Bio medical waste management

Bio Medial waste management

1. Presented By: Ajay Kumar Sahoo Phlebotomist Enteric Fever Project ICMR-MRHRU, Tigiria BIOMEDICAL WASTE MANAGEMENT

2. CONTENT CONTENT DEFINATION SOURCES CLASSIFICATION NEED FOR MANAGEMENT HOW IT CAME INTO EXISTANCE OBJECTIVE PROCESS AWARENESS AND EDUCATION CONCLUSION

3. WHAT IS A BIO-MEDICAL WASTE??

4. Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animal (WHO) Definition WHAT IS BIO-MEDICAL WASTE

5. SOURCES 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 Institution

6. CLASSIFICATION

7. TYPES OF BIOMEDICAL WASTE WASTES Solid Waste Liquid Waste Gaseous Waste

8. PATHOLOGICAL WASTE Excrete Human tissues/fluids Body parts Blood or body fluids WASTE TYPE SHARP WASTE Needles Infusion Sets Scalpels Knives Blades Broken Glass

9. GENOTOXIC WASTE Waste containing Cytotoxic drugs (often used in Cancer Therapy) Genotoxic Chemicals WASTE TYPE CHEMICAL WASTE Lab reagents Film developer Expired disinfectants Expired solvents

10. WASTE WITH HIGH CONTENT OF HEAVY METALS Batteries Broken thermometers Blood pressure guages , etc. WASTE TYPE PHARMACEUTAL WASTE Expired pharmaceuticals Contaminated pharmaceuticals Banned pharmaceuticals

11. Injuries from sharps leading to infection to all categories of hospital personnel and waste handler. Nosocomial infections in patients from poor infection control practices and poor waste management. Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals . NEED FOR BIO-MEDICAL WASTE MANAGEMENT

12. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels. “Disposable” being repacked and sold by unscrupulous elements without even being washed. Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers. Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash. NEED FOR BIO-MEDICAL WASTE MANAGEMENT

13. HOW IT CAME INTO EXISTANCE

14. In late 1980’s Items such as used syringes were washed up on several East Coast beaches Concern about HIV and HBV virus infection l ead to development of biomedical waste management law in USA However in INDIA the seriousness about the management came into limelight only after 1990’s LEGISLATION

15. LEGISLATION Recognizing the deadliest nature of the Bio-Medical Waste, the Government and Pollution Control Board under the guidelines of Ministry of Environment and Forests (MOEF) issued guidelines to the hospitals to ensure a proper and safe disposal of bio-medical waste. Bio-Medical Waste Management & Handing Rule 1998 came into effect . This Act provides uniform guidelines and code or practice for Bio-medical waste management.

16. These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose or handle bio-medical waste in any form. All Institution generating BMW must take all steps to ensure that such waste is handled without any adverse effect to human health and environment Biomedical Waste Management and Handling Rules, 1998 [Amended in 2000]

17. OBJECTIVE OF BMW MANAGEMENT To minimize the production/generation of infective waste. Recycle the waste after to the extent possible Treat the waste by safe environment friendly/ acceptable methods Adequate care in handling to prevent health care associate infections. Safety precautions during handling the BMW.

18. BMW MANAGEMENT PROECESS STEP - 1 SEGREGATION STEP - 2 COLLECTION & STORAGE STEP - 3 TRANSPORTATION STEP - 4 TREATMENT & DISPOSAL

19. SEGREGATION Segregation refers to the basic separation of different categories of waste generated at source and thereby reducing the risks as well as cost of handling and disposal. Segregation is the most crucial step in bio-medical waste management. Effective segregation alone can ensure effective biomedical waste management.

20. SEGREGATION Color coding Type of container Waste categories Yellow Plastic bags Cat 1. Human anatomical waste Cat 2. Animal Waste Cat 3. Microbiological Waste Cat 6. Solid Waste Red Disinfected container plastic bags Cat. 3 Microbiological Cat. 6 Soiled Dressing Blue/white Plastic bags, puncture proof containers Cat. 4 Waste sharp Cat.7 Plastic disposable Black Plastic bags, puncture proof containers Cat. 5 Discarded medicine Cat. 9 Incineration ash Cat 10 Chemical Waste

21. COLLECTION & STORAGE Ensure that waste bags/containers are properly sealed and labeled . Bags should not be filled completely, so that bags can be picked up by the neck again for further handling. Hand should not be put under the bag. At a time only one bag should be lifted. The waste may be temporarily stored at the central storage area of the hospital or lab and from there it may be sent in bulk to the site of final disposal once or twice a day depending upon the quantum of waste. During transportation following points should be taken care of:

