Bio - Medical Waste Management

Bio - Medical Waste Management

1. Bio-Medical Waste Management Dr. Binu Babu Ph.D., M.Sc. (N), MBA Mrs. Jincy Ealias M.Sc. (N)

2. INTRODUCTION Medical care – vital in our life and health. BMW -emerged as issue of concern world over. BMW real problem for Man Community Environment Safe scientific cost effective methods BMW management – need of hour.

3. WASTES  

4. Definitions Hospital waste refers to all waste, biological or non‐ biological that is discarded and not intended for further use . Bio‐medical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals , and including categories mentioned in Schedule I. Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients.

5. Bio-medical waste Bio-medical waste is generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals (WHO)

6. Healthcare waste WHO estimates 85 % of hospital waste is non-hazardous 10 % is infectious 5 % is non-infectious.

7. Sources of Bio-Medical Waste Major Sources Hospitals Labs Research centers Animal research Blood banks Nursing homes Mortuaries Autopsy centers Minor sources Clinics Dental clinics Home care Cosmetic clinics Paramedics Funeral services Institutions

8. Risk Groups

9. Hazardous health care waste can result in Infection Genotoxicity and Cytotoxicity   Chemical toxicity   Radioactivity hazards.  Physical injuries  

10. Infection The infectious agents enter into the body through Puncture Abrasion Cut in the skin Through mucous membranes By inhalation and ingestion.

11. Most Common Infections Gastro enteric through faeces and/or vomit e.g . Salmonella, Vibrio Cholera, Helminthes, Hepatitis A Respiratory through inhaled secretions e.g . Mycobacterium tuberculosis; Measles virus; Streptococcus pneumoniae Ocular infections through eye secretions e.g . Herpes virus, Skin infection through pus e.g . Streptococcus Meningitis through Cerebrospinal fluid e.g . Neisseria meningitides Blood borne diseases Eg . AIDS, Septicaemia and  bacteraemia , Viral Hepatitis B & C Hemorrhagic fevers through body fluids Eg . Lassa , Ebola and Marburg viruses

12. PROBLEM ASSOCIATED WITH BMW ORGANISM DISEASES CAUSED RELATED WASTE ITEM VIRUSES  HIV, Hepatitis B, Hepatitis A,C, Arboviruses, Enteroviruses AIDS, Infectious Hepatitis, Infectious Hepatitis, Dengue, Japanese encephalitis, tick-borne fevers, etc . Infected needles, body Fluids, Human excreta, soiled linen, Blood, body fluids. BACTERIA Salmonella typhi, Vibrio cholerae, Clostridium Tetani, Pseudomonas, Streptococcus Typhoid, Cholera, Tetanus Wound infections, septicemia, rheumatic fever, endocarditis, skin and soft tissue infections Human excreta and body fluid in landfills and hospital wards, Sharps such as needles, surgical blades in hospital waste. PARASITES Wucheraria Bancrofti, Plasmodium Cutaneous leishmaniasis, Kala Azar, Malaria Human excreta, blood and body fluids in poorly managed sewage system of hospitals.

13. Genotoxicity and Cytotoxicity Cytotoxicity is the ability of chemicals to destruct the cells Genotoxicity   is the property of chemical agents that damages the genetic (DNA) information within a cell causing mutations. Irritant to skin and eyes E.g . alkylating agent, intercalating agent Carcinogenic and Mutagenic e.g . Secondary neoplasia due to chemotherapy

14. Chemical Toxicity Many drugs are hazardous May cause intoxication, burns, poisoning on exposure

15. Radioactivity Hazards Radioactive waste exposure may cause headache, dizziness, vomiting, genotoxicity and tissue damage

16. Physical injuries Sharps Needles Glass bottles Chemicals Explosive agents Pressure containers Gas Cylinders

17. Legislation Recognizing the deadliest nature of the Bio-Medical Waste, the Government and Pollution Control Boards under the guidelines of Ministry of Environment and Forests(MOEF). MOEF have promptly designed and issued guidelines to the hospitals to ensure a proper and safe disposal of bio-medical waste “ BIO-MEDICAL WASTE Management & Handling RULE 1998 came into effect. Provides uniform guidelines and code of practice for Bio-medical waste management .

18. Penalties as per rules The PENALTIES are as specified in Environment (Protection) Act 1986. Imprisonment for upto five years with fine upto one lakh rupees, or both. In case the failure additional fine upto five thousand rupees for every day.

19. Bio-Medical Waste Disposal Cycle Common Facility (Transportation, Treatment And Disposal) Legislation (BMW Rule) Implement ting Authority Waste Generator (Hospitals)

20. Bio-Medical Waste Flow Chart In House Segregation (Collection, Segregation Packing in Color Coded Poly Bags) Re Use Generator (HOSPITALS) Waste Water to ETP Common Storage Point At Hospitals Transportation (Approved Special Vehicle) Unloading and Temp Storage at CBWTF Treatment (Incineration, Autoclaving and Shredding) Disposal ( Recycling & Landfill)

21. WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOSAL OPTION 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 and colleges, discharge from hospitals, animal houses) Incineration@ / deep burial* Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal cell cultures used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals , toxins and devices used for transfer of cultures) Local autoclaving/ microwaving / incineration @ Categories of Biomedical Waste Schedule as per WHO Standard

22. Category No. 4 Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Disinfecting (chemical treatment / autoclaving / microwaving and mutilation / shredding Category No. 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Incineration / destruction and drugs disposal in secured landfills Category No. 6 Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.) Incineration@ / autoclaving / microwaving Category No. 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# # Categories of Biomedical Waste Schedule as per WHO Standard

