Bio Medical Waste Management And Handling Rules 1998

This Presentation is all about Bio Medical Waste Management and Handling Rules 1998

1. Bio-Medical Waste (Management and Handling) Rules 1998 Presented By: Ashish Singh MBA – Power Management 500033217

2. Let T he Waste Of The “SICK” Not Contaminate The Lives Of “THE HEALTHY”

3. What is Bio – Medical Waste Bio-medical waste"  means any waste, which is generated during the diagnosis, treatment or immunisation 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; Biologicals"  means any preparation made from organisms or micro-organisms or product of metabolism and biochemical reactions intended for use in the diagnosis, immunisation or the treatment of human beings or animals or in research activities pertaining thereto; Specific to hospitals Bio-medical waste is defined as waste that is generated during the diagnosis, treatment or immunization of human beings and are contaminated with patient’s body fluids (such as syringes, needles, ampoules ,organs and body parts, placenta, dressings, disposables plastics and microbiological wastes).

4. What is Bio – Medical Waste Waste Sharps e.g.: Needles Discarded medicines Human anatomical waste Solid waste e.g.: cotton swabs

5. History In the late 1980’s Items such as used syringes washed up on several East Coast beaches USA   HIV and HPV virus infection Lead to development of Biomedical Waste Management Law in USA However in India the seriousness about the management came into lime light only after 1990’s

6. 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 L abs/ research organizations Vaccinating centers Bio tech institutions / production units

7. Definition Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use Medical waste : refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals Infectious waste: are the portion of medical waste that could transmit an ‘infectious disease ’. Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.

8. Magnitude of the Problem GLOBALLY- Developed countries generate 1 to 5 kg/bed/day Developing countries: meager data, but figures are lower. 12kg/pt ./ day WHO Report: 85% non hazardous waste : 10% infective waste : 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive ) INDIA :-No national level study - local or regional level study shows hospitals generate roughly 1-2 kg/bed/day

9. Classification of Bio-Medical Wastes

10. Classification of Health Care Waste Infectious Waste Lab cultures Waste from isolation wards Tissues(swabs) Materials/ equipment of infected patients Pathological Waste Excreta Human tissues/fluids Body parts Blood or body fluids

11. Cont. Sharp Waste Needles Infusion Sets Scalpels Knives Blades Broken Glass Geno toxic Waste Waste Containing Cytotoxic Drugs(often Used In Cancer Therapy) Geno toxic Chemicals

12. Cont. Pharmaceutical Waste Expired Pharmaceuticals Contaminated Pharmaceuticals Banned Pharmaceuticals

13. Cont. Chemical Waste Lab reagents Film developer Expired disinfectants Expired solvents Waste with High Content of Heavy Metals Waste with high content of heavy metals Batteries Broken thermometers Blood pressure gauges etc.

14. Cont. Pressurized Containers Gas cylinders Gas cartridges Aerosol cans Radioactive Waste Radiotherapy/lab research liquids Contaminated glass wares, packages , absorbent papers

15. Hospital Waste Disposal Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of hospital waste i.e . "Biomedical waste" is hazardous, not the complete. But when hazardous waste is not segregated at the source of generation and mixed with nonhazardous waste, then 100% waste becomes hazardous

16. Who’s at Risk Doctors and Nurses Patients Hospital Support Staff Waste Collection and Disposal Staff General Public Environment

17. Need for BMW Management The hospital waste, in addition to the risk for patients and personnel who handle these wastes poses a threat to public health and environment Health hazards of BMW : Type of Waste Health Hazard Human/ Animal Waste/ Solid Waste HIV,HBV,HCV, Hgic fevers, cholera, salmonellosis, shigellosis, rabies, leptospirosis, anthrax, TB, pneumonia, septicemia Sharps HIV, HBV, HCV, Injuries Cytotoxic/ radioactive waste Cancer, Genetic Mutation, birth defect Chemical Waste Poisonings, Dermatitis, Conjunctivitis, Bronchitis

18. Need for BMW Management Nosocomial infections to patients from poor infection control practices and poor waste management . 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 . Risk of infection outside hospital for waste handlers and scavengers, other peoples.

