Bio medical waste management

1. Presented by – Dr.DharmendraGahwai (PG Student) Guided by- Dr. Y.D. Badgaiyan Prof. and Head Deptt . of Community Medicine CIMS, Bilaspur (C.G.) BIO-MEDICAL WASTE MANAGEMENT ISSUES AND CHALLENGES

2. Let the waste of the “sick” not contaminate the lives of “The Healthy”

3. Medical care is vital for our life, health and well being. But the waste generated from medical activities can be hazardous, toxic and even lethal.

4. Indiscriminate disposal of waste has resulted in a rise in deadly infections such as – - HIV - Hepatitis B.

5. Its ability to contaminate other nonhazardous municipal waste jeopardise the efforts undertaken for overall municipal waste management . At the same time, illegal and unethical reuse can be extremely dangerous and even fatal.

6. Unfortunately, in the absence of reliable and extensive data, it is difficult to quantify the dimension of the problem. With a judicious planning and management, however, the risk can be considerably reduced.

7. DEFINITION According to Bio-medical Waste(Management and Handling ) Rules, 1998 of India, Bio-medical Waste means – “Any waste, which is generated during the diagnosis , treatment or immunization of human being or animal, or in research activity pertaining thereto or in the production or testing of biologicals , and including categories as mentioned in schedule I.”

8. Sources of health care waste Government/private hospitals Nursing homes Physician/dentist office or clinic Dispensaries Primary health care centers Medical research and training centers animal./slaughter houses labs/research organizations Vaccinating centers Bio tech institutions/production units

9. According to a WHO report- - 85% of the hospital wastes are non-hazardous. - 10% are infective (hence, hazardous), and 5% are non-infectious but hazardous (chemical, pharmaceutical and radioactive).

10. 1 . To minimize the potential for spread of disease from a medical settings to the general public. 2. To reduce the overall amount of infectious medical waste produced . 3. Prevention of Environment pollution . 4. Infectious agents may become toys of terrorists, as Bio-weapons of Mass Destruction Why Bio Medical Waste Regulated ?

11. MAGNITUDE OF PROBLEM

12. GLOBALY The quantity of Bio-Medical Waste generated will vary depending on the hospital policies and practices and the type of care being provided. The data available from developed countries indicate a range from 1-5 Kg/bed/day , with substantial inter country and inter speciallity differences.

13. Meager data from developing countries but the figures are lower. i.e. 1-2 Kg/bed/day.

14. INDIA - No national level study. - Local or regional level study shows hospitals generate roughly 1-2 kg/bed/day.

15. A survey done in Banglore revealed that the quantity of BMW generated in hospitals are – 1. Govt. Hospitals – ½ to 4 kg/ bed / day. 2. Private Hospitals – ½ to 2 kg / bed / day. 3.Nursing Homes – ½ to 4 kg / bed / day.

16. CLASSIFICATION OF BIO-MEDICAL WASTE

17. 1 . Infectious waste- 2. Pathological waste- 3. Pharmaceutical waste Lab cultures, tissues, swabs, equipments and excreta. Human tissue or fluids e.g. body parts, blood, other body fluids. Expired and contaminated medicines.

18. 4.Genotoxic waste- 5.Chemical waste- 6.Waste with high content of heavy metals- Cytotoxic drugs, genotoxic chemicals. Expired Lab reagents, film developer, disinfectants. Batteries, broken thermometers.

19. 8. Pressurized containers- 9. Radioactive waste- Gas cylinders, gas cartridges. Unused liquid in radiotherapy or lab research.

20. Pathological waste

21. Pharmaceutical waste

22. Genotoxic waste

23. Waste containing heavy metals

24. Pressurized containers

25. Radioactive waste

26. HAZARDS OF BIOMEDICAL WASTE

27. Hazards of BMW 1. Infectious wastes and sharps cause transmission of infections like HIV Hepatitis B and C. 2. Chemical and Pharma waste toxic, corrosive, flammable, reactive and shock sensitive.

