bmw -dr sadhana.pptx

BIOMEDICAL
WASTE
MANAGEMENT
BY : DR.SADHANA JOSHI

Essentials of Medical Microbiology by Apurba S Sastry © Jaypee Brothers Medical Publishers
LEARNING OBJECTIVES
▰ Biomedical Waste Rule
▰ Waste Segregation in Hospitals
▰ Treatment and Disposal Methods
2

WHAT IS BMW ????
▰ Wastes that are generated during the laboratory diagnosis, treatment or
immunization of human beings or animals, or in research activities .
3

SOURCES OF BIOMEDICAL
WASTE
Major source
▰ Hospitals
▰ Labs
▰ Research centers
▰ Animals research
▰ Bloods banks
▰ Nursing homes
▰ Mortuaries
▰ Autopsy centers
Minor source
▰ Clinics
▰ Dental clinics
▰ Home care
▰ Cosmetic clinics
▰ Paramedics
▰ Funeral services
▰ Institutions
4

WASTE GENERATED IN HOSPITALS
▰ In developing countries, the waste generated falls into two categories:
 General (non-hazardous solid waste, 80%)
 Biomedical waste: includes infectious waste (10%) and
chemical/radioactive waste (5%)
5

6

HAZARDS ASSOCIATED WITH BMW
1. Infections : Pathogens in infectious waste can infect
HCWs and BBV transmission can occur through sharp
wastes.
2. Genotoxicity and cytotoxicity :can be mutagenic,
teratogenic or carcinogenic.
7

3. Chemical toxicity: toxic, corrosive and some may
cause physical injuries and chemical burns
4. Radioactivity hazards :genotoxic, can also cause
tissue destruction
8

5. Physical injuries : sharps, pressurised
containers, chemicals etc
6. Public sensitivity :The general public is very
sensitive to visual impact of health care waste
especially to anatomical waste
9

10

11

HOW DOES BMW CAME 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 to biomedical waste management law in USA
▰ WHO studies millions of cases of Hepatitis B ,C and HIV infections
are only by ‘reused or contaminated syringes’
▰ In INDIA the seriousness come into lime light only after 1990’s
12

LEGISLATION
▰ Recognizing the ‘deadliest nature’ of the Biomedical waste , the Govt.
and Pollution Control Board 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 biomedical
waste
▰ “BIO-MEDICAL WASTE Management and Handling Rule 1998
came into effect.
▰ Provides uniform guideline and code of practice for Bio-medical
waste management
13

SITUATION IN INDIA
▰ According to the Ministry of Environment and Forests, gross generation
of BMW in India is about 484 TPD (only 447 TPD is treated)
▰ Karnataka tops the chart among all the states in generation of BMW
followed by Maharashtra.
14

WASTE MANAGEMENT HIERARCHY
▰ Largely based on the concept of the “3Rs”, namely:
 Reduce
 Recycle
 Recover (“not re-use”)
15

BIOMEDICAL WASTE RULE,
INDIA
16

BIOMEDICAL WASTE RULE, INDIA
▰ MoEF - formulated BMW rule in 1998, which had classified the waste
into 10 categories - segregated into five color coded containers.
▰ Considerable overlapping between categories - created ambiguity and
confusion.
▰ New BMW guideline - published in 2016 - amendment added in 2018
and 2019- 4 color coded containers
17

WASTE SEGREGATION IN HOSPITALS
▰ According to BMW Rule (2016), segregation should be done by using
containers of four different colors, each is designated for segregation of
a particular waste category.
18

BIOMEDICAL WASTE MANAGEMENT RULE, INDIA, 2016
(INCLUDING THE AMENDMENT ADDED IN 2018 AND
2019)
19
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Yellow infectious
non- plastic waste
Human anatomical waste Yellow coloured non
chlorinated plastic bags
Incineration/ Plasma pyrolysis/
deep burial
Animal anatomical waste
Soiled waste Incineration/plasma pyrolysis/
deep burial/autoclaving or
hydroclaving +
shredding/mutilation
Expired/discarded
medicines —
pharmaceutical waste,
cytotoxic drugs
Yellow colored
containers/non-
chlorinated plastic bags
with cytotoxic label
Sent back to manufacturer/
CBMWTF for incineration
(cytotoxic drugs at temperature
>1200°C)

