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BioBio--medical Waste Managementmedical Waste Management
Issues and ChallengesIssues and Challenges
Dr. Selwyn A ColacoDr. Selwyn A Colaco
Chief Operating OfficerChief Operating OfficerNarayana Hrudayalaya Hospitals, BangaloreNarayana Hrudayalaya Hospitals, Bangalore
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I. Environmental LegislationI. Environmental Legislation
The Air (Prevention and Control of Pollution) Act, 1981The Air (Prevention and Control of Pollution) Act, 1981
The Environment (Protection) Act, 1986The Environment (Protection) Act, 1986
The Hazardous Waste (Management & Handling) Rules,The Hazardous Waste (Management & Handling) Rules,
19891989 The National Environmental Tribunal Act, 1995The National Environmental Tribunal Act, 1995
The Biomedical Waste (Management & Handling) Rules,The Biomedical Waste (Management & Handling) Rules,19981998
The Municipal Solid Waste (Management & Handling)The Municipal Solid Waste (Management & Handling)Rules, 2000Rules, 2000
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BMW Rules have been adopted and notified with theobjective to stop the indiscriminate disposal ofhospital waste/ bio-medical waste and ensure thatsuch waste is handled without any adverse effect onthe human health and environment.
Implementation ofImplementation of
BIOBIO--MEDICAL WASTE RULES 1998MEDICAL WASTE RULES 1998
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Health care waste includesHealth care waste includes Waste generated by the health care facilitiesWaste generated by the health care facilities Research facilitiesResearch facilities LaboratoriesLaboratories
Biomedical waste in hospitalsBiomedical waste in hospitals 85% are non85% are non--infectiousinfectious 10% are infectious10% are infectious
5% are hazardous5% are hazardous
Implementation ofImplementation of
BIOBIO--MEDICAL WASTE RULES 1998MEDICAL WASTE RULES 1998
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Segregation and safe containment of waste at theSegregation and safe containment of waste at thehealth facility levelhealth facility level
Processing and storage for terminal disposalProcessing and storage for terminal disposal
Basic PrinciplesBasic Principles
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BioBio--medical waste shall not be mixed with other wastes.medical waste shall not be mixed with other wastes. Segregation at sourceSegregation at source both at ward and unit levelboth at ward and unit level Color coding to support segregation at sourceColor coding to support segregation at source BioBio--medical waste shall be segregated into containers/medical waste shall be segregated into containers/
bags at the point of generation in accordance with Schedulebags at the point of generation in accordance with ScheduleII (BMW Rules 1998) prior to its storage, transportation,II (BMW Rules 1998) prior to its storage, transportation,treatment and disposal.treatment and disposal.
Basic PrinciplesBasic Principles
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The containers shall be labeled according to Schedule IIIThe containers shall be labeled according to Schedule III(BMW Rules 1998)(BMW Rules 1998) Transport waste safely to pick up siteTransport waste safely to pick up site Identify destination for each type of waste and ensureIdentify destination for each type of waste and ensure
safe disposalsafe disposal Keep track of usageKeep track of usage
Basic PrinciplesBasic Principles
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Untreated biomedical waste shall be transported only inUntreated biomedical waste shall be transported only invehicles authorized for the purpose by the competent authorityvehicles authorized for the purpose by the competent authorityas specified by the government.as specified by the government.
Untreated bioUntreated bio--medical waste shall not be kept/stored beyondmedical waste shall not be kept/stored beyonda period of48 hours.a period of48 hours.
If for any reason it becomes necessary to store the wasteIf for any reason it becomes necessary to store the wastebeyond such period, measures must be taken to ensure thatbeyond such period, measures must be taken to ensure that
the waste does not adversely affect human health and thethe waste does not adversely affect human health and theenvironment.environment.