23. Category No. 8 Liquid Waste (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities) Disinfecting by chemical treatment and discharge into drains Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Category No.10 Chemical Waste (Chemicals used in production of biologicals , chemicals used in disinfecting, as insecticides, etc.) Chemical treatment and discharge into drains for liquids and secured landfill for solids. Categories of Biomedical Waste Schedule as per WHO Standard

24. Color Coding For Segregation of BMW 1998 COLOR WASTE Category TREAT Yellow Human & Animal anatomical waste / Micro-biology waste and soiled cotton/dressings/linen/beddings etc. Category 1,2,5,6 Incineration/DB/ Red Tubings , Catheters, IV sets. Category 3,4,7 Autocl / microwav /chemical treatment Blue Waste sharps ( Needles, Syringes, Scalpels, blades etc. ) Category – 8 Autocl / microwav /chemical treatment/destruction/shredding White Black Discarded medicines/cytotoxic drugs, Incineration ash (chemical waste) Disposal in land fields

25. DISPOSAL OF BIOMEDICAL WASTE Deep burial: – Category 1 and 2 only – In cities having less than 5 lakh population & rural area . Autoclave and microwave treatment – Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998. – All equipment installed/shared should meet these specifications. – Category 3, 4, 6 and 7 can be treated by these techniques. Shredding : – The plastic (I.V. bottles, I.V. sets, syringes, catheters etc.), sharps (needles, blades, glass etc ) should be shredded but only after chemical treatment/microwaving/autoclaving. – Needle destroyers can be used for disposal of needles directly without chemical treatment.

26. Land disposal: – Open dumps – Secured/Sanitary landfill: advantages. – The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste should be treated by this option . Incineration:- A high temperature dry oxidation process, which reduces organic and combustible waste to inorganic incombustible matter. Usually used for the waste that can not be reused, recycled or disposed of in landfill site. Category 1, 2, 3, 5, and 6 can be incinerated.

27. Source Reduction Source Reduction - ways to lessen the amount of material Segregation - keeping noninfectious waste out of the infectious waste stream Minimization - reduce or eliminate waste at the source Engineering controls - methods to reduce quantity of waste(smaller containers)

28. Steps to Manage Hazardous Wastes before Disposal Know what hazards you have. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists Limit use and access to trained persons with personal protective gear Use Engineering Controls such as Ventilation, Hoods for Select Hazards

29. 6. Label of Hazard Warnings toxic biohazard inflammable corrosive Radiation Gas bottle explosive Health danger

30. 7. Communicate about Work -place Hazards Job description Posters on doors Labels on hazards Give feedback on use of PPE and disposal in evaluation Role model safe use and disposal Contact point who is responsible

31. 8. Recycle Products When Possible

32. Segregation of BMW At the point of generation In a color coded leak-proof container Container should bear 'Biohazard' symbol and appropriate wording Container should never be completely filled

33. Segregation of waste should be observed strictly To avoid mixing of general (non-infectious) waste into infectious waste. Once mixed, becomes infectious and should not be removed. To reduce infectious waste To decrease expenditure on disposal of infectious waste Do not allow the containers to overfill Arrange containers near the operation area at accessible distance Ensure that the disposed item is inside the container and not hanging at the edge

34. Packaging and labeling Bags 3/4 th filled should be tied, be supervised Name of Ward, Date of Packaging, Destination (Treatment Site) Bio Hazard/Cytotoxic Symbol Weighing & Recording Separate Register and Weighing Machine Daily recording is mandatory

35. Collection, transportation, storage (within the hospital) Waste collected and stored in thick non-corrosive disposable plastic bags or containers of specific colour code. The waste in bags or containers should be stored in a separate area, room, or building of a size appropriate to the quantities of waste produced and the frequency of collection. Health care waste should be transported within the hospital or other facility by means of hand cart wheeled trolley .

36. Label for transport of bio-medical waste containers/bags Date of generation ................... Waste category No ........ Waste class…………… Waste description…………. Sender's Name & Address……….. Contact Person………….. Receiver's Name & Address……… Contact Person ………….. In case of emergency please contact, Name & address ………. Label shall be non-washable and prominently visible .

37. Transportation Transportation of BMW can be divided into internal and external transportation. INTERNAL: it is for yellow ,red ,blue and white bags. EXTERNAL: it is for the general waste collected in the black coloured plastic bags.

38. DISPOSAL METHODS OF BIO-MEDICAL WASTES Incineration Chemical disinfection Inertisation Autoclave Encapsulation Microwave Shredder Plasma pyrolysis Deep burial

39. 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

40. Safety measures All the generators of biomedical waste should adopt universal precautions and appropriate safety measures while handling the bio‐medical waste . It should be ensured that: drivers , collectors and other handlers are aware of the nature and risk of the waste. written instructions provided regarding the procedures to be adopted in the event of spillage/ accidents. protective gears provided and instructions regarding their uses are given. workers are protected by vaccination against tetanus and hepatitis B.

41. Staff safety Proper training Personal protective clothing and equipment Immunization Post-exposure prophylaxis Medical surveillance Personal hygiene

42. References Hari Singh. (2018). Essentials of management for healthcare professionals. Crc Press, Taylor & Francis Group. WHO . Review of Health Impacts from Microbiological Hazards in Health-Care Wastes. Geneva: World Health Organization ; R Radhakrishnan , Dr. (2006).  Bio Medical waste management . Sumit Enterprises . K Sasikumar , & Sanoop Gopi Krishna. (2009).  Solid waste management . Phi Learning .

43. THANK YOU