Bio medical waste management

Dr.Preyas Joshi
Assistant Professor
Rajasthan Dental College & Hospital

1. Bio - medical Waste Management Dr.Preyas Joshi Rajasthan Dental College

2. 12/16/2016 2 LET THE WASTEs OF THE “SICK” NOT CONTAMINATE THE LIVES OF “THE HEALTHY” K.park

3. CONTENTS Definition of Bio medical waste Classification of Health Care Waste (WHO) Source of Health Care Waste Generation/Segregation/Storage/Transportation/ Treatment & Disposal of waste Treatment technique & categorical treatment.

4. DEFINITION According to Bio-Medical Waste Rules, 1998 of India, "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 biological.

5. Biological Health Hazards Dentists constitute a group of professionals who are likely to become exposed to biological health hazards. These hazards are constituted by infectious agents of human origin and include viruses, bacteria and fungi. From the occupational view point percutaneous exposure incidents particularly needlestick and sharp instrument injuries represents the most efficient method for transmitting blood born infections between patients and health care workers.

6. This exposure is related to the fact that dentists work in a limited-access and restricted-visibility field and frequently use sharp devices. Percutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus [HIV], hepatitis C virus [HCV] and hepatitis B virus [HBV]. Needles and drilling instruments such as burs represented the most common devices as the cause of exposure and injury.

7. Shah SM et al carried out a study in Washington which revealed that 66.7% of the percutaneous injuries are sustained by dentists and most of the injuries (70%) occurred during administration of local anesthesia, recapping a needle and performing surgical procedures. In a epidemiological study of needle stick and sharp instrument accidents in a Nigerian hospital it was found that needle stick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needle stick injuries was 2.3 per person-year for dentists . Shah SM et al. Percutaneous injuries among dental professionals in Washington State. BMC Public Health 2006; 6: 269. Adegboye AA et al. The epidemiology of needlestick and sharp instrument accidents in a Nigerian hospital. Infect Control Hosp Epidemiol 1994 ;15(1):27-31.

8. Dental environment is also associated with a significant risk of exposure to various micro-organisms. Agents may be present in blood or saliva, as a consequence of bacterimia or viremia associated with systemic infections. Dental patients and Dental Health Care Workers [DHCW] may be exposed to variety of microorganisms via blood or oral or respiratory secretions.

9. These micro-organisms may include: Cytomegalo virus Hepatitis B virus Hepatitis C virus Herpes simplex virus types 1 and 2 HIV Mycobacterium tuberculosis Other viruses and bacteria, especially those that infect the upper respiratory tract.

10. A DIRECT INFECTION occurs when: Microorganisms enter through a cut on the skin of hand while performimg a dental procedure. Any dental procedure resulting in an accidental biting of the patient. By the patient, or through a needle wound created while imparting anaesthesia .

11. An indirect infection occurs when an infectious agent is transmitted into the dental care giver through the so-called carrier. The following are the main sources of INDIRECT INFECTION : Aerosols of saliva Gingival fluid Natural organic dust particles (dental caries tissue) mixed with air and water Accidental breakage of dental instruments and devices

12. The following are the main entry points of infection: Epidermis of hands Oral epithelium Nasal epithelium Epithelium of upper airways Bronchial tubes Alveoli Conjunctival epithelium

13. All members of the dental dental personnel team are at risk of exposure to Hepatitis B virus (HBV), HIV infection, and other types of communicable infections. In the United Kingdom for example, the carrier rate of HBV in the general population is 0.5%, while dentists have a carrier rate of approximately 1.6%.

14. CLASSIFICATION OF HEALTH-CARE WASTE WASTE CATEGORIES DESCRIPTION AND EXAMPLES 1.Infectious waste Waste suspected to contain pathogens e.g. laboratory cultures; waste from isolation wards; tissues (swabs), materials, o r equipments that have been in contact with infected patients; excreta. 2.Pathological Waste Human tissues or fluids e.g. body parts; blood and other body fluids. 3.Sharps Sharp waste e.g.: Needle, Scalpels, knives, B lades etc. 4.Pharmacutical Waste Waste containing pharmaceuticals e.g. pharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceuticals (bottles, boxes). 5. Genotoxic waste Waste containing substances with genotoxic properties e.g. waste containing cytostatic drugs (often used in cancer therapy); genotoxic chemicals.

15. WASTE CATEGORIES DESCRIPTION WITH EXAMPLES 6.Radio-active waste Waste containing radioactive substances. E.g.: Unused liquid from radiotherapy or lab research, contaminated glassware etc. 5.Chemical waste Waste containing chemical substances E.g.: Laboratory reagents; Film developer; Disinfectants that are expired or no longer needed etc. 8.Pressurized container Gas cylinder, Aerosol cans etc 9. Waste with high content of heavy metals. Batteries; Broken thermometers etc.