19. India: Extent of the Problem > 95,000 hospitals and healthcare facilities in India 4.2 lakh kg of biomedical waste is generated on a daily basis . Three million tonnes of medical wastes generated every year. Expected to grow 8% annually. 2,91,983 kg/day BMW is disposed. which means that almost 28% of the wastes is left untreated and not disposed finding its way in dumps or water bodies and re-enters our system. Karnataka tops the chart with 62,241 kg/day of BMW. Only 179 CTF to treat the BMW in the country. No . of HCF/CBWTF violated BMW rules 5472 No . of show cause notice/ Directions issued to defaulter HCE/CBWTF 3585

20. Cont. CHHATTISGARH(Annual report on BMW, 2011, CPCB ) No. of HCE- 740 No. of Bed- 14678 Total quantity of BMW generated(Kg/day) approximately 4492Kg/Day BMW treated 4492Kg/Day No. of HCF/CBWTF violated BMW rules 20 No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 20 No. CBWTF 06 No. of HCE using CBWTF/ Private agencies 446 No. of HCE having own treatment facility & Disposal facility 181 No. of HCE applied for authorization 478 No. of HCE granted authorization 425 No. of treatment equipment's INCINERATOR’S 14 AUTOCLAVES 305 OVEN 7 SHREDDERS 358

21. Present Practice Within Many Of The Hospitals Around 40% of the hospitals in the country are dumping the BMW with Municipal garbage Waste is not segregated at the site 3585 hospitals have been served notice for acting as defaulters of these rules. No proper treatment options No regulated disposal plan/sites

22. Bio – Medical Waste Rules 1998 The Government of India as contemplated under Section 6,8 and 25 of the Environment (Protection) Act,1986, has made the Biomedical Wastes (Management & Handling) Rules, 1998. The rules are applicable to every institution generating biomedical waste which includes hospitals, nursing homes, clinic, dispensary, veterinary institutions, animal houses, laboratory, blood bank . The rules are applicable to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form.

23. Bio-Medical Waste Rules 1998 Definition A ccording 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 there to or in the production or testing of bio medicals . Any unwanted residual material which cannot be discharged directly, or after suitable treatment can be discharged in the atmosphere or to a receiving water source, or used for landfill is waste. ( Wilson, 1981)

24. Bio-Medical Waste (Management and Handling) Rules by Govt. of India , 1998 Revised in 2011 Now known as BMW Rules, 2011 2011 1998 Every occupier generating BMW, irrespective of the quantum of wastes comes under the BMW Rules and requires to obtain authorisation Occupiers with more than 1000 beds required to obtain authorisation Duties of the operator listed Operator duties absent Treatment and disposal of BMW made mandatory for all the HCEs Rules restricted to HCEs with more than 1000 beds A format for annual report appended with the Rules No format for Annual Report Form VI i.e. the report of the operator on HCEs not handing over the BMW added to the Rules Form VI absent

25. Duty of the Occupier It is the duty of every occupier i.e. head of an institution generating bio-medical waste, to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment . Provides training to HCW engaged in handling BMW Duties The operators now have to ensure that the BMW is collected from all the HCEs and is transported, handled, stored, treated and disposed in an environmentally sound manner. The operators also have to inform the prescribed authority in form VI if any HCEs are not handing the segregated BMW as per the guidelines prescribed in the rules.  Operator of the Bio - medical Waste Treatment Facility to apply for Grant of Authorization in form –I to MPPCB (The Prescribed Authority).

26. Cont. Occupier / institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling Bio-medical waste To apply for Grant of Authorization in form –I to MPPCB which is the Prescribed Authority. Bio-medical Waste shall be treated and disposed of in accordance with the Schedule -I and in compliance with the standards prescribed in Schedule –V . Every Occupier, shall set- up the requisite Bio-medical Waste Treatment Facilities like incinerator, Autoclave, Microwave system for treatment of waste, or , ensure requisite treatment of waste at common or any other waste treatment facility l records subject to the inspection & verification by the MPPCB Accident during handling & Transportation of BMW needs to be reported by the authorized person in Form – III to MPPCB forthwith

27. Setting up BMW Treatment Facility Occupier set up adequate treatment facilities like autoclave /microwave/ incinerator/ hydroclave, shredder prior to commencement of its operation or ensure that the wastes are treated at a common bio medical waste treatment facility or an authorized waste treatment facility . The new Rules have omitted incinerator as one of the pre requisites for on-site treatment of BMW. The omission is owing to the various environmental impacts of incineration . Promotion of new technologies for treatment and disposal of waste Deep burial for disposal of BMW has also been removed from the Rules. The Rules says it can be an option only in rural areas with no access to CTF with prior approval from the prescribed authority.

