HOPESHOPES Planning & Management of Bio Medical Waste MS. JAGRUTI BHATIA.

HOPES

Planning & Management Planning & Management of of

Bio Medical Waste Bio Medical Waste

MS. JAGRUTI BHATIA

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TheThe HistoryHistory

Awareness campaign by Dr Paul Connett’s visit.

NGO and public pressure on the govt. & Policy

makers.

Involvement of the medical fraternity.

Pilot project to understand the implications.

Change in law.

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The Waste PlanThe Waste Plan• Setting up a team • Create Awareness/Sensitization• Conducting a waste audit - Identify quantum of

waste category wise• Decision on end treatment options• Drawing up a facility wise detail plan• Allocating resources • Training of Trainers • Extend the program to all staff from CEO to

sanitary attendants• Monitor - Implementation of plan • Record / Report• Monitoring, Review & Refresher training

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The TeamThe Team

A responsible person designated as ‘Waste Manager’ .

Housekeeping manager / Attendant In Charge

(Mukadam).

Nursing Director/Superintendent.

Infection Control Nurse, Key members from the

Infection Control Team.

A representative from the management.

A representative from the Doctors / Consultants.

Sister In Charges.

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AwarenessAwareness

Bio Medical Waste Management

The Whys???

and Why Nots’???

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AwarenessAwareness

Hospital Waste Disposal

Health Hazard Environmental Hazard

Aesthetic Issue

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Environmental Hazard :

Hospital waste contains a higher amount of

chlorinated plastics.

Dumped in dumping grounds where rag pickers burn it

leading to high levels of pollution

Burning chlorinated plastics under incomplete

combustion releases many harmful pollutants key

among them being Dioxins & Furans

AwarenessAwareness

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AwarenessAwareness

Dioxin : A Unique Killer

•Two aspects of Dioxin toxicity from the public health perspective:

- wide variety of harmful health effects

- low levels of exposure - EPA’s acceptable daily exposure 0.01 picograms/kg/day.

•Gets transferred through the food chain causing various health effects

Humans routinely consume 300 to 600 times this Humans routinely consume 300 to 600 times this amounts amounts

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Classification Of Hospital Waste

T Y P E S O F W A S T E S G E N E R A T E D IN H O S P IT A LS

SharpsCat 4

Bio Medical WasteCat 3,6,7

Human AnatomicalCat 1 & 2

Infectious

Kitchen / Organic Plastic & Recyclable D iscarded M edicinesC ytotoxic D rugs

C at 5

Non - Infectious Hazardous

Hospital Waste

The Waste Plan

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Color Coding System - Segregation

Incinerator ash (sec landfill), chemical waste (neutralise), Household / kitchen waste, Non-infectious bio degradable

Plastic Bag

Bio degrad

Black

Waste SharpsPuncture Proof cont

Blue / White

Microbiology & Biotechnology, toxins, Soiled waste(contaminated with bld & body fluids, plaster, cotton, dress), Solid Wastes (disposables) (Cat.3, 6,7)

Disinfected Container / Plastic bag

Red

Human Anatomical Waste, Discarded medicines, cytotoxic drugs (Cat. 1,2 &5)

Plastic BagYellow

Waste CategoryType of Container

Color Coding

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Color Coding System - Treatment

Disposal In secured landfill

- Bio degradable – vermi-composting / composting

Black

Autoclaving / Micro-waving / Chemical treatment and destruction & shredding

Blue / White

Autoclaving / Micro-waving / Chemical treatment

Red

Incineration / Deep BurialYellow

Treatment OptionsColor Coding

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Color Coding System - Segregation

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Based on the facility plan, areas for sample audit are selected for hospitals > 100 beds, for smaller hospitals all areas are covered

Is conducted in 2 phases – Before starting the training program– After waste management planning & training

The waste management team is trained to instruct, segregate & quantify waste as is the current hospital practice

Time frame one to two weeks based on the hospital size

Conducting a waste audit Conducting a waste audit

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WASTE AUDIT (SAMPLE FORMAT)

Sister In Charge / Departmental In Charge

Sign

Date of Audit

Classification / Segregation of Waste:

Infectious Organic Waste Sharps Waste Non-infectious

Waste generated / bins changed per day (24 hours)Department/Floor Ward No.Beds Date

Time/Shift

Qty.(kg) Date Time Qty. Date Qty.

Conducting a waste audit

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After waste audit decision on the end facility to be developed

Should be based on type of waste generated, quantity & statutory requirement

Will also depend on available options from central facility.

Population etc.

