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Biomedical waste management dr.praveen doddamani

Biomedical waste management, BMW,biomedical waste,hospital waste,BMW 1998,BMW 2011,BMW categories and colour codes,

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Biomedical waste management dr.praveen doddamani

  2. 2. Contents Introduction Definition WHO statistics Components Hazards Rules and penalties BMW 1998 Management conclusion
  3. 3. INTRODUCTION • Medical care – vital in our life and health. • BMW -emerged as issue of concern world over. • BMW real problem for MAN, COMMUNITY,& ENVIRONMENT • Safe scientific cost effective methods BMW management – need of hour.
  4. 4. WASTES Wastes Solid waste Liquid Waste Gaseous Waste • Household waste • Industrial waste • Biomedical waste or hospital waste
  5. 5. What is Bio-medical waste ?? Definition Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals (WHO)
  6. 6. • WHO estimates 85% of hospital waste is non-hazardous 10% is infectious 5% is non-infectious.
  7. 7. Non-Infectious waste, 80% Pathological and Infectious waste, 15% Chemical and Pharmaceutical waste, 3% Sharps, 1% Radioactive, Cytotoxic and heavy metals, 1% Bio-Medical Wastes
  8. 8. WHO has estimated that In year 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)
  9. 9. Developed Countries- 1-5 kg/bed/day, with variations among countries. In India- 1-2 kg/bed/day with variation among Govt. and Private establishments. Approximately 506.74 tons/ day wastes generated Out of which only 57% waste undergoes proper disposal Biomedical waste Statistics
  10. 10. Sources of Bio-Medical Waste Major Sources Hospitals Labs Research centers Animal research Blood banks Nursing homes Mortuaries Autopsy centers Minor sources  Clinics  Dental clinics  Home care  Cosmetic clinics  Paramedics  Funeral services  Institutions
  11. 11. WHO IS AT RISK?? Sanitation workers Medical & Paramedical staff Patients & attenders 7/28/2013 Biomedical Waste (BMW) Management 13 Public
  12. 12. Need of BMW Management in Hospitals???
  13. 13. Small amount of infectious waste generated during patient care can make non-infectious to infectious
  14. 14. Hazardous health care waste can result in 1. Infection 2. Genotoxicity and Cytotoxicity 3. Chemical toxicity 4. Radioactivity hazards. 5. Physical injuries 6. Public sensitivity.
  15. 15. Infection The infectious agents enter into the body through  Puncture  Abrasion  Cut in the skin  Through mucous membranes  By inhalation and ingestion.
  16. 16. Most Common Infections 1. Gastro enteric through faeces and/or vomit e.g. Salmonella, Vibrio Cholera, Helminthes Hepatitis A 2. Respiratory through inhaled secretions e.g. Mycobacterium tuberculosis; Measles virus; Streptococcus pneumoniae 3.Ocular infections through eye secretions e.g. Herpes virus, 4. Skin infection through pus e.g. Streptococcus spp , 5. Meningitis through Cerebrospinal fluid e.g. Neisseria meningitides
  17. 17. Most Common Infection Cont. 6. Blood borne diseases • AIDS • Septicaemia and bacteraemia • Viral Hepatitis B & C 7. Hemorrhagic fevers through body fluids • Lassa, Ebola and Marburg viruses
  18. 18. PROBLEM ASSOCIATED WITH BMW ORGANISM DISEASES CAUSED RELATED WASTE ITEM VIRUSES HIV, Hepatitis B, Hepatitis A,C, Arboviruses, Enteroviruses AIDS, Infectious Hepatitis, Infectious Hepatitis, Dengue, Japanese encephalitis, tick-borne fevers, etc. Infected needles, body Fluids, Human excreta, soiled linen, Blood, body fluids. BACTERIA Salmonella typhi, Vibrio cholerae, Clostridium Tetani, Pseudomonas, Streptococcus Typhoid, Cholera, Tetanus Wound infections, septicemia, rheumatic fever, endocarditis, skin and soft tissue infections Human excreta and body fluid in landfills and hospital wards, Sharps such as needles, surgical blades in hospital waste. PARASITES Wucheraria Bancrofti, Plasmodium Cutaneous leishmaniasis, Kala Azar, Malaria Human excreta, blood and body fluids in poorly managed sewage system of hospitals.
  19. 19. Genotoxicity and Cytotoxicity • Irritant to skin and eyes E.g. alkylating agent, intercalating agent • Carcinogenic and Mutagenic e.g. Secondary neoplasia due to chemotherapy
  20. 20. Chemical Toxicity • Many drugs are hazardous • May cause intoxication , burns, poisoning on exposure
  21. 21. Radioactivity Hazards Radioactive waste exposure may cause headache, dizziness, vomiting, genotoxicity and tissue damage Visual impact of the anatomical waste, recognizable body parts
  22. 22. Physical injuries • Sharps • Chemicals • Explosive agents
  23. 23. Waste with high content of heavy metals Blood pressure guages 26
  24. 24. Gas cartridges Gas cylinders Aerosol PRESSURISED CONTAINERS 27
  25. 25. Waste Sharps eg: Needles Human anatomical waste Discarded medicines Solid waste eg: cotton swabs
  26. 26. Blood bags found in the municipal waste stream in violation of rules for such waste. Hospital waste disposal 29
  27. 27. How did BMW come into Existence • In the late 1980’s – Items such as used syringes washed up on several East Coast beaches USA – Concern about HIV and HBV virus infection – Lead to development of Biomedical Waste Management Law in USA. • However in India the seriousness about the management came into lime light only after 1990’s.