28. 3. Genotoxic and Radioactive wastes are responsible for toxicity ranges from the headache , nausea and vomiting to the skin reactions and malignancies . 4. Public sensitivity for visual impact of anatomical wastes.

29. 30 Who’s at Risk ? • Doctors and nurses • Patients • Hospital support staff • Waste collection and disposal staff • General public and • the Environment

30. 1. Identification of points of generation of waste. 2.Waste minimization & recycling of waste. 3.Waste segregation at source. 4.Waste treatment (disinfection etc.) at the site. 5. Waste collection and transportation, on-site and off-site. 31 Principles of Waste Management

31. 6. Waste treatment , on-site & off the site 7. Final disposal of waste 8. Occupational safety 9. Continuous monitoring of the system 10.Training of the staff.

32. PROCESS OF BMW MANAGEMENT

33. Biomedical Waste Management Process 1. Source Identification. 2. Segregation. 3. Collection and storage. 4. Transport. 5. Treatment and Disposal.

34. 1. Source Identification Identification of source required both at - the macro level . (Institutes that generates wastes) - the micro level . (Points and activities within the institution).

35. 2. SEGREGATION “Separation of different types of waste as per treatment and disposal options.” It is the key to the active process of scientific waste management.

36. 3. COLLECTION AND STORAGE Storage of waste refers to storage within wards or collection points within the departments. Collection centers are planned between 2-3 wards. Central collection. Common Treatment Facility (CTF)

37. No untreated biomedical waste shall be kept stored beyond period of 48 hours. If any reason it is necessary then permission of the prescribed authority is essential.

38. 4. TRANSPORT Transportation system should be secured with special containers and well defined route with minimum patient influx. The containers should have non-washable and prominently visible label showing the type of waste it contains – Cytotoxic or Biohazrds .

39. 5. TREATMENT AND DISPOSAL The main objectives of treatment are - disinfecting and decontaminating the waste and - volume reduction .

40. Broadly two categories – 1. BURN TECHNOLOGY. 2. NON-BURN TECHNOLOGY.

41. BURN TECHNOLOGY NON-BURN TECHNOLOGY Open Burning. Small Scale incinerators. Single Chamber Incinerators. Double Chamber Incinerator. Pyrolyltic incinerators and Ratary Kiln. 1.Chemical Disinfection. 2. Microwave Irradiation. 3. Dry and Wet thermal techniques.( AUTOCLAVING ) 4. Sanitary landfill 5. Deep Burial 6. Inertization and Encapsulation.

42. INCINERATION Method of choice for most hazardous health care waste. High temp dry oxidation process . Reduces organic and combustible waste to inorganic and incombustible material. Significant reduction in waste volume and weight.

43. INCINERATORS SINGLE CHAMBER INCINERATOR DRUM/BRICK INCINERATION

44. INCINERATORS ROTARY KILN PYROLYTIC INCINERATOR

45. AUTOCLAVING Autoclaving is efficient thermal disinfection process. Commonly used for reusable medical equipments. Effective inactivation of all the micro-organism and bacterial spores at 121 degree C temperature and 30 psi pressure for 3 minutes holding time .

46. TEMPERATURE PRESSURE HOLDING TIME 134 C 30 psi 03 minutes 126 C 20 psi 10 minutes 121 C 15 psi 15 minutes

47. CHEMICAL DISINFECTION Most suitable for treating liquid waste such as infected blood, urine, stools, or hospital sewage . Chemicals are added to waste to kill the pathogens.

48. MICROWAVE IRRADIATION Microorganisms are destroyed by the action of microwave at - - a frequency of about 2450 MHz and - a wavelength of 12.24 nm.

49. LAND DISPOSAL Whatever may the modality of waste treatment, final product has to be taken to the land. Two types of methods – 1. Open dump. 2. Sanitary landfill.

