BY K.SRAVAN VARMA(11MBMH13) MADHURI(11MBMH18)

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DEFINITIONSBIO MEDICAL WASTE May be defined as any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during its diagnosis, treatment or immunization of human beings or animals, in research pertaining or in the production or testing of biological and the animal waste from slaughter houses or any other like establishments.2

CONTD.

(b) Medical Waste : Is a term used to describe any waste that is

generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining or in the production or testing of biological. care provided in hospitals or other medical care establishments, but does not include waste generated at home.

(c) Clinical Waste : Is defined as any waste coming out of medical

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CONTD

(d) Hospital Waste : Refers to all waste, biological or non-

biological that is generated from a hospital, and is not intended for further use. (e) Pathological Waste : Is defined as waste removed during

surgery/autopsy or other medical procedures including human tissues, organ, body parts, body fluids and specimens along with their containers.

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CONTD.

(f) Infectious Waste : Refers to that portion

of Bio-Medical Waste which may transmit viral, bacterial or parasitic diseases, if concentration and virulence of pathogenic organisms is sufficiently high. Waste which has a potential to cause hazards to health and life of human beings..

(g) Hazardous Waste : Refers to that portion of Bio-Medical

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CONTD

In addition, other types of waste generated in hospitals are : (h) Radioactive Waste : Which includes waste contaminated with

radio nuclides, it may be solid, liquid or gaseous waste. These are generated from in-vitro analysis of body fluids and tissues, in-vitro imaging and other therapeutic procedures.

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CONTD.

(I) Pressurized Waste : Include compressed gas cylinders, aerosol

cans and disposable compressed gas containers.

(j) General Waste : Includes general domestic type waste from

offices, public areas, stores, catering areas, comprising of newspapers, letters, documents, cardboard containers, metal cans, floor sweepings and also includes kitchen waste.

(k) Recyclable Waste : Includes the following: Glass after cleaning

and disinfection, paper, corrugated cardboard, aluminum, X-ray film, reclaimed silver from X-ray developing solution, Plastics after disinfection.

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CATAGRIZATION OF BIO MEDICAL WASTE

Bio-Medical waste have been categorized into ten different categories as

mentioned in the table below :Wastes parts)

Category No.1 Human Anatomical (human tissues, organs, body Category No.2 Animal Wastes (animal tissues, organs, body parts

carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, discharge from hospitals, animals houses)

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CONTD Category No.3 Microbiology & Biotechnology waste (waste from

laboratory cultures, stocks or specimens of m i c r o -organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, waste from production of biological, toxins, dishes and devices used for transfer of cultures)

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CONTD

Category No. 4 : Waste Sharps (needles, syringes, scalpels, blades,

glass, etc. that may cause puncture and cuts. This includes both used and unused sharps).

Category No. 5 : Discarded Medicines (waste comprising of

outdated contaminated and discarded medicines)

Category No. 6: Solid Waste (items contaminated with blood, and

body fluids including cotton, dressings, solid linen, plaster casts, linen, beddings, other material contaminated with blood)

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CONTD. Category No. 7: Solid Waste (Wastes generated from disposable

items other than the waste sharps such as tubing, catheters, intravenous sets etc.) Category No. 8: Liquid Waste (waste generated from laboratory

and washing, cleaning, housekeeping and disinfecting activities)

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CONTD..

Category No. 9 Incineration Ash (ash from incineration of any bio-

medical waste)

Category No.10 Chemical Waste (chemicals used in production of

biologicals,chemicals used in disinfection, as insecticides, etc.)

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ROLE OF HOSPITAL WASTE MANAGEMENT COMMITTEE

A Hospital Waste Management Committee has been established in

each of the associated hospitals in order to improve and streamline Hospital Waste Management and for proper implementation of BioMedical Waste Management Rules 98, under the chairmanship of the Medical Superintendents. It is a broad based committee with representative from hospital

administration, clinical departments, pathology and microbiology departments and has powers to take decisions on all matters related to Bio-Medical Waste Management in the respective hospitals.

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CONTD.. The responsibilities of the various categories of the staff involved in the

generation, collection, transportation, collection, treatment and disposal of wastes is formulated and implemented by this committee.

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FUNCTIONS OF HOSPITAL WASTE MANAGEMENT COMMITTEE

1. To ensure the circulation of enough copies of Bio-Medical WasteRules and guidelines .The responsibilities of the individual professionals will be highlighted in these guidelines. 2. To conduct Awareness Programmed of the Biomedical Waste

(Management & Handling)Rules98 3. To conduct training programmes for Medical Professionals, Nursing

Professionals and Sanitation Professionals.

