Bio-medical Waste Management Issues and Challenges Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore
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Bio-medical Waste Management
Issues and Challenges
Dr. Selwyn A ColacoChief Operating Officer
Narayana Hrudayalaya Hospitals, Bangalore
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I. Environmental Legislation
The Air (Prevention and Control of Pollution) Act, 1981
The Environment (Protection) Act, 1986
The Hazardous Waste (Management & Handling) Rules,
1989 The National Environmental Tribunal Act, 1995
The Biomedical Waste (Management & Handling) Rules,1998
The Municipal Solid Waste (Management & Handling) Rules, 2000
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BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of
hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment.
Implementation of
BIO-MEDICAL WASTE RULES 1998
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Health care waste includes Waste generated by the health care facilities Research facilities Laboratories
Biomedical waste in hospitals 85% are non-infectious 10% are infectious
5% are hazardous
Implementation of
BIO-MEDICAL WASTE RULES 1998
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Segregation and safe containment of waste at thehealth facility level
Processing and storage for terminal disposal
Basic Principles
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Bio-medical waste shall not be mixed with other wastes.
Segregation at source – both at ward and unit level Color coding to support segregation at source Bio-medical waste shall be segregated into containers/bags at the point of generation in accordance with ScheduleII (BMW Rules 1998) prior to its storage, transportation,treatment and disposal.
Basic Principles
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The containers shall be labeled according to Schedule III(BMW Rules 1998) Transport waste safely to pick up site Identify destination for each type of waste and ensure
safe disposal Keep track of usage
Basic Principles
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Untreated biomedical waste shall be transported only invehicles authorized for the purpose by the competent authorityas specified by the government.
Untreated bio-medical waste shall not be kept/stored beyond
a period of 48 hours.
If for any reason it becomes necessary to store the wastebeyond such period, measures must be taken to ensure that
the waste does not adversely affect human health and theenvironment.
Transportation & Storage of BMW
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Use/Reuse of
equipment
Unsafe collection Unsafe disposal
Biomedical Waste Management - Issues
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Biomedical Waste Management - Issues
• 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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– 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 done
Biomedical Waste Management - Issues
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– Protection of healthcare workers not given adequatethought – Clinical waste dumped with non infectious waste - Risk forhealthcare workers and public – Waste disposal not effective, often dumped in open landfills
Biomedical Waste Management - Issues
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– Responsibility for waste disposal – head of facility, butdevolved to members of the waste management team – Each healthcare worker – segregation and appropriatedisposal – Private companies – from collection point in hospital todisposal – Medical waste segregation awareness and Informationshould be available in all areas of hospital
Biomedical Waste Management - responsibilities
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Challenges: Need for protocol and policies… To provide protection for
– Healthcare workers
– Patients
– Community at large - from the risk of infections
• Compliance with statutory requirements• Government of India -1998 biomedical waste management
and handling rules under EPA (compels hospitals, clinics, labs to ensure safe and environmentally sound management of waste generated at their establishments)
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Challenges
Establishing robust waste management policies within theorganization Organization wide awareness about the health hazards Sufficient financial and human resources
Monitoring and control of waste disposal Clear responsibility for appropriate handling and disposal of waste.
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ADRESSING THE ISSUES
1. Need to build-up of a comprehensive system, addressresponsibilities, resource allocation, handling anddisposal
2. This is a long-term process, sustained by gradual
improvements.3. Specific personnel need to be assigned to monitor the
bio-medical waste management in the hospital.4. Man power needs and other resources for the BMWM of
hospital to be addressed.5. Quality assessment of bio-medical waste management
should be done from time to time.
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ADRESSING THE ISSUES
6. Segregated collection and transportation - The use of
color coding and labeling of hazardous waste.7. Clear directives in the form of a posters and notice to
be displayed in all concerned areas in English and locallanguages.
8. Safety of handlers.9. Raising Awareness about risks related to health-carewaste; training staff and HCW on safe practices.
10.Selection of safe and environmentally friendlymanagement options, to protect people from hazards
when collecting, handling, storing, transporting, treatingor disposing of waste.
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ADRESSING THE ISSUES
11.Issue of all protective clothes such as, gloves, aprons,masks etc. to all HCW.
12.Regular medical check-up (half-yearly) of staff associated with BMWM.
13.Maintenance of Record registers for this purpose.14.Containers should be robust and leak proof 15.Tracking of Bio Medical Waste upto point of Disposal.16.Proper treatment and final disposal.
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Thank you
Any Questions?
S h d l I
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Option Waste Category Treatment & Disposal
Category No. 1 Human Anatomical Waste
(human tissues, organs, body parts)
incineration @/deep burial*
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,
colleges, discharge from hospitals, animal
houses)
incineration@/deep burial*
Category No. 3 Microbiology & Biotechnology Waste
(Wastes from laboratory cultures, stocks or
micro-organisms live or vaccines, human
and animal cell culture 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)
local autoclaving/micro-
waving/incineration@
Category No. 4 Waste Sharps
(needles, syringes, scalpels, blade, glass,
etc. that may cause punture and cuts. This
includes both used and unused sharps)
disinfection (chemical treatment
@@@/auto claving/microwaving
and mutilation/shredding##
Category No. 5 Discarded Medicines and Cytotoxic drugs
(Waste comprising of outdated,contaminated and discarded medicines)
incineration@/destruction and
drugs disposal in securedlandfills
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE
S h d l I
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Category No. 6 Soiled Waste
(items contaminated with blood,
and body fluids including cotton,dressings, soiled plaster casts,
lines, bedding, other material
contaminated with blood)
incineration@autoclaving/micro
waving
Category No. 7 Solid Waste
(Waste generated from disposal
items other than the sharps such a
tubings, catheters, intravenoussets etc.)
disinfection by chemical
treatment@@
autoclaving/microwaving and
mutilation/shredding##
Category No. 8 Liquid Waste
(Waste generated from laboratory
and washing, cleaning,
housekeeping and disinfecting
activities)
disinfection by chemical
treatment@@ and discharge
into drains
Category No. 9 Incineration Ash
Ash from incineration of any bio-
medical waste)
disposal in municipal landfill
Category No. 10 Chemical Waste
(Chemicals used in production of
biologicals, chemicals used in
production of biologicals,
chemicals used in disinfection, asinsectricides, etc.)
chemical treatment@@ and
discharge into drains for liquids
and secured landfill for solids
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continued)
S h d l I
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Note :
@ There will be no chemical pretreatment before incineration. Chlorinated
plastics shall not be incinerated.
* Deep burial shall be an option available only in towns with population less
than five lakhs and in rural areas.
@@ Chemicals treatment using at least 1% hypochlorite solution or any other
equivalent chemical reagent. It musts be ensured that chemical treatment
ensures disinfection.
## Multilation/shredding must be such so as to prevent unauthorised reuse.
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continue)
Schedule II
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Schedule-II
COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO
MEDICAL WASTES
Colour
Coding
Type of
Container
Waste
Category
Treatment options
Yellow Plastic BagCategories1, 2, 3 & 6.
Incineration/ deep burial
Red Disinfectedcontainer/Plasticbag
Categories3, 6, 7
Autoclaving/Micro-waving/ChemicalTreatment
Blue/WhiteTranslucent
Plastic Bag/puncture proof containers
Cat. 4,Cat. 7
Autoclaving/Micro-waving/ ChemicalTreatment & Destruction / shredding
Black Plastic BagCategories5, 9, 10
Disposal in secured landfill.
Notes: 1. Colour coding of waste categories with multiple treatment options as defined in schedule 1, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.
3. Categories 8 and 10 (liquid) do not require containers/bags.