BIOMEDICAL WASTE MANAGEMENT RULE, INDIA, 2016 (INCLUDING THE
AMENDMENT ADDED IN 2018 AND 2019) (CONT..)
20
Yellow infectious
non- plastic waste
Chemical solid waste Yellow colored
containers/nonchlorinated
plastic bags
Incineration or plasma pyrolysis
or encapsulation
Chemical liquid waste
such as discarded
disinfectants, infected
body fluids and
secretions, liquid from
house-keeping related
activities
To be discharged into
separate collection
system, which leads to
effluent treatment system
Not to be discarded into
yellow bag
Pre-treated before mixing with
other wastewater

21
Yellow infectious
non- plastic waste
Discarded linen waste
contaminated with
blood/body fluids, mask,
cap, gown and shoe
cover
Non-chlorinated yellow
plastic
bags/suitable packing
material
Non-chlorinated chemical
Disinfection followed by
incineration/plasma pyrolysis
Microbiology, other
clinical laboratory waste,
blood bags, live/
attenuated vaccines
Autoclave safe plastic
bag/
container
Pre-treat to sterilize with non
chlorinated chemicals2 on-site
as per NACO/ WHO guidelines
(Blue book 2014) + incineration

22
Red Infectious plastic waste
Disposable items such
as tubing, bottles,
intravenous tubes and
sets, catheters, urine
bags, syringes (without
needles and fixed needle
syringes) and vacutainer
with their needles cut),
gloves, plastic apron and
goggles
Red colored non-
chlorinated plastic bags or
containers
 Autoclaving/microwaving/
hydroclaving + shredding
 Mutilation/sterilization+
shredding
 Treated waste sent to
authorized recyclers or for
energy recovery

23
White
(Translucent)
Waste sharps including
metal sharps:
Needles, syringes with
fixed needles, needles
from needle tip cutter or
burner, scalpels, blades,
or any other
contaminated sharp
(used or discarded)
Puncture-proof, leak-proof,
tamper-proof containers
Autoclaving/dry heat
sterilization followed by:
 Shredding or mutilation or
encapsulation in metal
container or cement
concrete or
 Sanitary landfill or
 Designated concrete waste
sharp pit

24

LOGOS USED FOR SEGREGATION OF
BIOMEDICAL WASTE
25
E S S E N T I A L S O F M E D I C A L
M I C R O B I O L O G Y

STEPS TO MANAGE BMW
1. Segregation of hospital waste at the point of generation
2. Pre treatment of waste (liquid waste)
3. Categorized collection of waste
4. Record log keeping of waste
5. Transportation of waste from site of generation to central
storage area of hospital.
6. Transport of waste from central storage area to common bmw
treatment facilty(CBMWTF)
7. Disposal or treatment of waste(within 48 hrs of generation)
26

TREATMENT AND DISPOSAL METHODS
▰ As per the mandate of the BMWM rules, 2016, the final disposal and
recycling must be performed at common biomedical waste treatment
facility (CBMWTF).
▰ Only when there is no CBMWTF within 75 km, the hospital can create
its own the disposal facility.
27

INCINERATION
▰ High temperature (800-1200°C) dry oxidation process that reduces
organic and combustible waste into nonorganic incombustible matter,
resulting in a very significant reduction of waste volume and weight.
▰ Done for those wastes that cannot be reused, recycled or disposed of in
a landfill site.
28

INCINERATION (CONT..)
▰ Example - human and animal anatomical waste, microbiological waste,
solid non-plastic infectious waste.
▰ Halogenated plastics such as PVC should never be incinerated as it
generates furans which are carcinogenic.
29

INCINERATOR
30

AUTOCLAVE
▰ Thermal process - steam is brought
into direct contact with waste in a
controlled manner and for sufficient
duration to sterilize the wastes.
▰ It is mainly used for the treatment of
infectious plastic and sharp waste.
31

CHEMICAL DISINFECTION
▰ A chemical such as hypochlorite 1-2% is mixed to waste which results
in disinfection.
▰ More suitable for liquid waste such as discarded blood and body fluid
and also for hospital sewage.
32