28. Health Waste Characterization

29. Types of Waste Liquid Wastes Approx . Quantity : 4 to 250 liters / bed / day Sewage from isolation wards, ICU’s toilets & urinals, Bed-bath, bathroom and hospital’s laundry Wash waters from laboratories , OPD, Dressing rooms & Operation theaters . Solid Wastes Approximate Quantity : 0.3 to 3.5 kg/bed/day Garbage 55% ( Bulk Density :330 kg/m 3 ,Cal.Value:1000 K.cal / kg, Moisture :40 % ) Bio – Medical Waste 13% Wasted body remains 05% (Blood, Cultures, Anatomical) Pharmaceutical and Chemical Wastes 02% Pathological Wastes 06% Sharp Objects 20% Pressurized Containers & Discarded Instruments 02% Radio actives Wastes 0.3%

30. Schedule I – Categories of Bio-Medical Waste Waste Category Waste Type Treatment & Disposal 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, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses Incineration/deep burial Category 3 Microbiology & Biotechnology Wastes: Wastes from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live or attenuated vaccines human and animal cell culture used in research and infectious agent from research and industrial laboratories, waste from production of biologicals, toxins, dishes and devices used for transfer of cultures Disinfection at source by chemical treatment or by Autoclaving / Microwaving / followed by Mutilation / shredding and after treatment final disposal in secured landfills or disposal of recyclable waste (plastic or glass ) through registered or authorized recycler

31. Cont. Waste Category Waste Type Treatment & Disposal Category 4 Waste Sharps (needles, glass syringes or syringes with fixed needles, scalpels ,blades, glass etc.) that may cause puncture and cuts(Includes both used and unused sharps). Disinfection (chemical treatment / destruction by needle & tip cutter, autoclaving/microwave and mutilation/shredding and final disposal through CBWTF / landfills Category 5 Discarded Medicines & Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Disposal in secured landfills or Incineration Category 6 Soiled Waste (Items contaminated with blood, & body fluids including cotton, dressings, soiled plaster casts, linens, beddings, other material contaminated with blood) Incineration

32. Cont. Waste Category Waste Type Treatment & Disposal Category 7 Infectious Solid Waste (waste generated from disposable items other than the waste sharps such as tubing's, hand gloves, saline bottles with IV tubes, catheters, glass, intravenous sets etc. Disinfection by chemical Treatment / autoclaving /Microwaving followed by mutilation / shredding & final disposal through registered recycler Category 8 Chemical Waste ( Chemicals used in production of biologicals, chemicals used in disinfection as insecticides etc.) Chemical treatment and discharge into drains for liquids and secured landfill for solids Category 9 Incineration Ash (ash from incineration of any bio-medical waste) Disposal in municipal landfill Category 10 Chemical Waste (chemicals used in production of biological, chemicals, used in disinfect ion, as insecticides, etc.) Chemical treatment   & discharge into drain for liquid & secured landfill for solids 

33. Schedule – II Color Coding and Type of Containers for different Bio-Medical Wastes Color Coding Type of Container Waste Category Treatment/ Disposal Yellow Non Chlorinated Plastic Bag 1, 2, 5, 6 Incineration/ Deep Burial Red Non chlorinated plastic bag / puncture proof Container for sharps 3, 4, 7 Chemical Treatment / Autoclaving / Microwaving and followed by Mutilation & shredding and disposal in landfills or disposal of recyclable waste Blue Non Chlorinated Plastic Bags/ Containers 8 Chemical Treatment and discharge into drains for liquids and secured landfill for solids Black Non Chlorinated Plastic Bags Municipal Waste Disposed as per the Municipal Solid Waste

34. Schedule – III Label for Bio-Medical Waste Containers/ Bags Bio-Hazard Cytotoxic Handle with Care Note: Label shall be non-washable and prominently visible Bio-Hazard Symbol Cytotoxic Hazard Symbol

35. Segregation and Packing Bio-medical waste shall not be mixed with other wastes Bio-medical waste shall be segregated into containers / bags at the point of generation in accordance with Schedule II The containers shall be labeled according to Schedule III.

