Bio medical waste management

BIOMEDICAL WASTE MANAGEMENT IN HEALTHCARE FACILITY

1. Biomedical Waste Management Dr. UPENDRA KUSHWAH (CPHC-Consultant ) 1

2. What are Biomedical wastes? Biomedical waste has been defined as “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 biological or in health camps, including the categories mentioned in Schedule I appended to these Rules ” as per Biomedical Waste Rules 2016. 3

3. MAJOR SOURCES Hospitals/Nursing Homes/Dispensaries. Primary health centres. Medical collages and research Centre. MINOR SOURCES Physician /dentists clinic Blood donation camps.

4. Why manage Hospital Waste?

5. Need for Managing Waste Danger to the patients Many patients have poor immunological status Resistance to antibiotics Vulnerability of Hospital Staff Danger to the community Spread of infection through waste Access of waste to animals Spread of Infection through recycling trade Problems caused by Incinerators/ burning Contamination of Water-table

6. BMW (Management & Handling) Rules 1998 Was applicable to any hospital/ health centre/O.P.D. facility/clinic, where more than 1000 patients are seen/ treated/ investigated in a month Segregation, disinfection and mutilation of waste No storage of waste beyond 48 hrs No incineration of chlorinated plastics No chemical pre-treatment before incineration Proper labelling of waste with Biohazard symbol

7. BMW (Management & Handling) Rules 1998 Introduction of new treatment options with CPCB (Central Pollution Control Board) approval. Municipal authorities to pick up general waste and treated (disinfected) Biomedical waste. Centralised facilities preferred. Standards for Incinerators & Deep Burial Pit. Penalty as under EPA(Environmental Protection Agency).

8. Biomedical waste rules 2016 Gazetted on 28 th March 2016 Replaces Biomedical Waste (Management & handling) Rules 1998 Major Changes – Scope – also includes Ayush Health Facilities, Vaccination Camps, First-Aid Rooms of Schools, Forensic Labs, etc. Constitution of a new committee at the state level Small facilities less than thirty beds may designate a qualified person to review and monitor the activities relating to bio-medical waste management

9. Biomedical waste rules 2016 Bar Code System for bags & containers (after 28 th March 2017) Phase-out Chlorinated bags and Non-chlorinated plastic bags after 28 th March 2018 On-site disinfection of laboratory waste, microbiological waste, blood samples & blood bags Treatment & disposal of Liquid waste in accordance with the water (Prevention & control of Pollution) 1974 ‘On-site’ Waste Management can be established if nearest CTF is 75 kms away Segregated collection – Four Categories Prior Approval for ‘Deep Burial’

10. Identify Bio Medical Waste Used Syringes Blood Bags Vaccines Stained Cotton Swabs Placenta Expired Medicines Fixer & Developer in Xray Established Procedures Linen Glass Slides Sanitary Napkin Medicine Card Boxes Lab Samples Lead Batteries Condemned X Ray Machine Kitchen Waste Catheter X Ray Films

11. 12 What are the different hospital waste categories?

12. Categories of BMW (as per BMW Rules 1998) Category Waste 1 Human Anatomical 2 Animal 3 Microbiology & Biotechnology 4 Sharps 5 Discarded Medicines & Cytotoxic Drugs 6 Soiled (Contaminated with Blood & Body Fluids) 7 Solid (Disposable Items other than Sharps) 8 Liquid 9 Incineration Ash 10 Chemical

13. Category Type of Waste Treatment and Disposal Options Category 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration/Deep Burial Category 2 Animal waste (Animal tissues, organs, body parts, carcasses, bleeding parts,blood and experimental animals used in research) Incineration/Deep Burial Category 3 Microbiology and biotechnology waste(waste from lab culture, specimens from microorganisms, vaccines, cell cultures, toxins, dishes, devices used to transfer cultures) Local Autoclaving/ Microwaving/ Incineration Category 4 Waste Sharps (Needles, Syringes, scalpels, blades, glass) Chemical Disinfection Autoclaving/ Microwaving, Mutilation and Shredding Category 5 Discarded medicines and cytotoxic drugs (outdated, contaminated, discarded drugs) Incineration/Destruction and disposal in land fills 14