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CONTD

4. To hold meeting of the Hospital Waste Management Committee andformulate the detailed plan of action in regard to segregation, collection, storage and transport of waste from all the patient care areas. 5. Each Clinical Department (Unit), Lab Services, Blood Bank,

Microbiology, Pathology will make one Faculty Member responsible for supervision of segregation in their area of activities. 6. Floor wise one Nursing Sister (Nursing Supervisor) will be

responsible for supervision of segregation in the wards of each floor. In each and every OT the same instruction of supervision.

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TRAINING ON HOSPITAL WASTE MANAGEMENT In order to implement the Bio-Medical Waste (Management and

Handling) Rules 1998, it is mandatory to provide training to all categories of staff i.e. resident doctors, nurses, paramedical staff, hospital and sanitation attendants, patient and their attendants, canteen staff, operation of Bio-Medical Waste treatment facilities. It should be interactive and should include awareness sessions, demonstrations and behavioral science inputs.

It should definitely include the following : (I) Awareness of different categories of waste and potential hazard. (ii) Waste minimization, reduction in use of disposables (iii) Segregation policy

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CONTD..

(iv) Proper and safe handling of sharps (v) Use of protective gear (vi) Colour coding of containers (vii) Appropriate treatment of waste (viii) Management of spills and accidents (ix) Occupational health

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BIO-MEDICAL WASTE (MANAGEMENT & HANDLING) RULES 1998 MINISTRY OF ENVIRONMENT & FORESTS NOTIFICATION New Delhi, 20th July 1998

These rules apply to all persons who generate, collect,

receive, store, transport, treat, dispose, or handle bio medical waste in any form. DUTY OF OCCUPIER: It shall be the duty of every occupier of an institution

generating bio-medical waste which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.19

TREATMENT AND DISPOSAL

(1) Bio-medical waste shall be treated and disposed of in accordance with Schedule I, and in compliance with the standards prescribed in Schedule V. (2) Every occupier, where required, shall set up in accordance with the time-schedule in Schedule VI, requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or, ensure requisite treatment of waste at a common waste treatment facility or any other waste treatment facility.

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SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE

(1) Bio-medical waste shall not be mixed with other wastes. (2) Bio-medical waste shall be segregated into containers/bags at the point of generation in accordance with Schedule II prior to its storage, transportation, treatment and disposal. The containers shall be labeled according to Schedule III. (3) If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV. (4) Notwithstanding anything contained in the Motor Vehicles Act, 1988, or rules hereunder, untreated biomedical waste shall be transported only in such vehicle as may be authorized for the purpose by the competent authority as specified by the government. (5) No untreated bio-medical waste shall be kept stored beyond a period of 48 hours Provided that if for any reason it becomes necessary to store the waste beyond such period, the authorized person must take permission of the prescribed authority and take measures to ensure that the waste does not adversely affect human health and the environment.21

COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICALWASTESColour coding WHAT GOES WHERE ?Waste Category identification & Constituents Treatment Option

1)Yellow colour polyethene bag of different in yellow colour bins/drums

Human anatomical waste: All human tissue,organs,body parts that are generated in patient care area. Animal Wastes i.e. Cytotoxic all animals tissues, organs, body parts , fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, discharge from hospitals, animal

incineration

incineration

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CONTD.

Waste Sharps i.e. all needles,syringes, blades.

disinfection (chemical treatment /auto calving/microwaving)

Solid Waste i.e.proof container all wastes generated from disposable items (other than the waste sharps) such as tubing's, catheters, intravenous sets etc. (should be cut into smaller pieces with the help of scissors)

incineration autoclaving/microwaving

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Colour coding identification

various category & constituents

Treatment option

3) Black colour polythene bag of different size.

Discarded Secure plastic bags of

MUNICIPAL AUTHORITIES

Medicines and Cytotoxic drugsdifferent sizes i.e. all wastes comprising of outdated, contaminated and discarded medicines. (should be returned back to medical stores for further disposal)

Incineration Ashi.e. ash from incineration of any Bio-Medical Waste

Chemical Wastei.e. all chemicals used in production24

COLOUR coding identification

various category & constituents

Treatment option

RED polythene bag of different size.