  28. 28. LEGISLATION • Recognizing the deadliest nature of the Bio-Medical Waste, the Government and Pollution Control Boards under the guidelines of Ministry of Environment and Forests(MOEF). • MOEF have promptly designed and issued guidelines to the hospitals to ensure a proper and safe disposal of bio-medical waste • “BIO-MEDICAL WASTE Management & Handling RULE 1998 came into effect. • Provides uniform guidelines and code of practice for Bio-medical waste management.
  29. 29. Biomedical Waste Management and Handling Rules, 1998 [Amended in 2000] • These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose or handle bio-medical waste in any form. All Institutions generating BMW must take all steps to ensure that such waste is handled without any adverse effect to human health and the environment
  30. 30. PENALTIES AS PER RULES • The PENALTIES are as specified in Environment (Protection) Act 1986. • Imprisonment for upto five years with fine upto one lakh rupees, or both. • In case the failure additional fine upto five thousand rupees for every day.
  31. 31. Bio-Medical Waste Disposal Cycle Common Facility (Transportation, Treatment And Disposal) Legislation (BMW Rule) Implement ting Authority Waste Generator (Hospitals)
  32. 32. Bio-Medical Waste Flow Chart In House Segregation (Collection, Segregation Packing in Color Coded Poly Bags) Common Storage Point At Hospitals Transportation (Approved Special Vehicle) Unloading and Temp Storage at CBWTF Treatment (Incineration, Autoclaving and Shredding) Disposal ( Recycling & Landfill) Waste Water to ETP Re Use Generator (HOSPITALS)
  33. 33. 36 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@ Categories of Biomedical Waste Schedule as per WHO Standard
  34. 34. 37 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# # Categories of Biomedical Waste Schedule as per WHO standards Cont….
  35. 35. 38 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. Categories of Biomedical Waste Schedule as per WHO standards cont….
  36. 36. COLOR WASTE TREAT Yellow Human & Animal anatomical waste / Micro- biology waste and soiled cotton/dressings/linen/beddings etc. Incineration/DB/ Red Tubings, Catheters, IV sets. Autocl/microwav /chemical treatment Blue / White Waste sharps ( Needles, Syringes, Scalpels, blades etc. ) Autocl/microwav /chemical treatment/destr uction/shredding Black Discarded medicines/cytotoxic drugs, Incineration ash, Chemical waste. Disposal in land fields
  37. 37. 2011
  38. 38. Awareness of BMW Management and treatment among HCW Study subjects Total Aware (%) Doctors 56 43 (76.8) Interns 65 25(38.5) Nurses 83 68(81.9) Technicians 44 12(27.3) Attenders 78 23(29.5) House keeping staff 57 11(19.3) Source:International Journal for Basic Medical Science
  39. 39. 1. Survey of waste generated 2. reduction at source . 3. Segregation of hospital waste. 4. Collection & Categorization of waste. 5. Storage of waste. 6. Transportation of waste. 7. Treatment of waste.
  40. 40. If you are not measuring it, you are not managing it.
  41. 41. Source Reduction • Source Reduction - ways to lessen the amount of material – Segregation - keeping noninfectious waste out of the infectious waste stream – Minimization - reduce or eliminate waste at the source – Engineering controls - methods to reduce quantity of waste(smaller containers)
  42. 42. Steps to Manage Hazardous Wastes before Disposal 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
  43. 43. Steps to Manage Hazardous Wastes (cont..) 3. Limit use and access to trained persons with personal protective gear
  44. 44. 4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards
  45. 45. 5. Get Rid of Unnecessary Stuff • Don’t accumulate unneeded products • Don’t let peroxides and oxidising agents turn into bombs 5: Managing Medical Waste Slide 48
  46. 46. 6. Label of Hazard Warnings toxic biohazard inflammable corrosiveRadiation Gas bottle explosive Health danger
  47. 47. 7. Communicate about Work -place Hazards • 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 5: Managing Medical Waste Slide 50
  49. 49. 8. Recycle Products When Possible 5: Managing Medical Waste
  50. 50. Segregation of waste At the point of generation In a color coded leak-proof container Container should bear 'Biohazard' symbol and appropriate wording Container should never be completely filled
  51. 51. Segregation of waste should be observed strictly To avoid mixing of general (non-infectious) waste into infectious waste. Once mixed, becomes infectious and should not be removed. To reduce infectious waste To decrease expenditure on disposal of infectious waste
  52. 52. COLOR WASTE Yellow Human & Animal anatomical waste / Micro-biology waste and soiled cotton/dressings/linen/beddings etc. Red Tubings, Catheters, IV sets. Blue / White Waste sharps ( Needles, Syringes, Scalpels, blades etc. ) Black Discarded medicines/cytotoxic drugs, Incineration ash, Chemical waste.
  53. 53. Microbiological waste Autoclaving Final disposal as a general waste- Black Bag Wastes requiring pretreatment before disposal