Transportation & Storage of BMWTransportation & Storage of BMW
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Use/Reuse of
equipment
Unsafe collection Unsafe disposal
Biomedical Waste ManagementBiomedical Waste Management -- IssuesIssues
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Biomedical Waste ManagementBiomedical Waste Management -- IssuesIssues
Not considered importantNot considered important
Lack of interest from senior managementLack of interest from senior management
No ownership of the processNo ownership of the process
Awareness of problemsAwareness of problems
Appreciate the need for constant monitoringAppreciate the need for constant monitoring
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Segregation of waste not taken seriously at user levelSegregation of waste not taken seriously at user levelNon compliance with color codingNon compliance with color codingMonitoring segregation at sourceMonitoring segregation at source low budgets allocatedlow budgets allocated costs are not always knowncosts are not always knownCost of color coding, staff, transport and disposalCost of color coding, staff, transport and disposalQuantification of waste generated is not accurately doneQuantification of waste generated is not accurately done
Biomedical Waste ManagementBiomedical Waste Management -- IssuesIssues
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Protection of healthcare workers not given adequateProtection of healthcare workers not given adequatethoughtthoughtClinical waste dumped with non infectious wasteClinical waste dumped with non infectious waste -- Risk forRisk forhealthcare workers and publichealthcare workers and publicWaste disposal not effective, often dumped in open landfillsWaste disposal not effective, often dumped in open landfills
Biomedical Waste ManagementBiomedical Waste Management -- IssuesIssues
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Responsibility for waste disposalResponsibility for waste disposal head of facility, buthead of facility, butdevolved to members of the waste management teamdevolved to members of the waste management teamEach healthcare workerEach healthcare worker segregation and appropriatesegregation and appropriatedisposaldisposalPrivate companiesPrivate companies from collection point in hospital tofrom collection point in hospital todisposaldisposalMedical waste segregation awareness and InformationMedical waste segregation awareness and Informationshould be available in all areas of hospitalshould be available in all areas of hospital
Biomedical Waste ManagementBiomedical Waste Management -- responsibilitiesresponsibilities
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Challenges: Need for protocol and policiesChallenges: Need for protocol and policies
To provide protection forTo provide protection for
Healthcare workersHealthcare workers
PatientsPatients
Community at largeCommunity at large -- from the risk of infectionsfrom the risk of infections
Compliance with statutory requirementsCompliance with statutory requirements
Government of IndiaGovernment of India --1998 biomedical waste management1998 biomedical waste managementand handling rules under EPAand handling rules under EPA
(compels hospitals, clinics, labs to ensure safe and environmentally(compels hospitals, clinics, labs to ensure safe and environmentallysound management of waste generated at their establishments)sound management of waste generated at their establishments)
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ChallengesChallenges
Establishing robust waste management policies within theEstablishing robust waste management policies within theorganizationorganization Organization wide awareness about the health hazardsOrganization wide awareness about the health hazards Sufficient financial and human resourcesSufficient financial and human resources Monitoring and control of waste disposalMonitoring and control of waste disposal Clear responsibility for appropriate handling and disposal ofClear responsibility for appropriate handling and disposal ofwaste.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 ofcolor 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-care
waste; training staff and HCW on safe practices.10.Selection of safe and environmentally friendly
management options, to protect people from hazardswhen 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 staffassociated with BMWM.
13.Maintenance of Record registers for this purpose.14.Containers should be robust and leak proof15.Tracking of Bio Medical Waste upto point of Disposal.16.Proper treatment and final disposal.
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Thank you
Any Questions?
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OptionOption Waste CategoryWaste Category Treatment & DisposalTreatment & Disposal
Category No. 1Category No. 1 Human Anatomical WasteHuman Anatomical Waste
(human tissues, organs, body parts)(human tissues, organs, body parts)
incineration @/deep burial*incineration @/deep burial*
Category No. 2Category No. 2 Animal WasteAnimal Waste
(animal tissues, organs, body parts(animal tissues, organs, body parts
carcasses, bleeding parts, fluid, blood andcarcasses, bleeding parts, fluid, blood and
experimental animals used in research,experimental animals used in research,
waste generated by veterinary hospitals,waste generated by veterinary hospitals,
colleges, discharge from hospitals, animalcolleges, discharge from hospitals, animal
houses)houses)
incineration@/deep burial*incineration@/deep burial*
Category No. 3Category No. 3 Microbiology & Biotechnology WasteMicrobiology & Biotechnology Waste
(Wastes from laboratory cultures, stocks or(Wastes from laboratory cultures, stocks or
micromicro--organisms live or vaccines, humanorganisms live or vaccines, human
and animal cell culture used in research andand animal cell culture used in research and
infectious agents from research andinfectious agents from research and
industrial laboratories, wastes fromindustrial laboratories, wastes from
production of biologicals, toxins, dishes andproduction of biologicals, toxins, dishes anddevices used for transfer of cultures)devices used for transfer of cultures)
local autoclaving/microlocal autoclaving/micro--
waving/incineration@waving/incineration@
Category No. 4Category No. 4 Waste SharpsWaste Sharps
(needles, syringes, scalpels, blade, glass,(needles, syringes, scalpels, blade, glass,
etc. that may cause punture and cuts. Thisetc. that may cause punture and cuts. This
includes both used and unused sharps)includes both used and unused sharps)
disinfection (chemical treatmentdisinfection (chemical treatment
@@@/auto claving/microwaving@@@/auto claving/microwaving
and mutilation/shredding##and mutilation/shredding##
Category No. 5Category No. 5 DiscardedMedicines and Cytotoxic drugsDiscardedMedicines and Cytotoxic drugs
(Waste comprising of outdated,(Waste comprising of outdated,contaminated and discarded medicines)contaminated and discarded medicines)
incineration@/destruction andincineration@/destruction and
dru
gs disposal in secu
reddru
gs disposal in secu
redlandfillslandfills
ScheduleSchedule--II
CATEGORIES OF BIOCATEGORIES OF BIO--MEDICAL WASTEMEDICAL WASTE
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Category No. 6Category No. 6 Soiled WasteSoiled Waste
(items contaminated with blood,(items contaminated with blood,and body fluids including cotton,and body fluids including cotton,
dressings, soiled plaster casts,dressings, soiled plaster casts,
lines, bedding, other materiallines, bedding, other material
contaminated with blood)contaminated with blood)
incineration@autoclaving/microincineration@autoclaving/micro
wavingwaving
Category No. 7Category No. 7 Solid WasteSolid Waste
(Waste generated from disposal(Waste generated from disposal
items other than the sharps such aitems other than the sharps such atubings, catheters, intravenoustubings, catheters, intravenous
sets etc.)sets etc.)
