Technological advances in bio-medical waste management

&disposal

Dr. B. N. GokulConsultant Microbiologist & ICO

Wockhardt HospitalVivus Hospitals

Mallige Medical Centre Prof of Microbiology & Infection Control In-charge

SDUMC, Kolar

What is bio-medical waste?

• Biomedical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals, in research activities or in the production or testing of biologicals and the animal waste from slaughter houses or any other similar establishment.

• All biomedical waste are hazardous. In hospital it comprises of 15% of total hospital waste.

Bio-medical waste

Non-hazardous85%

Hazardous infective

10%

Hazardous non-infective

5%

Categories of bio-medical waste

Category No.1- Human Anatomical Waste

Human tissues, organs, and body parts

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 and animal houses

Categories of bio-medical waste (contd…..)

Category No.3 - Microbiology & Biotechnology Waste Waste from laboratory cultures, stocks or specimens of micro-organisms, live or attenuated vaccines, human and animal cell cultures used in research, infectious agents from research and industrial laboratories, waste from production of biologicals, toxins, dishes and devices used for transfer of cultures

Category No.4 - Sharps waste Needles, syringes, scalpels, blades, glass, etc. that

may cause puncture and cuts, both used and unusable

Categories of bio-medical waste (contd…..)

Category No.5 - Discarded Medicines and Cytotoxic drugs

Waste comprising of outdated, contaminated and discarded medicines

Category No.6 - Soiled waste Items contaminated with blood/ body

fluids including cotton dressings, soiled plaster casts, linens, beddings, other material contaminated with blood

Classification of bio-medical waste (contd…..)

Category No. 7- Solid waste Waste generated from disposable

items, other than sharps, such as tubings, catheters, intravenous sets, etc

Category No. 8 - Liquid waste Waste generated from laboratory,

washing, cleaning, housekeeping and disinfecting activities

Classification of bio-medical waste (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, disinfectants, insecticides, etc.

What is bio-medical waste (BMW) management?

• It is the segregation, collection, treatment, transportation and disposal of the hospital waste

• It is a part of hospital hygiene, infection control and maintenance activities.

Rationale of bio-medical waste management

• Only 15% of bio-medical waste is hazardous • When hazardous waste is not segregated at the source

of generation and mixed with non-hazardous waste, 100% waste becomes hazardous.

The reasons for BMW management are:• Injuries from sharps leading to infection to all categories

of HCWs• Healthcare associated infections in patients from poor

infection control practices and poor waste management

Rationale of bio-medical waste management (contd…..)

• Risk of infection outside hospital for waste handlers and at times general public living in the vicinity of hospitals

• Risk associated with hazardous chemicals and drugs to persons handling wastes at all levels

• “Disposable" being repacked and sold by unscrupulous elements without even being washed

• Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers

• Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash

Approach for bio-medical waste management

Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India), approach comprises of :1.Segregation of waste2.Collection of bio-medical waste 3.Storage of waste4.Transportation5.Treatment & disposal of hospital waste6.Safety measures7.Coordination between hospital and outside

agencies

FOCUS ON SEGREGATION FIRST

• Should be done at the site of generation of BMW e.g. all patient care activity areas, diagnostic service areas, operation theatres, labour rooms, treatment rooms etc.

• The responsibility of segregation should be with the generator of bio-medical waste i.e. doctors, nurses, technicians etc.

• The bio-medical waste should be segregated as per categories applicable.

Type of container and colour for collection of bio-medical waste

No Category Type of container

Colour

coding

1 Human anatomical waste Plastic bag Yellow

2 Animal waste Plastic bag Yellow

3 Microbiology and Biotechnology waste

Plastic bag Yellow/Red

4 Waste sharp Puncture proof container

Blue/

white/

translucent

5 Discarded medicines and

Cytotoxic waste Plastic bags Black

6 Solid waste (Soiled) Plastic bag Yellow/

Red

Type of container and colour for collection of bio-medical waste

No Category Type of container

Colour

coding

7 *Solid (plastic) Plastic bag Blue / white

8 Liquid waste ….. …..

9 Incineration waste Plastic bag Black

10 Chemical waste (solid) Plastic bag Black

Type of container and colour for collection of bio-medical waste

• Those plastics which contains liquid like blood, urine, pus, etc., should be put into red colour bag for microwaving / autoclaving and other items should be put into blue or white bag after chemical treatment and mutilation / shredding

Segregation of bio-medical waste

Collection of bio-medical waste

• Collection should be done as per BMW Management and Handling Rules 1998.

• The collection bags and the containers should be labelled as per guidelines, i.e. symbols for biohazard and cytotoxic.

• Labels shall be non-washable and prominently visible

Collection of bio-medical waste (contd….)

• Separate container at every point of generation for general waste to be disposed of through municipal authority

• Trolleys, used to collect hospital waste, be designed, there should be no leakage or spillage of BMW while transporting

Collection of bio-medical waste (contd…)

• Location of containers- All containers having different coloured plastic bags should be located at the point of generation of waste

• Waste bags filled up to three-fourth capacity, tied securely and removed from the site of generation to the storage area regularly

• The colour bags should be replaced, garbage bins, cleaned with disinfectant regularly.