Microbiology & Biotechnology Wastes i.e. wastes from laboratory cultures, stocks or specimens of micro-organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins. Solid Waste i.e. all items contaminated with blood, and body fluids including cotton,dressings, soiled plaster casts, linen, beddings, other material contaminated

incineration local autoclaving/ microwaving/incin eration

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CONTD.. Solid Waste i.e.proof container all wastes generated from disposable items (other than the waste sharps) such as tubing's, catheters, intravenous sets etc. (should be cut into smaller pieces with the help of scissors) incineration autoclaving/microwaving

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COLOUR coding identification

various category & constituents

Treatment option

BLUE COLOUR polythene bag of different size.

Waste Sharps i.e. allneedles, syringes, blades.

disinfection (chemical treatment /auto calving/microwavi ng)

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AUTHORIZATION

(1) Every occupier of an institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling bio-medical waste in any other manner, except such occupier of clinics, dispensaries, pathological laboratories, blood banks providing treatment/service to less than 1000 (one thousand) patients per month, shall make an application in Form 1 to the prescribed authority for grant of authorization. (2) Every operator of a bio-medical waste facility shall make an application in Form 1 to the prescribed authority for grant of authorization. (3) Every application in Form 1 for grant of authorization shall be accompanied by a fee as may be prescribed by the Government of the State or Union Territory.28

FORM I (see rule 8) APPLICATION FOR AUTHORISATION (To be submitted in duplicate.) To The Prescribed Authority (Name of the State Govt/UT Administration) Address. 1. Particulars of Applicant (i) Name of the Applicant (In block letters & in full) (ii) Name of the Institution: Address: Tele No., Fax No. Telex No. 2. Activity for which authorisation is sought: (i) Generation (ii) Collection (iii) Reception (iv) Storage (v) Transportation (vi) Treatment (vii) Disposal (viii) Any other form of handling 3. Please state whether applying for resh authorisation or for renewal: (In case of renewal previous authorisation-number and date) 4. (i) Address of the institution handling bio-medical wastes: 33 (ii) Address of the place of the treatment facility: (iii) Address of the place of disposal of the waste: 5. (i) Mode of transportation (in any) of bio-medical waste: (ii) Mode(s) of treatment: 6. Brief description of method of treatment and disposal (attach details): 7. (i) Category (see Schedule 1) of waste to be handled (ii) Quantity of waste (category-wise) to be handled per month 8. Declaration I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information. I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority. Date: Signature of the Applicant Place: Designation of the Applicant

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ANNUAL REPORT Every occupier/operator shall submit an annual report

to the prescribed authority in Form 11 by 31 January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. The prescribed authority shall send this information in a compiled form to the Central Pollution Control Board by 31 March every year.

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FORM II [see rule- 10 of the Bio-medical Waste (Management & Handling) (Amendment) Rules, 2000] ANNUAL REPORT (To be submitted to the prescribed authority by 31 January every year) 1. Particulars of the applicant (i) Name of the authorized person (occupier/operator) : . (ii) Name & address of the institution : .. Telex No. Fax No. .. 2. Category of waste (as per Schedule-I of the Rule) generated and quantity on a monthly average basis : Category Waste Quantity Category Waste Quantity Category No. 1 Kg. Category No. 6 Kg. Category No. 2 Kg. Category No. 7 Kg. Category No. 3 Kg. Category No. 8 Ltr. Category No. 4 Kg. Category No. 9 Kg. Category No. 5 Kg. Category No. 10 Kg. Note: all quantities to be given in kg/month, except Category No. 8, which will be in ltrs./month 3. Brief details of the treatment facility : In case off-site facility : (i) Name of the Operator (ii) Name and Address of the facility : .. . Tel. No. , .. Telex No., .. Fax No. .. 4. Category-wise quantity of waste treated : i) Incineration/Burial (Yellow bag) : ____________ kg/month ii) Autoclave/Microwave (Blue bag) :___________ kg/month 5. Mode of treatment with details : 6. Any other information : 7. Certified that the above report is for the period from Date : Signature : Place : Designation :

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MAINTENANCE OF RECORDS

(1) Every authorized person shall maintain records related to the generation, collect ' ion, reception, storage, transportation, treatment, disposal and/or any form of handling of bio-medical waste in accordance with these rules and any guidelines issued. (2) All records shall be subject to inspection and verification by the prescribed authority at any time. ACCIDENT REPORTING When any accident occurs at any institution or facility or any other site where bio-medical waste is handled or during transportation of such waste, the authorized person shall report the accident in Form III to the prescribed authority forthwith.32

FORM III (see Rule 12) 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 Date ............................... Signature ........................................... Place.............................. Designation..........................................33

Issues and Challenges

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Biomedical Waste Management - Issues

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Not considered important Lack of interest from senior management No ownership of the process

Awareness of problems Appreciate the need for constant monitoring

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Issues CONTD.. Segregation of waste not taken seriously at user level Non compliance with color coding Monitoring segregation at source low budgets allocated

costs are not always known Cost of color coding, staff, transport and disposal Quantification of waste generated is not accurately done37

CONTD.. Protection of healthcare workers not given adequate

thought. Clinical waste dumped with non infectious waste - Risk

for healthcare workers and public. Waste disposal not effective, often dumped in open

landfills.

