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Biomedical waste management. Presenter: Dr.L.Karthiyayini Moderator: Dr. A.Mehendale . Framework. Definition Burden of biomedical waste Sources of waste Types of health care waste & its health hazards Legislations Waste generation Principles of managing waste Waste minimization

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biomedical waste management

Biomedical waste management

Presenter: Dr.L.Karthiyayini

Moderator: Dr. A.Mehendale

framework
Framework
  • Definition
  • Burden of biomedical waste
  • Sources of waste
  • Types of health care waste & its health hazards
  • Legislations
  • Waste generation
  • Principles of managing waste
    • Waste minimization
    • Managing sharps
    • Chemical disinfectants
  • Handling of health care waste
    • Waste segregation & labeling
    • Waste storage & transport
    • Waste treatment & disposal
  • Infection control
  • BWM at MGIMS
  • BMWM in national programs
  • Biomedical waste audit
definition
Definition

“Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological”

[Source: Biomedical Waste (Management and Handling) Rules, 1998 of India]

magnitude of the problem
MAGNITUDE OF THE PROBLEM

GLOBALLY:

  • Developed countries generate 1 to 5 kg/bed/day
  • Developing countries: 1-2kg/pt/day

WHO Report:

  • 85% non hazardous waste
  • 10% infective waste
  • 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive)
  • 2002, 22 countries, health care facilities not using proper disposal 18%-64%
slide6

INDIA:

  • No national level study
  • Hospitals generate 1-2 kg/bed/day
  • BMW generation :
    • 4,05,702 kg/day
    • 2,91,983 kg/day is disposed
    • 28% of the wastes is untreated
  • 53.25% HCE – not authorized
sources of biomedical wastes
Sources of biomedical wastes

Major Sources:

  • Govt. hospitals/private hospitals/nursing homes/ dispensaries.
  • Primary health centres.
  • Medical colleges and research centres/ paramedic services.
  • Veterinary colleges and animal research centres.
  • Blood banks/mortuaries/autopsy centres.
  • Biotechnology institutions.
slide9

Minor Sources:

  • Physician’s/ dentist’s clinics
  • Animal houses/slaughter houses.
  • Blood donation camps.
  • Vaccination centres.
  • Acupuncturists/psychiatric clinics/cosmetic piercing.
  • Funeral services.
  • Institutions for disabled persons
legislations
LEGISLATIONS

ENVIRONMENTAL REGULATIONS FROM MoEF:

  • Environment protection act,1986:
  • Bio-medical waste management rules,1998(RENEWED 2011)
  • Municipal solid waste rules,2000
  • Hazardous waste rules,1989
  • EIA Notification, July 2004
bio medical waste rules 2011
Bio-Medical Waste Rules 2011
  • Elaborate, stringent and several new provisions have been added
  • Not applicable:
    • Radioactive waste,
    • Hazardous waste,
    • Municipal solid waste
    • Battery waste
slide14