End treatment facilityEnd treatment facility

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Central Treatment Facility - Mumbai

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Waste Collection Hopper -Central Treatment Facility -

Mumbai

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Implementing Waste PlanImplementing Waste Plan

Allocating color coded bags and bins in accordance with facility plan ensuring segregation as per the rules

TOT – explaining the plan, to also include worker safety measures

Scheduling the collection timings within the hospital

Transportation system within hospital

Developing Storage facilities in-house

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Institute a sharps management plan

Available option:– Needle burners (are a better option)– Needle cutters after which you disinfect & discard– Disinfect in puncture proof jerry cans with

disinfecting solution (like 1% Na Hypochorite) if tranporter takes authorisation from PCB for responsibility of pilferage, the better option is still to mutilate and disinfect before discard.

Sharps Management PlanSharps Management Plan

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Color Coding System - SegregationColor Coding System - Segregation

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Sharps Management PlanSharps Management Plan

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Points to be remembered: The containers to be puncture proof and bags to be

sturdy, leak proof for high risk waste The bags to be tied by the neck while transportation Transportation trolleys and specific lifts or timings to

be designated Staff handling this to wear protective clothing,

gloves, mask, aprons etc. If bags tear or get contaminated they be placed in a

new clean bags ( double bagging ) Never allow any person to put hands inside the bag Stringent Infection Control Policies to be formed &

implemented

Transportation:Transportation:

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Evaluation Training Tools:

Conducting pre and post training tests

Monitoring of model sessions by Trainers

Post training exams conducted for trained staff by trainers

Monitor & Review Monitor & Review TrainingTraining

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Evaluation feedback for BMW training of trainers: (Marks )

1. Name the act and ministry under which the program gets its legal f ace.2. Defi ne the f ollowing:

a. Hospital wasteb. Bio medical waste

3. Give any 4 important reasons because of which medical waste management gains itsimportance.

4. What are the eff ects of incineration?5. Mention the diff erent categories of waste generated in your hospital6. Draw a color coding plan f or the diff erent categories of waste segregation in your

hospitalOr

Segregate the f ollowing waste in the color-coded bags decided by your hospitalmentioning its category (as inf ectious, etc.)Needles, blood stained dressings, potato peels, contaminated syringes, I V set, I Vbottles, body fluid stained cotton, paper, cytotoxic drugs, lancets, placenta, plasticpackaging.

7. Mention any 4 points that one has to take care of while transporting waste.8. Mention the diff erent methods of waste disposal available.9. Explain the importance of waste segregation.10. Mention 4 instructions that you would give your team as a part of health care

worker saf ety.

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Records & Reports:Records & Reports:

Waste Audit & record keeping Ward reporting format checklist

– Nurse Station– Sanitation Supervisor– Program In Charge

As per the MOEF Rules, Annual Report format (Form II, Rule 10) Accident Reporting (Form III, Rule 12)

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SUGGESTED REPORTING FORMATS - II SANITARY SUPERVISORHospital Name : _______________________________________Name of Person : _______________________________________Name of Safai karamcharis : _______________________________________Date : _______________________________________Time & Shift :________________________________________Area : _______________________________________

Sr. No. Work Completion (Y/N) & Comments1. Separate bins for different waste types2. Plastic Bags with waste sealed3. Is the area around the bin clean4. Are bins routinely disinfected5. Waste from bin routinely picked up3. Kitchen waste being composted

a. Kitchen waste being segregated

4. Bleach solution prepared in bin formutilated Plastic and Rubber waste

5. Each bin lined with Plastic baga. Infectious-Redb. Non-Infectious-Black

6. Different coloured plastic bags for wastecollection from points of generationa. Infectious-Red/Yellowb. Plastic and Rubber-In blue,translucent or whitec. Non-infectious –Black

7. Is everything collected by thehousekeeping staff

8. Gloves being worn9. Sharps collected in separate containers

10. Only non-infectious waste in patientsbin

11. Are bins labeled

FO

RM

2 Photostat

and use

Signed(Designation)

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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 accident________________________

Date : / / Signature

Place : _____________

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Recycling & Waste Recycling & Waste Minimization:Minimization:

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Recycling & Waste Recycling & Waste Minimization:Minimization:

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Teach employees’ responsibility

Issuance of protective equipment like gloves, mask

Establishment of an occupational health program that includes immunization, post-exposure prophylaxis, and medical surveillance

Worker Safety:Worker Safety:

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THANK YOU

THINK TODAY

TO ENSURE

A BETTER TOMMOROW

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Contact:Contact:

HOPES – HELP ORGANISATION FOR PEOPLE HOPES – HELP ORGANISATION FOR PEOPLE ENVIRONMENT & SOCIETYENVIRONMENT & SOCIETY

119, UDYOG BHAVAN

SONAWALA ROAD

GOREGAON (EAST) 400 063.

TEL: 28777214 FAX: 28777431

EMAIL: [email protected]

WEB: www.hopesindia.com