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CHALLENGES

1)Organization wide awareness about the health hazards.

2) Sufficient financial and human resources. 3)Monitoring and control of waste disposal. 4)Clear responsibility for appropriate handling and disposal of waste.39

ADRESSING THE ISSUES Issue of all protective clothes such as, gloves, aprons,

masks etc. to all HCW

. Regular medical check-up (half-yearly) of staff associated with BMWM. Maintenance of Record registers for this purpose. Containers should be robust and leak proof Tracking of Bio Medical Waste up to point of

Disposal. Proper treatment and final disposal.

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Points to remember for Waste Management in the Hospital 1. Do segregate waste at point of generation to : (a) Infection (b) Non-Infectious/Garbage (c) Sharps/Needles. 2. Do collect waste in color coded containers/bags : (a) Yello Infectious waste for incineration. (b) Black Garbage for dumping in municipal bin. ( c) Blue (inner perforated) Sharps/needles. 3. Do decontaminate all sharps and plastic waste by chemical/autoclave. 4. Do shred plastic waste (cul all tubings into pieces by scissors). 5. Do use syringe and needle destroyer. 6. Do incinerate blood soaked dressings/body parts etc. 7. Do cover waste collection containers. 8. Do transport through covered trolleys/wheel barrows. 9. Do provide protective wear (mask, gloves, plastic aprons, gum boots to transporters and handlers. 10. Do immunise all waste handlers.

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Donts for handing and Disposal of Hospital Waste 1. Dont mix the infectious with non-infectious waste. 2. Dont throw sharps in the trash or into non-puncture

proof containers. 3. Dont recap the needle or bend or break needles by hand. 4. Dont fill the waste container more than 3/4th of capacity. 5. Dont allow unauthorised persons access to waste collection/storage areas. 6. Dont use open buckets for infectious waste or sharps. 7. Dont incinerate plastic waste.

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Dos and Donts for Chemical Treatment 1. Do apply to sharp or infectd plastic waste. 2. Do use 1% hypochlorite or equivalent disinfectant.

Proper concentration is essential. 3. Do ensure all surfaces come in contact with chemical (including lumen). 4. Do let the contact time be atleast 30 minutes. 5. Do change chemical solutions frequently (with every shift). 6. Do handle with gloves and mask. Wear appron and boots if splashing is expected. 7. Dont chemically treat incinerable waste.43

TEST YOUR KNOWLEDGE: 1. Needle goes to .? 2. Gloves goes to..? 3. Mask goes to.? 4. Plastic apron goes to? 5. Yellow bin contains waste? 6. Blue bin contain .. Waste? 7. Black/green bin for. Waste? 8. Sharps bin contain solution? 9. We dont re-cap.? Please DO Handwash. Save yourself and others life.!!44

References: 1. Basu R.N. Issues involved in Hospital Waste Management : an experience from a large teaching Institution, Journal of Academy of hospital Administration. July 1995, Jan. 1996 7(2), *(1) ; 79-83. 2. Draft Bio-medical wastes (Management and Handling) rules 1998. Gazette of India Extraordinary, Part II Section 3 Sub-section (ii) dated 27th July, 1998. 3. Jain T.P., Aggarwal R. Hospital Waste Management; A holistic view. Proceedings of National Workshop as Management of hospitl waste, 1998 Apr. 16-18 Jaipur, IIRD and Shristi 1998. 4. Hospital Waste ManagementA holistic approach. Anand R.C., S. Satpathy 1998 edition, Book published by Department of Hospital administration, AIIMS, New Delhi. 5. Management of Waste from Hospitals and other health care establishments. Euro Report and Studies No. 97 WHO, 1985 ; 1-61. 6. Module on Hospital Waste Management by Sulabh International Institute of Health and Hygience, New Delhi. 7. Problems in community waste management, Public Health Paper; No. 38 W.H.O. Geneva 1969. 8. Wikipedia 9. www.google.com 10. HAAT incinerators Pvt Ltd., Banglore.45

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