16. SOURCE OF HEALTH CARE WASTE Governmental Hospital Private Hospital Nursing Homes Physician’s Office Dentist Office Dispensaries Mortuaries Blood Bank and collection center Animal Houses Laboratories Research Organizations

17. GENERATION,SEGREGATION,COLLECTION,STORAGE, TRANSPORTATION AND TREATMENT OF WASTE 1. GENERATION: TYPE SITE OF GENERATION DISPOSAL BY Non-Hazardous waste/General waste Office, Kitchen, Administration, Hostels, Stores,Rest rooms etc Municipal/Public Authority Hazardous (Infectious & toxic waste) Wards, Treatment room, Dressing room, OT, ICU, Labour room, Laboratory, Dialysis room, CT scan, Radio-imaging etc Hospital itself

18. 2. SEGREGATION : Done at point of generation of waste and put in separate colored bags. Color coding varies from nation to nation. In India following color code bags are practiced. a) Yellow b) Red c) Blue/ White Translucent d) Black

19. Colour coding and type of container for disposal of bio-medical waste Yellow Plastic Bag Human Anatomical waste (Human tissues, Organs, Body parts) Animal waste Microbiology and biotechnology waste (Cultures, Dishes, Vaccines, Toxins) Solid waste (contaminated with blood - cotton, dressings

20. Red Disinfected container / Plastic Bag Microbiology and biotechnology waste (Cultures, Dishes, Vaccines, Toxins) Solid waste (Disposable items Tubings , catheters, IV sets) Solid waste (contaminated with blood - cotton, dressings, beddings, linen)

21. Blue / White translucent Puncture Proof container / Plastic Bag Waste sharps (Needles, Syringes, Scalpels, Blades, Glass ) Solid waste (Disposable items Tubings , catheters, IV sets)

22. Black Plastic Bag Discarded medicines and cytotoxic drugs ( outdated, contaminated and discarded medicines ) Incineration ash Chemicals used in disinfection and as insecticides

23. 3. COLLECTION OF WASTE: Centralized sanitation staffs or any other sanitation staffs should collect the waste during morning, afternoon or evening under the supervision of nursing staff and sanitation supervisor; documentation should be done in register The garbage bin should be cleaned and disinfected regularly.

24. 4. STORAGE OF WASTE: Waste should be stored in separate area, room or building of a size appropriate to the quantity of waste produced. 5. TRANSPORTATION: Wastes should be transported by means of wheeled trolley, containers or carts making sure that they are not being used for any other purposes.

25. LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS Note : Label shall be non-washable and prominently visible. HANDLE WITH CARE BIOHAZARD CYTOTOXIC BIOHAZARD SYMBOL CYTOTOXIC HAZARD SYMBOL

26. 6. TREATMENT & DISPOSAL TECHNOLOGIES: Incineration: - Double chamber pyrolytic incinerators - Single chamber furnaces with static grate - Rotary Kilns B. Chemical Disinfection: - Formaldehyde -Ethylene oxide - Sodium Hypochlorite - Glutaraldehyde

27. C. Wet thermal treatment D. Microwave irradiation E. Burial F. Encapsulation G. Inertization

28. Incineration : Incineration is a high temperature dry oxidation process, that reduces organic and combustible waste to inorganic incombustible matter and results in a very significant reduction of waste-volume and weight. ORGANIC INORGANIC Matter from a once-living organism Not consisting of or deriving from living matter Capable of decay or the product of decay Able to break down into smaller components Chemical compounds  whose  molecules contain carbon Chemical compounds that do not contain  carbon

29. Gas exiting to the atmosphere via a flue (pipe or channel for conveying exhaust gases from a fireplace, oven, furnace, boiler or steam generator).

30. Waste types not to be incinerated are : (a) Pressurized gas containers. (b) Large amount of reactive chemical wastes. (c) Silver salts and photographic or radiographic wastes. (d) Halogenated plastics / Chlorine based plastics such as PVC

31. (e) Waste with high mercury or cadmium content, such as broken thermometers, used batteries. Types of incinerators: Double chamber pyrolytic incinerators. Single chamber furnaces with static grate Rotary Kilns

32. Double chamber pyrolytic incinerators: Also called as pyrolytic incinerators or controlled air incineration. This is the most common and reliable used process for health care waste. It comprises of two parts : - Pyrolytic chamber - A post combustion chamber PYROLYSIS Chemical reaction that occurs in the burning of solid organics. In pyrolysis there is a gas phase present. (wood fire - visible flames -gases released) flame-less burning of a solid – smouldering - combustion of the solid residue (charcoal) left behind by pyrolysis .