disinfection by chemicaldisinfection by chemical
treatment@@treatment@@
au
toclaving/microwaving andau
toclaving/microwaving andmutilation/shredding##mutilation/shredding##
Category No. 8Category No. 8 Liquid WasteLiquid Waste
(Waste generated from laboratory(Waste generated from laboratory
and washing, cleaning,and washing, cleaning,
housekeeping and disinfectinghousekeeping and disinfecting
activities)activities)
disinfection by chemicaldisinfection by chemical
treatment@@ and dischargetreatment@@ and discharge
into drainsinto drains
Category No. 9Category No. 9 Incineration AshIncineration Ash
Ash from incineration of any bioAsh from incineration of any bio--
medical waste)medical waste)
disposal in municipal landfilldisposal in municipal landfill
Category No. 10Category No. 10 Chemical WasteChemical Waste
(Chemicals used in production of(Chemicals used in production of
biologicals, chemicals used inbiologicals, chemicals used in
production of biologicals,production of biologicals,
chemicals used inchemicals used in disinfection, asdisinfection, asinsectricides, etc.)insectricides, etc.)
chemical treatment@@ andchemical treatment@@ and
discharge into drains for liquidsdischarge into drains for liquids
and secured landfill for solidsand secured landfill for solids
ScheduleSchedule--II
CATEGORIES OF BIOCATEGORIES OF BIO--MEDICAL WASTE (continued)MEDICAL WASTE (continued)
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Note :Note :
@@ There will be no chemical pretreatment before incineration. ChlorinatedThere will be no chemical pretreatment before incineration. Chlorinatedplastics shall not be incinerated.plastics shall not be incinerated.
** Deep burial shall be an option available only in towns with population lessDeep burial shall be an option available only in towns with population less
than five lakhs and in rural areas.than five lakhs and in rural areas.
@@@@ Chemicals treatment using at least 1% hypochlorite solution or any otherChemicals treatment using at least 1% hypochlorite solution or any other
equivalent chemical reagent. It musts be ensured that chemical treatmentequivalent chemical reagent. It musts be ensured that chemical treatment
ensures disinfection.ensures disinfection.
#### Multilation/shredding must be such so as to prevent unauthorised reuse.Multilation/shredding must be such so as to prevent unauthorised reuse.
ScheduleSchedule--II
CATEGORIES OF BIOCATEGORIES OF BIO--MEDICAL WASTE (continue)MEDICAL WASTE (continue)
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ScheduleSchedule--IIII
COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIOCOLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO
MEDICAL WASTESMEDICAL WASTES
ColourColourCodingCoding
Type ofType ofContainerContainer
WasteWasteCategoryCategory Treatment optionsTreatment options
YellowYellow Plastic BagPlastic BagCategoriesCategories1, 2, 3 & 6.1, 2, 3 & 6.
Incineration/ deep burialIncineration/ deep burial
RedRedDisinfectedDisinfectedcontainer/Plasticcontainer/Plasticbagbag
CategoriesCategories3, 6, 73, 6, 7
Autoclaving/MicroAutoclaving/Micro--waving/Chemicalwaving/ChemicalTreatmentTreatment
Blue/WhiteBlue/WhiteTranslucentTranslucent
Plastic BagPlastic Bag/puncture proof/puncture proofcontainerscontainers
Cat. 4,Cat. 4,Cat. 7Cat. 7
Autoclaving/MicroAutoclaving/Micro--waving/ Chemicalwaving/ ChemicalTreatment & Destruction / shreddingTreatment & Destruction / shredding
BlackBlack Plastic BagPlastic BagCategoriesCategories5, 9, 105, 9, 10
Disposal in secured landfill.Disposal in secured landfill.
Notes:1. Colour coding of waste categories with multiple treatment options asdefined in schedule 1, shall be selected depending on treatment optionchosen, which shall be as specified in Schedule I.2. Waste collection bags for waste types needing incineration shall notbe made of chlorinated plastics.3. Categories 8 and 10 (liquid) do not require containers/bags.