  54. 54. WASTE •Tubes used for serum separation, centrifugation of samples, preparation of dilutions etc. sample cups ,Tips , Caps. Any other contaminated plastic wares Sodium hypochlorite Method: Chemical Disinfection Pretreatment before disposal Cont… Final Disposal- Blue bag
  55. 55. -Frequency of changing of Na hypochlorite solution-Daily Who prepares the solution? -Technical person. A trained housekeeping person can do preparation under observation. Disposal of liquid and solid -Liquid: Pour into drain with running tap - Solid: Blue bag
  56. 56. Yellow bag Contaminated gloves; latex & plastic(Uncontaminated – general waste) Contaminated tissue /blotting papers Contaminated cotton Human tissue/organs White sharp disposal container Broken glass, pipettes, broken test tubes,  Needles, razor blade, scalpel Waste disposed without pretreatment
  57. 57. Attention !! Do not allow the containers to overfill Arrange containers near the operation area at accessible distance Ensure that the disposed item is inside the container and not hanging at the edge
  58. 58. PACKAGING & LABELING: • Bags 3/4th filled should be tied, • be supervised Name of Ward, • Date of Packaging, • Destination (Treatment Site) • Bio Hazard/Cytotoxic Symbol • Weighing & Recording • Separate Register and Weighing Machine • Daily recording is mandatory
  59. 59. Bad Practice -Storage:
  60. 60. Collection, transportation, storage (within the hospital) • Waste collected and stored in thick non-corrosive disposable plastic bags or containers of specific colour code. • The waste in bags or containers should be stored in a separate area, room, or building of a size appropriate to the quantities of waste produced and the frequency of collection. • Health care waste should be transported within the hospital or other facility by means of hand cart wheeled trolley .
  61. 61. LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS/BAGS • Date of generation ................... • Waste category No ........ • Waste class…………… • Waste description…………. • Sender's Name & Address……….. Contact Person………….. • Receiver's Name & Address……… Contact Person………….. • In case of emergency please contact, Name & address………. Label shall be non-washable and prominently visible.
  62. 62. TRANSPORTATION • Transportation of BMW can be divided into internal and external transportation. • INTERNAL: it is for yellow ,red ,blue and white bags. • EXTERNAL: it is for the general waste collected in the black coloured plastic bags.
  64. 64. Do you have a bio-spill kit?  Container of undiluted household bleach  Several pairs of gloves  Safety glasses  Absorbent material  Biohazardous waste (autoclave) bags  Dust pan & scoop or tongs for broken glass Place in a labeled bag or bucket and keep in areas where biohazards are used
  65. 65. DISPOSAL METHODS OF BIO-MEDICAL WASTES • Incineration • Chemical disinfection • Inertisation • Autoclave • Encapsulation • Microwave • Shredder • Plasma pyrolysis • Deep burial • G.J multiclave Ltd is external agency managing final disposal in this zone.
  66. 66. BMW RULES 2011 v/s 1998 2011 1998 Every occupier generating BMW, irrespective of the quantum of wastes comes under the BMW Rules and requires to obtain authorisation Occupiers with more than 1000 beds required to obtain authorisation Duties of the operator listed Operator duties absent Categories of Biomedical Waste reduced to Eight Biomedical waste divided in ten categories Treatment and disposal of BMW made mandatory for all the HCEs Rules restricted to HCEs with more than 1000 beds A format for annual report appended with the Rules No format for Annual Report
  67. 67. ACCIDENT REPORTING • 1. Date and time of accident: • 2. Sequence of events leading to accident • 3. The waste involved in accident : • 4. Assessment of the effects of the accidents on human health and the environment,. • 5. Emergency measures taken • 6. Steps taken to alleviate the effects of accidents • 7. Steps taken to prevent the recurrence of such an accident
  68. 68. ANNUAL REPORT • To be submitted to the prescribed authority by 31 January every year • Name of the occupier with Address • Categories of waste generated and Quantity [monthly average] basis: • Name of treatment facility with Address • Category-wise quantity of waste treated • Mode of treatment with details: • Any other information
  69. 69. STAFF SAFETY • Proper training • Personal protective clothing and equipment • Immunization • Post-exposure prophylaxis • Medical surveillance • Personal hygiene
  70. 70. Responsibility Infection control is everyone's business. You are not only protecting yourself, but also those around you
  71. 71. Conclusion  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.  PPE does not replace proper procedures and techniques, consider all as hazard.
  72. 72. Our’s is a Beautiful Planet…Let us save together… Lets Make This World A Better Place to Live in.
  73. 73. THANK YOU • References: • MOEF guidelines INDIA • BMW(management & handling) RULES 1998 • WHO guidelines & CDC guidelines • Current world environment journal-Need for BMW management system vol 7,2012.

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Biomedical waste management, BMW,biomedical waste,hospital waste,BMW 1998,BMW 2011,BMW categories and colour codes,


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