14. 15 Category Type of Waste Treatment and Disposal Options Category 6 Soiled waste (contaminated with blood and body fluids including cotton, dressings, soiled plasters, linen) Autoclaving/ Microwaving/ Incineration Category 7 Solid waste (tubes, catheters, IV sets) Chemical Disinfecion /Autoclaving/ Microwaving, Mutilation and Shredding Category 8 Liquid waste (Waste generated from laboratory and washing, cleaning, disinfection) Disinfection by chemical treatment and discharge into the drains Category 9 Incineration ash Land fills Category 10 Chemical waste Chemical disinfection and discharge into the drains

15. Colour Coding for Collection System (BMW Rules 1998) Colour Coding Type of Container Waste Category Treatment options Yellow Plastic Bag Categories 1, 2, 3 & 6. Incineration deep burial  Red Plastic Bag Categories 3, 6, 7 Autoclaving/Micro-waving Chemical Treatment Blue/ White Translucent Plastic Bag /puncture-proof containers Cat. 4, Cat. 7 Autoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding Black Plastic Bag Categories 5, 9, 10 Disposal in secured landfill.

16. Categories of Waste: Schedule I (BMW Rules 2016) Category Type of Waste Bag/ Container Treatment/ Disposal 1. Yellow a. Human Anatomical Yellow colour Non-chlorinated Plastic Bag or Containers Incineration/ Plasma Pyrolysis/ Deep-burial b. Animal Anatomical c. Soiled Waste Incineration/ Plasma Pyrolysis/ Deep-burial OR Autoclave/ Microwave/ Hydoclave d. Expired Drugs Return/ Plasma Pyrolysis e. Chemical Incineration/ Plasma Pyrolysis f. Chemical liquid Separate Collection System leading to Effluent treatment system Pre-treatment then discharge g. Discarded linen Non-Chlorinated Yellow Colour bags or suitable packing material Incineration/ Plasma Pyrolysis OR Shredding & mutilation h. Microbiology Autoclave Safe bag NACO/ WHO Norms (On-site)

17. Categories of Waste: Schedule I (BMW Rules 2016) Category Type of Waste Bag/ Container Treatment/ Disposal Red Contaminated Waste (Recyclable) Red Coloured non-chlorinated plastic Autoclave/ Microwave/ Hydroclave followed by shredding or mutilation or combination White SHARPS including Metals Puncture Proof/ Leak Proof/ Tamper proof Autoclave/ Dry Heat Sterilisation or shredding or Mutilation or Encapsulation Blue Glassware Cardboard Boxes with Blue colour marking Disinfection by Sodium Hypochlorite solution or Autoclaving/ Microwaving/ Hydroclaving Metallic Body Implant

18. Different colour coded plastic containers with waste category: Category 1,2,3,5,6 waste will collected in yellow colour plastic container. Category 4, 7 waste will collected in red colour coded plastic container Category 8 waste will collected in Blue colour coded plastic container

19. Municipal waste will collected in Black colour coded plastic container. The collected bio-medical waste will transported to CBWTF in a fully covered specially designed vehicles (as per guidelines of CPCB)

20. Segregation Different types of waste should be collected separately Should be done at point of generation Different coloured bins are to be used Segregation ensures occupational and health safety Segregation also reduces the cost of treatment and disposal

21. Collection: biomedical waste will be collected in the different coded bags or containers as mentioned in biomedical waste management rules, 2011. Transportation: collected waste will be transported in closed vehicles from waste generating site to treatment facility. Treatment: collected waste will be treated with Incineration/Shredder/Autoclave. Final Disposal: After treatment of waste ash from incinerator will be sent to Municipal Landfill site.