Storage of waste

• Refers to holding BMW for a certain period of time at the site of generation till transit for treatment and final disposal.

• No untreated BMW stored beyond a period of 48 hours

• Requires permission of the prescribed authority if for any reason becomes necessary to store the waste beyond 48 hours

Transportation

• Transportation of waste within the hospital– Avoid passage of waste through patient care

areas as far as possible– Separate time schedules for transportation of

bio-medical waste and general waste – Dedicated wheeled containers, trolleys or

carts with proper label– Trolleys or carts cleansed and disinfected in

the event of any spillage

Transportation

• Transportation of waste for disposal outside the hospital– through desiccated vehicles specially constructed for

the purpose having fully enclosed body, lined internally with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned

– The drivers compartment separate from the load compartment with a bulkhead

– The load compartment provided with roof vents for ventilation.

Treatment & disposal of bio-medical waste

• Yellow bags- (Cat. 1, 2, 3, 6) Incineration / deep burial 

• Red bags (Cat. 3,6) – microwave / autoclave treatment• Blue/ White translucent bag (Cat. 4,7) - should be sent

to shredder after autoclaving / microwaving / chemical treatment

• Black – Cat. 5, Cat. 9 and Cat.10 (solid) Disposal in secured landfill

• Liquid waste: 1 part bleach to 9 parts contaminated liquid – let stand for 20 to 30 minutes. After treating, dispose down drain with lots of H2O

Disposal of bio-medical waste

• General waste (non-hazardous, non-toxic, non-infectious– Through local municipal authority

• Bio-medical waste– Incineration:

• should be installed and made operational as per specification under the BMW rules 1998 regarding the incinerator and norms of combustion efficiency and emission levels

• The temperature of the primary chamber shall be 800 +/- 50 deg.C°

• secondary chamber temperature at 1050 +/- 50 deg.C°• Minimum stack height shall be 30 meters above ground

Note:• Waste to be incinerated shall not be chemically treated with

chlorinated disinfectants• Chlorinated plastics shall not be incinerated

Disposal of bio-medical waste-Deep burial

• Option in towns with population less than five lakhs• A pit or trench should be dug about 2 meters deep. It should be

half filled with waste, then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil.

• Animals should not have any access to burial site• On each occasion when wastes are added to the pit, layer of 10

cm of soil shall be added to cover the wastes• Burial must be performed under close and dedicated supervision • The deep burial site should be relatively impermeable and no

shallow well should be close to the site.• The pits should be distant from habitation so as to ensure that no

contamination occurs of any surface water or ground water. The area should not be prone to flooding or erosion

• The location of the deep burial site will be authorized by the prescribed authority

• The institution shall maintain a record of all pits for deep burial.

Treatment of Bio-medical waste (Category 3,4,6,7) - Autoclave

Type of autoclave Temp Pressure Time (minutes)

       

Gravity flow autoclave 121° C 15 psi 60

  135° C 31 psi 45

  149° C 52 psi 30

       

       

Vacuum autoclave 121° C 15 psi 45

  135° C 31 psi 30

       

Treatment of Bio-medical waste- (Category 3,4,6,7) Microwaving

• Should not be used for cytotoxic, hazardous or radioactive waste, contaminated animal parts and large metal parts

• Should completely and consistently kill bacteria and other pathogenic organisms. Biological indicators of Bacillus subtilis spores be used to monitor

Treatment of bio-medical waste

• Shredding- The plastics (IV bottle, IV sets, syringes, catheters, etc.), sharps (needles, blades, glass, etc) should be shredded but only after chemical treatment / microwaving/ autoclaving, ensuring disinfection

• Needle destroyers can be used for disposal of needles directly without chemical treatment

Treatment of bio-medical waste

• Secured land fill:

The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste should be treated by this option

Treatment of bio-medical waste

• It may be noted that there are multiple options available for certain category of waste

• The individual hospital can choose the best option depending upon treatment facilities available

• The management of radioactive waste should be undertaken as per the guidelines of BARC

Safety Measures

Required for– Clinical workers generating waste– Workers collecting and transporting wastes -- Staff operating hospital incinerator– Staff taking waste to municipal bins– Municipal worker collecting waste at the municipal bins and

transporting to dumping sites– Rag pickers

Education and training programs must be developed to speak to each category in a way that will best meet the

needs, build understanding and change behavior in that population

Coordination between hospital & outside agencies

• Hospital authorities should have constant interaction with the municipal authorities so that the general category of waste is regularly taken out of the hospital premises for further disposal

• Involvement of private sector / NGO’s for creation of common facilities for treatment

• Coordination with NGO’s and environmental groups, for public awareness & education

Coordination between hospital & outside agencies

• Sharing of facility by hospitals which do not have their own facility for treatment

• Hospitals having additional capacity may extend their facility to nearby smaller hospital or healthcare units

• Coordinated agencies required to take care of disruption of waste treatment equipment in a unit