshi
  82. 82. Different Formats & Applicability Application for Grant /Renewal of Authorization in form –II to MPPCB, the Prescribed Authority. Grant of Authorization in form –III by MPPCB to Occupier(BMW Generator/CBMWTDF. Submission of Annual Report by Occcupier inSubmission of Annual Report by Occcupier in form –IV by 31st June Every year about the categories & quantities of BMW handling during the preceding year Application for Appeal against Refusal in Form-V Accident Reporting by the Occupier in Form-I 8/27/2016 83Dr. Gunwant Joshi
  83. 83. Duties of the Occupier[Generator] (1)Bio-medical waste not to be mixed with MSW. (BMW shall be segregated into containers or bags at the point of generation in accordance with Schedule I prior to its storage, transportation, treatment and disposal. (3) The containers or bags be labelled as per Schedule IV. (4) Bar code & GPS be added by the Occupier & CBMTDF in 01 year time. (5) The operator of CBMTDF shall transport the bio-medical waste from the premises of an occupier to any BMWTDF only in the vehicles having label as per part ‘A’ of the Schedule IV along with necessary information as specified in part ‘B’ of the Schedule-IV. 8/27/2016 84Dr. Gunwant Joshi
  84. 84. Duties of the Occupier[Generator] (6) The vehicles used for transportation of BMW to comply with the conditions if any stipulated by SPCB in addition to the requirement contained in the Motor Vehicles Act, 1988 (59 of 1988), if any or the rules made there under for transportation of such infectious waste. (7) Untreated human/animal anatomical waste, soiled waste(7) Untreated human/animal anatomical waste, soiled waste and, biotechnology waste shall not be stored beyond a period of 48 hours: Provided that in case for any reason it becomes necessary to store such waste beyond such a period, the occupier shall take appropriate measures to ensure that the waste does not adversely affect human health and the environment and inform the prescribed authority along with the reasons for doing so. 8/27/2016 85Dr. Gunwant Joshi
  85. 85. Please Remember! The Primary responsibility ofresponsibility of the disposal of the Bio-Medical Waste lies with the Generator 8/27/2016 86Dr. Gunwant Joshi
  86. 86. Every Occupier to ensure that Bio-medical waste shall not be mixed with other Wastes such as Municipal Waste Bio-medical Waste shall be segregated, treated & disposed off in accordance with the Schedule -Idisposed off in accordance with the Schedule -I and in compliance with the standards prescribed in Schedule –V. Preferably at a Common Bio Medical Waste Treatment Facility or, if one is not within 75 kilometers, to do it on his own 8/27/2016 87Dr. Gunwant Joshi
  87. 87. 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 8/27/2016 88Dr. Gunwant Joshi
  88. 88. 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. 8/27/2016 89Dr. Gunwant Joshi
  89. 89. The contravention of the Act , Rules, Orders & directions may lead to legal action The punishment may lead to the imprisonment up to 5 years with fine up to Rs. 1 lakh.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. 8/27/2016 90Dr. Gunwant Joshi
  90. 90. –Segregation of waste not taken seriously at generator level –Non compliance with color coding –Monitoring segregation at source – low budgets allocated – costs are not always known/nor worked out properly Biomedical Waste Management - Issues 91 costs are not always known/nor worked out properly –Cost of color coding, staff, transport and disposal is a major deterrent but must be met –Quantification of waste generated is not done accurately 8/27/2016 91Dr. Gunwant Joshi
  91. 91. –Protection of healthcare workers not given adequate thought –Clinical waste dumped with non infectious waste - Risk for healthcare workers and public Biomedical Waste Management – Issues contd… 92 Risk for healthcare workers and public –Residual Waste disposal not effective, often dumped in open landfills 8/27/2016 92Dr. Gunwant Joshi
  92. 92.  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 Biomedical Waste Management – Issues contd…  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 8/27/2016 93Dr. Gunwant Joshi
  93. 93. Biomedical Waste Management – Issues contd… When infectious waste and regular MSW mixes together, it can not be permitted to separate them  Once combined, the entire contents are considered infectious waste!  Increased Volumes of medical waste generation increases the risk of costly accidents and spills due to increased handlling & Transportation required to haul the waste 8/27/2016 94Dr. Gunwant Joshi
  94. 94. Challenges Establishing robust waste management policies within the Health Care Facility/organization  Organization wide awareness about the health hazards  Sufficient financial & Trained human resources needed 95  Sufficient financial & Trained human resources needed  Monitoring and control of waste disposal  Clear responsibility and tracebility for appropriate handling and disposal of waste. 8/27/2016 95Dr. Gunwant Joshi
  95. 95. Hospital Waste Management is a real issue together we can address it Successfully

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