22. COLLECTION & STORAGE Waste bags and containers should be removed daily from wards / OPDs / Labs or even more frequently if needed (as in Operation Theatres, ICUs, labour rooms). Waste bags should be transported in a covered wheeled containers or large bins in covered trolleys . No untreated bio ‐medical waste shall be kept stored beyond a period of 48 hours

23. COLLECTION & STORAGE Manual handling of waste bags should be minimized to reduce the risk of needle prick injury and infection. BMW should be kept only in a specified storage area. After removal of the bag, clean the container including the lid with an appropriate disinfectant.

24. TRANSPORT TO FINAL DISPOSAL SITE Transportation from health care establishment to the site of final disposal in a closed motor vehicle (truck, tractor‐trolley etc.) is desirable as it prevents spillage of waste on the way . Vehicles used for transport of BMW must have the “Bio‐Hazard” symbol and these vehicles should not be used for any other purpose

25. DISPOSAL OF BIO-MEDICAL WASTE Autoclave The process of autoclaving involves  steam sterilization . Instead of incineration, which can be expensive, autoclaving simply introduces very hot steam for a determined amount of time. At the end of the process,  microorganisms have been completely destroyed.   While some biomedical waste isn’t able to be disposed of via autoclaving, around  90% of materials are sanitized this way  before being sent on to a landfill. Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998.

26. DISPOSAL OF BIO-MEDICAL WASTE Deep burial: – Category 1 and 2 only – In cities having less than 5 lakh population & rural area . Incineration – The major benefits of incineration are that it is quick, easy, and simple. It effectively removes the waste entirely, and safely removes any microorganisms. However, when burning hazardous materials, emissions can be particularly dangerous. Some states prefer for waste disposal companies to look towards incineration as their first choice, but materials must be reviewed and determined as safe to burn.

27. DISPOSAL OF BIO-MEDICAL WASTE 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 .

28. DISPOSAL OF BIO-MEDICAL WASTE Chemicals Disinfection When it comes to liquid waste, a common biomedical waste disposal method can be chemical disinfection. Chlorine is a regular choice for this process, and is introduced to the liquid waste in order to kill microorganisms and pathogens. Chemical disposal can also be used for solid wastes, but it is recommended that they be grinded first to ensure maximum decontamination. Liquid waste, once decontaminated , is then disposed into the sewer system . Microwaving During this process, waste is shredded, mixed with water, and then internally heated to kill microorganisms and other harmful elements. One of the main benefits of this process is the shredding aspect; it lowers the volume of biomedical waste, and it is reportedly more energy efficient to use this method than to incinerate.

29. USE OF PERSONNEL SAFETY DEVICES DURING BIO-MEDICAL WASTE MANAGEMENT The use of protective gears should be made mandatory for all the personnel handling waste. Gloves:   Heavy-duty rubber gloves should be used for waste handling by the waste retrievers. This should be bright yellow in colour. After handling the waste, the gloves should be washed twice. The gloves should be washed after every use with carbolic soap and a disinfectant.  Aprons , gowns, suits or other apparels: Apparel is worn to prevent contamination of clothing and protect skin. It could be made of cloth or impermeable material such as plastic.

30. USE OF PERSONNEL SAFETY DEVICES DURING BIO-MEDICAL WASTE MANAGEMENT Masks:  Various types of masks, goggles, and face shields are worn alone or in combination, to provide a protective barrier. Boots:  Leg coverings, boots or shoe-covers provide greater protection to the skin when splashes or large quantities of infected waste have to be handled. The boots should be rubber-soled and anti-skid type. They should cover the leg up to the ankle.

31. AWARENESS & TRAINING Every hospital must have well planned awareness and training programme for all category of personnel. Training should be conducted in appropriate language/medium and in an acceptable manner. All the medical professionals must be made aware of Bio‐medical Waste (Management and Handling) Rules 1998.

32. CONCLUSION Bio-medical waste management issue cannot be solved without public education Individual participation is required. Educating and motivating oneself first is important and then preach others about it. Municipality and government should pay importance to disposal of waste economically. Start disposing waste first from within our home, then outside home, then neighbourhood, then street, city and then the nation and the world. Lets make this world a better place to live in.

33. Let the waste of the “Sick” not contaminate the lives of “The Healthy”