Accident reporting must

  • HCE- BMWM unit & meetings
  • Mandatory treatment & disposal
    • Adequate treatment facilities
    • Promote new technologies
    • Omitted- Incinerator & deep burial
  • District level monitoring committee
  • Allocation : Funds & Equipments
  • Lacking: guidelines for linen & mattress, blood bags & pressurized containers
schedules
Schedules
  • Schedule I :Categories of Biomedical waste
  • Schedule II :Color coding
  • Schedule III :Labels for Hazardous waste
  • Schedule IV :Label for transport of BMW container/bags
  • Schedule V :Standards for – incineration , autoclaving, sewerage, deep burial
  • Schedule VI :Deadlines for implementation
schedule iv label for transport of bio medical waste containers bags
SCHEDULE-IV LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS
  • Day... ...Month ….……. Year…………Date of generation
  • Waste category No ... Waste Class ………
  • Waste description ………………………………………………….
  • Sender's Name & Address
  • Receiver's Name & Address .
  • In case of emergency please contact……….
forms
Forms
  • FORM-I : Application for authorization/ renewal of authorization
  • FORM II : Annual report(To be submitted to the prescribed authority by 31 January every year
  • FORM III :- Accident reporting
  • FORM IV: Authorization granting format
  • FORM V : Application for filing appeal against order passed by the prescribed authority
  • FORM VI: Operator of CBMWTF filing against HCE- if no proper segregation
annexure ii
ANNEXURE-II
  • GUIDELINES FOR DESIGN AND CONSTRUCTION OF BIO-MEDICAL WASTE INCINERATOR
  • Air Pollution Control Device (APCD)
    • Emission limit - 150 mg/Nm3 (corrected to 12% CO2) for Particulate Matter
principles of managing health care waste
PRINCIPLES OF MANAGING HEALTH CARE WASTE
  • Waste minimization
  • Safe reuse & recycling
  • Managing sharps
waste minimization
Waste minimization
  • Source reduction
  • Management and control measures at hospital level
  • Stock management of chemical and pharmaceutical products
safe reuse recycling
SAFE REUSE & RECYCLING

Sterilization methods for reusable items:

Thermal sterilization

• Dry sterilization - Exposure to 160 °C for 120 minutes or 170 °C for 60 minutes in a “Poupinel” oven.

• Wet sterilization - Exposure to saturated steam at 121°C for 30 minutes in an autoclave.

Chemical sterilization

• Ethylene oxide - Exposure to an atmosphere saturated with ethylene oxide for 3–8 hours, at 50–60°C, in a reactor tank

  • Glutaraldehyde - Exposure to a glutaraldehyde solution for 30 minutes
managing sharps
Managing sharps

Auto disable syringes

slide31

In 2000, WHO estimation-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 infections).
  • One needle stick injury risks:
    • 30% -HBV
    • 1.8% -HCV
    • 0.3% -HIV. 
slide48

Disinfectants commonly used for disinfection of materials contaminated with blood & body fluids

infection control
Infection control
  • Hand washing
  • Personnel protective equipment
  • Safe handling of waste
  • Prevention of needle stick injuries
  • Environmental cleaning & spillage management
  • Proper training to health care workers
  • Immunization of health care workers
bmw committee mgims sevagram
BMW committee – MGIMS, Sevagram
  • Occupier - Secretary, KHS
  • Dean, MGIMS
  • Medical superintend
  • Officer in charge - HOD, Community Medicine
  • HOD, Microbiology
  • Faculty member, community medicine
  • Faculty Member, Microbiology
  • CAO KHS & KH
  • Matron
  • Engineering Section-In-charge & civil section
  • Sanitary Inspector
  • Infection control Nurse
bmwm national programs
BMWM – NATIONAL PROGRAMS
  • NVBDCP
  • RNTCP
  • NACO-ICWM plan

BIOMEDICAL WASTE AUDIT

references
References
  • Pruss A, Giroult E and Rushbrook P. (1999) Safe Management of Wastes from Health Care Activities, World Health Organization, Geneva
  • Kishore J and Ingle G.K. (2004) Biomedical Waste Management in India, Century Publications, New Delhi
  • Srishti - Managing Hospital Waste, A Guide for Healthcare Facilities, September 2000
  • Agarwal, A.G. and Singh, R. (2005) Understanding and Simplifying Bio-Medical Waste Management, Toxics Link, New Delhi
  • Mandal S. K & Dutta J , Integrated Bio-Medical Waste Management Plan for Patna City, Institute of Town Planners, India Journal 6-2:01-25 (2009)
  • The Bio Medical Waste(Management & Handling) Rules, (1998)& (2011)
  • WHO - Healthcare Waste Management – www.Healthcarewaste.org
  • NRHM-Infection management & environment plan. Policy framework march 2007.Ministry of Health & Family Welfare , Government of India.
  • http://www.cseindia.org -Biomedical waste rules made stringent . 2012.