EFFLUENT TREATMENT PLANT
▰ The liquid waste (effluent) generated in the hospital if mixes directly
with groundwater it can create significant health risks.
▰ Therefore, it is first subjected to chemical treatment and then is drained
in to effluent treatment plant (ETP).
33

EFFLUENT TREATMENT PLANT (CONT..)
▰ ETP removes the suspended
solids and organic matter in
wastewater and then
disinfects the wastewater
(with hypochlorite) and
finally drain the water to
municipal drainage.
34

EFFLUENT TREATMENT PLANT
35

MICROWAVING
▰ Microwaves are radio-frequency waves,
used at a frequency of 2450 MHz.
▰ They produce friction of water molecules
which generates heat.
▰ Large size microwaves are used for
disposal of BMW
36

HYDROCLAVING
▰ Low-temperature steam sterilizer, involving steam treatment with
fragmentation and drying of waste.
▰ It breaks up the waste into small pieces of fragmented material; thus
obviates postcycle shredding (unlike autoclave).
37

HYDROCLAVING
38

SHREDDER
▰ Process by which wastes are de-shaped or cut into smaller pieces so as
to make the wastes unrecognizable.
▰ It helps in prevention of reuse of BMW and also helps to reduce the
waste volume.
39

DEEP BURIAL
▰ Deep burial is a pit dug about two meters deep.
▰ It needs to be half filled with waste, and then covered with lime within
50 cm of the surface, before filling the rest of the pit with soil.
▰ The ground water level should be a minimum of six meters below the
lower level of deep burial pit.
40

SHARP PIT
▰ Constructed within the hospital
premises.
▰ Provides an alternative method for
disposal of the sharp waste generated
from the facility.
41

ENCAPSULATION
▰ Involves filling the containers with waste, adding immobilizing material
and sealing the containers, to prevent the access to unscrupulous
activities.
▰ Cubic boxes (metallic drums) which are three quarters filled with sharps
or chemicals or pharmaceutical wastes  then filled with plastic foam,
cement mortar or clay material.
42

INERTIZATION
▰ Involves mixing waste with cement before disposal
▰ It is especially suitable for pharmaceuticals and for incinerated ashes
with a high metal content.
43

PLASMA PYROLYSIS
▰ Uses ionized gas in the plasma state to convert electrical energy to
temperatures of several thousand degrees using plasma arc torches or
electrodes.
▰ The system provides high temperatures combined with high UV
radiation flux which destroys pathogens completely.
44

45

DISPOSAL OF CYTOTOXIC DRUG WASTE
▰ Expired cytotoxic drugs to be returned back to the manufacturer or
supplier or CBMWTF for incineration at >1,200°C or encapsulation or
plasma pyrolysis at >1,200°C.
46

DISPOSAL OF GENERAL WASTE (SOLID
WASTE)
▰ Constitute the large component of hospital waste (80%).
▰ They are not biomedical waste - their disposal can be carried out by
several strategies.
▰ Composting: It is the decomposition of organic matter by microorganism
in warm moist environment.
47

DISPOSAL OF GENERAL WASTE (SOLID
WASTE) (CONT..)
▰ Waste-to-energy - by various methods such as incineration,
pelletisation, biomethanation etc.
▰ Recycling of the waste
▰ Landfilling in dump yard (least preferred method)
48

MONITORING OF BMW
MANAGEMENT
49

MONITORING OF BMW MANAGEMENT
▰ Monitoring is an essential component of managing biomedical waste in
the hospital.
50

(CONT..)
▰ BMW management committee should be formed, which serves several
functions—
 (1) to oversee the implementation of BMW practices,
 (2) to educate HCWs about BMWM practices, and
 (3) to monitor BMW management in a hospital.
51

(CONT..)
▰ Monitoring of BMW management practices can be carried out through
following ways:
 Biomedical waste segregation audit by direct observation
 Biomedical waste segregation audit by CCTV camera
 Onsite inspection of BMW segregation at common storage area
 Conducting surveys through structured questionnaires
 Barcoding-based tracking of BMW, starting from segregation to
disposal.
52

IF YOU ARE NOT MEASURING IT ,
YOU ARE NOT
MANAGING IT.
53

THANK YOU
54

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