33. Firstly, the waste is loaded in to waste bags or containers. Then in the pyrolytic chamber the waste is thermally decomposed by the combustion process leading to solid ashes and gases formation. Holes in the grate supplying the primary combustion air

34. Incineration plants must be designed to ensure that the flue gases reach a temperature of at least 850 °C (1,560 °F) for 2 seconds in order to ensure proper breakdown of toxic organic substances. In order to comply with this at all times, it is required to install backup auxiliary burners (often fueled by oil), which are fired into the boiler in case the heating value of the waste becomes too low to reach this temperature alone.

35. This process is suitable for: - Infectious waste (including sharps) and pathological waste. - Pharmaceutical and chemical residues. Inadequate for: - Non-risk health care waste - Genotoxic waste - Radioactive waste Drawbacks: - Requires expensive equipment - Well trained personnel

36. Single – chamber incinerator Used if a pyrolytic incinerator can’t br afforded. Treats waste in batches. A good fire should first be established on the ground underneath the drum / brick-lined cell. Wood should be added to the fire until the waste is completely burnt. After burning, the ashes should be collected and buried safely.

37. The rotary-kiln incinerator has 2 chambers: primary chamber : consists of an inclined refractory lined cylindrical tube. The  refractory lining  is a protective layer installed inside the kiln or furnace to insulate the furnace steel structure from high temperatures. It also protects it from thermal shocks and chemical attack, and abrasion wears. Movement of the cylinder on its axis facilitates movement of waste.  Conversion of solid fraction to gases

38. Secondary chamber : The secondary chamber is necessary to complete gas phase combustion reactions.

39. CTF or Common Treatment Facilities The CTFs are responsible for waste collection and transportation from the hospitals site, followed by treatment and destruction as necessary and finally disposal at the site of CTF.

40. 2. Chemical disinfection: In this process chemicals are added to waste to kill or inactivate the pathogens. This treatment usually results in disinfection rather than sterilization. Chemical disinfection is most suitable for treating liquid waste such as blood, urine, stools or hospital sewage. However, solid wastes including microbiological cultures, sharps etc. may also be disinfected chemically with certain limitations.

41. Types of disinfectants: - Formaldehyde - Glutaraldelhyde - Sodium hypochlorite - Ethylene oxide - Chlorine dioxide

42. 3. Wet Thermal treatment: Wet thermal treatment/steam disinfection is based on exposure of infectious waste to high temperature and high pressure steam similar to process of autoclaving. This process is inappropriate for treating anatomical waste, chemical and pharmaceutical waste.

43. Biomedical Waste Autoclave

44. 4. Microwave irradiation: Most microorganisms are destroyed by the action of microwave of a frequency of about 2450 MHz and a wave length of 12.24 nm. The water contained within the waste is rapidly heated by the microwaves and the infectious components are destroyed by heat conduction. But since due to its high operational cost it is not yet recommended in developing countries.

45. 5. Land Disposal: There are two types of disposal land: (a) Open dumps (b) Sanitary landfills Health-care waste should not be deposited on or around open dumps. Because of the risk of either people or animals coming into contact with infectious pathogens.

46. Sanitary landfills are designed to have many advantages over open dumps : (a) Geological isolation of waste from the environment. (b) Appropriate engineering preparation before the site is ready to accept waste. (c) Staff is present on the site to control operations.

47. Deep Burial Pits for Disposal of Bio-medical waste

48. 6. Inertization : The process of " inertization " involves mixing waste with cement and other substances before disposal, in order to minimize the risk of toxic substances contained in the wastes migrating into the surface water or ground water. A typical proportion of the mixture is: 65 per cent pharmaceutical waste, 15 per cent lime, 15 per cent cement and 5 per cent water.

49. A homogenous mass is formed (on site) and cubes or pellets are then transported to suitable storage sites.

50. 7. Encapsulation: This procedure involves filling containers made of high density polyethylene or metal drums, with waste. These containers are then filled up with a medium of immobilizing material such as cement mortar or clay. When the medium has dried, the containers are sealed and disposed off in a landfill sites. Advantages: It is a simple, low-cost and safe method

51. 68 WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOSAL OPTION Category No. 1 H uman Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep burial* Category No. 2 A nimal 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 M icrobiology & 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 biological, toxins and devices used for transfer of cultures) Local autoclaving/ microwaving / incineration @ CATEGORIES OF BIOMEDICAL WASTE SCHEDULE

52. 69 Category No. 4 W aste 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 Category No. 5 D iscarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Incineration@ / destruction and drugs disposal in secured landfills Category No. 6 S oiled 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 S olid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting by chemical treatment@@ / autoclaving / microwaving

53. 70 Category No. 8 L iquid 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 I ncineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Category No.10 C hemical Waste (Chemicals used in production of biological, chemicals used in disinfecting, as insecticides, etc.) Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids.

54. Sometimes people just need to sleep!! ..Thanks anyways!