C ommon H ealthcare waste A ppropriate M anagement P lant (CHAMP)

1. CommonHealthcarewaste Appropriate ManagementPlant(CHAMP) An economically appropriate approach for Bio Medical Waste Management in rural and smaller cities of India.

2. PROJECT DETAILS • Name of the Project   : Healthcare Establishment Waste Management and Education Programme (HEWMEP)  • Name of the Facility: Common Healthcare waste Appropriate Management Plant (CHAMP) • Project Location : Gulbarga city, Karnataka, INDIA  • Implementing Agency : Centre for Environment Education (CEE) 

3. The Implementing Agency  Centre for Environment Education (CEE)is a national Institute engaged in developing programmes and materials to increase awareness about the environment. CEE was established in 1984 as a Centre of Excellence in Environmental Education, supported by the Ministry of Environment & Forests, Government of India. It is affiliated to the Nehru Foundation for Development. CEE's primary objective is to improve public awareness and understanding of environmental issues with a view to promote the conservation and wise use of nature and natural resources.

4. Objectives of HEWMEP Gulbarga  • To set up a completely operational common facility for Bio-medical Waste Collection, Transportation, Treatment and Disposal for Healthcare Establishments (HCEs) in Gulbarga • To train hospital staff regarding methodology for proper Bio-Medical Waste Management in their HCEs • To create awareness among the general public regarding Bio-Medical Waste and its hazards • To prepare Educational materials regarding Bio-Medical Waste Management

5. Aims of HEWMEP, Gulbarga project  • Waste minimization- • Segregation- • Collection- • Storage- • Transportation- • Treatment-          & • Disposal-of biomedical waste in an eco-friendly and technologically sound way.

6. Salient features of CHAMP CTF  • Comprehensive facility - involves collection, transportation, storage, treatment and disposal of the biomedical waste of Gulbarga city.   The facility has- • Specially fabricated transport vehicles for  biomedical waste. The vehicles are retrofitted with  the ionizer and filter system to check escape of  micro organisms to the surroundings. • On site cold storage facility for the waste. • Treatment facilities like Incinerator, Modified  Autoclave, Metal Sharps Manager and ETP for  treatment of the waste. • Landfill and deep burial for disposal of the waste. • Eco friendly technique - solar water heater supplementing the system.                   

7. Implementation of HEWMEP, Gulbarga project - Historical 1) Quantification Survey – to ascertain quantity of biomedical waste (bmw) generated in Gulbarga which in turn, is required to ascertain the technologies to be employed. 2)Formation of Committees – District level and State level committees to facilitate implementation of project. 3) Land Acquisition and EIA – 5 acres of land been leased from District Administration for setting up the Common Facility under the project. EIA was carried out to assess the suitability of the site for the purpose. 4)Motivation and Orientation programmes – to encourage the participation of the stakeholders. 5)Signing of MoU with the individual HCEs to ensure their participation 6)Development of the training material for training and orientation of the stakeholders.                                                                                      Contd…

8. 7) Setting up of the CHAMP common treatment facility- • Construction work at the CHAMP site • Finalization of the technologies and the capacities of the equipments / vehicles to be procured. • Tendering and contracting • Installation of the equipments and commissioning, trial run of the equipments / vehicles. • Routing plan for the collection of the waste. • Trial run of the complete plant. • Inauguration and the commissioning and operation of the plant 8) Operation and Monitoring of the plant (ongoing till 2011)

9. CHAMP CTF at Gulbarga

10. View of CHAMP CTF

12. Treatment Options at CHAMP CTF  • Treatment at the CTF site, Gulbarga is being done as per the Schedule 1 of Rule 5 of Biomedical Waste (Management and Handling) Rules, 1998. • To ensure the efficacy of the treatment, the project has been aiming at achieving 100 % segregation of waste at the source level. • The various treatment technologies engaged at the CHAMP CTF are…..

13. Incinerator (1 in no.) of capacity 50 kgs /hr for treatment of waste under categories* 1,2 • Modified Autoclaves (2 in no) each of capacity 100kg/hr for treatment of waste under categories* 3,4,6,7 • Metal Sharps Manager (1 in no) of capacity 10 kg/hr for treatment for metal sharps • Land filling for rejects, incinerator ash and hazardous chemicals categories 5 and 9 & solid part of category 10 • Deep Burial as a stand-by option in case of breakdown or maintenance of incinerator at the site • ETP for the liquid waste generated at the site of category 10 * The various categories of the biomedical waste as classified in the BMWM Rules 1998 explained in the subsequent slides

14. Onsite Cold Storage Facility  The CTF has on site cold storage facility where the biomedical waste after collection and transportation from the HCEs is kept till the time of treatment 

15. Incineration at the CHAMP CTF   • The burning of wastes at high temperatures, under controlled conditions, is called incineration and this is carried out in a double-chambered device known as an incinerator • Waste is burnt in the primary chamber at 800-8500C and volatile gases emitted are again burnt in the secondary chamber at 1050 -11000C (residence time - at least 2 sec). • The incinerator at the CHAMP CTF is retrofitted with the High Pressure Venturi Scrubber, as air pollution control device. The equipment also has the facility of computer recording for CO, CO2  and  O2 in gaseous emission of critical parameters. • The cycle time for the entire operation is about 1 hour. The volume is significantly reduced with assured sterilization and destruction. • The equipment follows all the latest specifications and guidelines specified by the CPCB in Sept 2003 for the Common Facility Incinerators • The equipment is used for the treatment of waste falling under Category 1,2 of BMWM Rules which consists of ……

16. Incinerable Waste  • Category 1– Human Anatomical Waste (human tissues, organs, body parts)  • Category 2– Animal Waste (animal tissues, organs, body parts, carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses)  The category 1 and 2 waste are stored in yellow liners which have to be non chlorinated so as to minimize the chances of emission of dioxins and furans, major pollutants having carcinogenic properties