50. Land Disposal Facility for Cities & Towns

51. INERTIZATION Mixing of waste with cement and other substances . Commonly used for the pharmaceutical waste. A typical proportion of mixture is – - 65 % of Pharmaceutical waste. - 15 % lime - 15 % cement and - 5 % water.

52. Bio-medical Waste (Management and Handling) Rule 1998 of India

53. Bio-Medical Waste Management and Handling Rule 1998, of India. Govt. of India, by sections 6, 8 and 25 of Environment (Protection ) Act 1986 , notified rules to improve the environment by prescribing norms and rules for health care waste management under the notification called Bio-Medical Waste (Management and Handling ) Rules 1998.

54. Bio-Medical Waste Management and Handling Rule 1998, of India. This rule is prescribed by the Ministry of Environment and Forests , Government of India. Came in to force on 28 July 1998 .

55. Bio-Medical Waste Management and Handling Rule 1998 of India. This rule applies to those who generate , collect , receive , store , dispose , treat or handle bio-medical waste in any manner.

56. Any violation of these rules is punishable up to 5 years rigorous imprisonment or fine of rupees one lakh or both.

57. Bio-medical Waste (Management and Handling) Rule 1998 Schedule- 1. Categories of bio-medical waste in India. Schedule- 2. Color coding and type of container for disposal of bio-medical waste. Schedule- 3. Label for bio-medical waste container/bags.

58. Categories of Bio-medical Waste Category Waste Type Treatment and Disposal Method Category 1 Human Anatomical Wastes (Tissues, organs, body parts ) Incineration / deep burial Category 2 Animal Waste Incineration / deep burial Category 3 Microbiology and Biotechnology waste Autoclave/microwave/incineration Category 4 Sharps Disinfection (chemical treatment)+/autoclaving/microwaving and mutilation shredding Category 5 Discarded Medicines and Cytotoxic Drugs Incineration/ destruction and drugs disposal in secured landfills Schedule-I

59. Category Waste Type Treatment and Disposal Method Category 6 Contaminated solid waste Incineration/autoclaving / microwaving Category 7 Solid waste (disposable items other than sharps) Disinfection by chemical treatment+ microwaving/autoclaving & mutilation shredding Category 8 Liquid waste (generated from laboratory washing, cleaning, housekeeping and disinfecting activity) Disinfection by chemical treatment+ and discharge into the drains Category 9 Incineration ash Disposal in municipal landfill Category10 Chemical Wastes Chemical Treatment + and discharge in to drain for liquids and secured landfill for solids Schedule-I. contd …

60. ISSUES AND CHALANGES

61. ISSUES. . . . 1.Lack of Priority in policy on Bio-Medical Waste Management and funds on the issue. 2. Lack of Managerial skill and Training of Bio-Medical Waste Management. 3. Lack of Appropriate technologies for treatment and disposal of Bio-Medical Waste.

62. 4. Lack of Strict implementation of infection control measures like sterilization and disinfection techniques. 5. Lack of Awareness among medical personal, patients, attendants and people at large.

63. 6. Lack of coordination between municipality, Pollution Control Board and hospital authorities. 7. Lack of Accountability of persons involved in the management of Bio-Medical Waste.

64. 67 Challenges 1. Establishing robust waste management policies within the Health Care Facility. 2. Organization wide awareness about the health hazards. 3. Sufficient financial and Trained human resources needed.

65. 4. Monitoring and control of waste disposal . 5. Clear responsibility and traceability for appropriate handling and disposal of waste.

66. 69 Environmental Legislations in India 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.

67. CONCLUSION

68. Safe and effective management of bio-medical waste is not only a legal necessity but also a Social Responsibility.

69. Bio-Medical Waste Management cannot successfully be implemented without the willingness, devotion, self-motivation, cooperation and participation of all sections of employees of any health care establishment.

70. If we want to protect our environment and health of the community we must see ourselves to this important issue not only in the interest of health managers but also in the interest of community.

71. THANK YOU