22. LIQUID WASTE MANAGMENT KARNATKA

23. What are the disinfectants commonly used for disinfection of materials contaminated with blood and body fluids? High level disinfectants like chlorine releasing compounds are used for disinfecting materials contaminated with blood and blood products. The recommended dilutions for these compounds are given as follows: 25

24. Liquid disinfection unit

25. Liquid Disinfectant unit for DH, TLH, CHC

26. Further improvements

27. Name of Disinfectant Available chlorine Required chlorine Required chlorine Contact period Amount of disinfectant to be dissolved in 1 ltr of water Sodium hypochlorite 5% 0.5% 30 min 100 ml Calcium hypochlorite 70% 0.5% 30 min 7.0 gm Na OCl powder - 0.5% 30 min 8.5 gm Na Dichloroisocyanurate (NaDCC) tablets 60% 0.5% 30 min 4 tabs Chloramine 25% 0.5% 30 min 20 gm 30

28. How is disinfection of the various items commonly used in the hospital carried out? 31

29. General use items Disinfection Bath water Add savlon when necessary Bed pans Wash with hot water and dry Disinfect with phenol after use by infected patients Autoclave Bowls Wash with hot water and keep dry Autoclave Crockery, Cutlery Wash with hot water/detergent and keep dry Floors Vacuum clean; No use of broom Furnitures Damp dust with detergent/phenol/2% Lysol Mattresses/Pillows Use water impermeable cover Wash cover with detergent and keep dry Disinfect with phenol/2%lysol Trolley tops Wipe with warm water and detergent to remove dust and keep dry Thermometers Wash with warm water/detergent and keep dry Endoscopes/ Arthroscopes / Laparoscopes/ Fiberoptic Endoscopes Immerse in2% Cidex solution Use latex gloves, eye protection plastic covering mask while handling Alternatively, use ethylene oxide sterilization 32

30. General use items Disinfection Endotracheal suction catheter Should be disposable Endotracheal tubes Recycled after cleaning and autoclaving Ambu Bags Ideally heat disinfect Immerse in 2% glutaraldehyde and wash with sterile distilled water to reduce respiratory irritation Oxygen delivery face mask Wash and dry Use 70% isopropyl alcohol to remove mucus Suction drainage bottles Ideally autoclave Ventilatory circuits, respiratory equipment in Neonatal/Pediatric unit Heat disinfection for 800 F for 30 min Autoclave Ethylene oxide sterilization Incubators Clean thoroughly wiyh warm water / soap Use 70% isopropyl alcohol Humidifiers Empty daily refill with sterile water Disinfect when contaminated with 1% Na hypochlorite Autoclave Urinary Catheter Should be disposable 33

31. How are common hospital instruments sterilized? Instruments should be disinfected for 30 min, cleaned and sent for sterilization. 34

32. Sterilization Methods: 35   Dry Heat Autoclave Ethylene oxide 2% Glutaraldehyde Formaline Gamma radiation Gloves - a - - - a Plastic Syringe - - a - - - Glass Syringe - a - - - - Needles - - - - - - Endoscopic instruments - - - a a - Suction tubes - - - a - - Suction bottles - a a a a a Cautery cable - - a a a a Cautery points - - - a a a Laryngoscopes - - - a a a Endotracheal tubes - - a a a a Catheters - - a a a a Cath Lab Material - - a a - a Blanket a - - - - - Mattresses a - - - - - Suturing Material a - - a - a

33. ANALYSIS OF PROPOSAL Social benefits to the local population Cleaner and healthier environment. Reduction in the incidence of hospital acquired and general infection. Reduction in the cost of infection control within the hospital. Reduction in the possibility of disease and death due to reuse and repacking of infectious disposal. Low incidence of community and occupational health hazards Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste. This project will also give an employment opportunity. We build a pollution free environment and planet earth a better place to live in.

34. Annual report On Form IV before 30 th June every year Details of training - programmes conducted , number of personnel trained and number of personnel not undergone Major Accidents including Nil report in Form I to the prescribed authority and also along with the annual report Review committee’s minutes of the meetings Record of recyclable wastes referred to in sub-rule (9) which are auctioned or sold and the same shall be submitted to the prescribed authority as part of its annual report.

35. THANK YOU By:- Dr. UPENDRA KUSHWAH (CPHC-Consultant ) 38