17. 50 Kg / hr capacity Incinerator at the CHAMP site

18. Deep Burial at the CTF Site  • Deep Burial is the stand-by option in case of the failure of incinerator operation for Category 1 and 2 Infectious waste • Infectious Waste belonging to Category 6 (soiled cotton, dressings etc.) is also disposed of in deep burial after sterilization in the modified autoclave

19. Autoclaving at the CHAMP CTF site  • Steam is applied inside a double-walled jacket under pressure. • Waste is fed into the chamber where it  gets hydrated, agitated & sterilised • The waste is internally fragmented to attain a high level of sterilization. • Steam sterilization followed by dehydration, results in dry waste, greatly reduced in weight and volume • The sterilized waste is then shredded in the shredding assembly fitted below the autoclave system. • Along with the shredding, hot water washing also takes place in the shredder, making the sterilized and shredded waste suitable for recycling • The salient feature of the modified autoclave system at CHAMP CTF site is that the solar water heater which supplies hot water for steam, which ensures energy efficiency and reduces the cost of operation by reducing diesel / electrical consumption for producing steam • Autoclaving is used to treat waste falling under the category 3, 6 and 7.

20. Sterilizable Waste  • Category 3 –Microbiology & Biotechnology waste (wastes from laboratory cultures, stocks or specimens of micro organisms live 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, dishes and devices used for transfer of cultures) • Category 6 – Soiled Waste (items contaminated with blood and body fluids including cotton, dressings, soiled plaster casts, lines, beddings and other materials contaminated with blood.) • Category 7 – Solid Waste (wastes generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets – mostly plastic & latex disposables)  The waste belonging to the category 3, 6 and 7 are stored in Red liners

21. 100 kg / hr each – Modified Autoclaves

22. Solar Water heater system supplementing the autoclave system and catering to the hot water needs at site

23. Treatment of waste sharps   • The waste metals sharps are treated in the Metal Sharps Manager at the site. • All the HCEs are provided with puncture proof metal boxes which have  keyhole  arrangements that separate the needles from syringes. A protected opening for  dropping the blades, canula needles and scalpels is also present in the box • The metal boxes are brought from the HCEs to the site; the metal sharps from the metal boxes are then transferred to the metal sharps manager, present at the site • The metal sharps manager has a powerful shredding mechanism which mutilates the needles into small pieces. The system is also retrofitted with hot air oven that sterilizes the mutilated needles at 164oC • Waste belonging to category 4 (needles, syringes, disposable scalpels, blades, sutures etc.) are treated in the equipment

24. Metal Sharps Collection Box at HCES Key hole arrangement Opening for bigger sharps Hopper for sharp feeding Shredding Mechanism Oven assembly for hot air sterilization Shredded and sterilized sharps Metal Sharps Manager at CHAMP

25. Discarded Medicines, Cytotoxic Drugs and Incineration Ash  • Category 5 comprises of wastes comprising of outdated, contaminated and discarded medicines • Category 9 consists of incineration ash • Category 10 consists of solid Chemical wastes The above mentioned waste is stored in BlackPlastic Bags and kept for secured landfilling as per the BMWM Rules, 1998 

26. ETP at the CHAMP site • The liquid effluent from the washing of the transport vehicles (nearly 4 cu.m. / day) will be treated in the ETP • The treated water is to be used for plantation at the site.

27. Vehicles for biomedical waste collection and transport   Specially fabricated transport vehicles for biomedical waste. The vehicles are retrofitted with the ionizer – filter system to check escape of micro organisms to the surroundings

28. Flowchart of process at CHAMP

29. Incinerator ash storage

30. Treated plastic waste before sale

31. Treated Glass & Metal Sharps

32. Education &Training on Biomedical Waste Management • Education and Training is an integral component of O&M of CHAMP which we call Healthcare Establishments Waste Management and Education Programme (HEWMEP) • Training of HCE personnel is being done at different levels. This includes training for doctors, nurses, administrators, paramedical personnel, housekeeping staff, engineering, kitchen and laundry personnel, ayahs, wardboys, security staff, gardeners, rag pickers, sorters, reprocessors and people from different areas in the hospitals who are involved in Bio-Medical Waste Management (BMWM) • Different types of educational material have been prepared, published and used for the training, with approval from MoEF, Govt of India, WHO-India & Govt. of Karnataka. The materials used are in Kannada, Hindi and English

39. Scenario before and after HEWMEP, Gulbarga & Implementation of CHAMP • A ‘Knowledge, Attitude and Practice (KAP)’ survey in all Healthcare Establishments (HCEs) in Gulbarga was carried out in 2002 (prior to implementation of CHAMP) and subsequently in 2007 - 2008 (after CHAMP became operational) for ascertaining the level of awareness and compliance to the biomedical waste management (BMWM) Rules and prescribed procedures • The survey showed that although the HCEs still lag behind in the implementation of various recommended BMWM procedures (specifically those which have cost implications), there has been tremendous improvement in awareness amongst the healthcare workers especially after implementation of CHAMP

45. Conclusion • Segregation of waste at source is improving but needs to be combined with improvement of collection and segregated treatment • Although the hospital staff in Govt. hospitals and Maternity homes are trained and aware about BMWM practices but they are not able to implement the practices properly due to lack of resources, facilities and motivation among the seniors in the HCEs • None of the hospitals were found disposing their liquid wastes properly • Emphasis on procedures for chemical disinfection for glass and immunization waste in rural areas, disposing of liquid waste in the urban and rural areas and training programmes for all Healthcare Workers (HCWs) is strongly recommended

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