36. Management of Hospital Waste Black Dustbin & Bags Paper waste, food waste and other non infectious wastes generated from the hospitals should be stored in black coloured bags / containers & Disposed as per MSW management rules, 2000

37. Waste Disposal – Black Bin For Noninfectious - Solid waste Paper/Plastic Kitchen Waste/Food Outer Packing/ Cardboard Wrappers General/ Kitchen Waste

38. Waste Disposal – Yellow Bin Soiled Linen, Contaminated Gowns, Drapes Bandages Dressing Discarded medicine/cytotoxic drugs Animal Waste Swaps

39. Cont. Human/Animal tissue organs or body parts Animal carcasses Any non plastic soiled waste( contaminated with blood/ body fluids ) Cotton dressings, bandages Linen beddings Soiled plaster casts, Soiled paper Used/ removed sutures

40. Waste Disposal – Red Bin All infectious waste sharp, non sharp & sharps plastic waste Urine bag Gloves Drains Pathological Waste Plastic Culture Plates & Tubes

41. Microbiology & Laboratory Waste, Waste Sharps Infectious Solid Waste (Category 3, 4, 7) Wastes from clinical samples, pathology, biochemistry, hematology, blood bank, laboratory cultures, stocks specimens of micro-organisms, live or attenuated vaccines human and animal cell culture used in research and infectious agent from research and industrial laboratories, waste from production of biologicals, toxins, dishes and devices used for transfer of cultures. Waste Sharps (needles, glass syringes or syringes with fixed needles, scalpels ,blades, glass etc.) that may cause puncture and cuts(Includes both used and unused sharps ). Infectious Solid Waste (waste generated from disposable items other than the waste sharps such as Gloves , tubing , saline bottles with tubes, Catheters , Urine bags, Blood bags, Syringes, Suction tips, Infected plastic containers, Rubber base materials, Retraction cords.

42. Personnel Safety Devices The use of protective gears should be made mandatory for all the personnel handling waste.

43. Storage In an area away from general traffic and accessible only to authorized personnel DO NOT store for more tha n 48 hours If for any reason it becomes necessary to store the waste beyond such period take measures to ensure that the waste does not adversely affect human health and environment

44. Transport Transport by wheeled trolleys/containers / carts only in vehicles authorized for the purpose They should be Easy to load and unload No sharp edges Easy to clean Trolleys ,Wheelbarrows: covered Disinfect daily

45. Transportation and Storage If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises , the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV.

46. Schedule – IV Label for Transportation of Bio-Medical Waste Containers/ Bags Waste Category No. Day ……….. Month ………….. Waste Class Year ……………………………….. Waste Description Date of Generation ………… Sender’s Name and Address Receiver’s Name and Address Phone No. …………………. Phone No. ……………………… Telex No. …………………… Telex No. ………………………... Fax No. ……………………… Fax No. …………………………… Contact Person …………. Contact Person ………………. In Case of Emergency, Please Contact Name & Address Phone No.

47. Schedule – V Treatment and Disposal Standard For Treatment And Disposal o f BMW Standard For Incinerator Standard For Autoclave Standard For Microwave

48. Please Remember The Primary responsibility of the disposal of the Bio-Medical Waste lies with the Generator

49. And Also Do Not Forget That Bio-medical waste shall not be mixed with other Wastes such as Municipal Waste Segregate the Bio-medical Waste in separate containers at point of generation (schedule-II) and label as prescribed (schedule-III) Biomedical waste that are to be transported, must be securely packed, and Labeled as per (schedule-IV ) Transportation of BM Waste is allowed only in vehicles authorized by the prescribed Authority A day -to -day record of the Quantity under different categories of the Bio – Medical Waste generated in premises must be maintained No untreated Bio-medical Waste shall be kept stored beyond 48 Hrs .

50. Legal Aspects The Contravention Of The Act, Rules, Orders & Directions may lead to legal action The punishment may lead to the imprisonment up to 5 years with fine up to Rs . 1 lakh For failure or continued contravention a fine @ Rs.5000 /Day may be charged If the failure or the contravention continues beyond one year, the imprisonment may be extended up to 7 years.

51. Incineration Combustion efficiency (CE) shall be at least 99.00%. The Combustion efficiency is computed as follows: C.E . = X 100 The temperature of the primary chamber shall be 800 +/-50 C The secondary chamber gas residence time shall be at least 1 (one) second at 1050 +/- 50 C Drawbacks: toxic products like furnaces and dioxins can cause air pollution  

52. Bio-Medical Wastes Destruction by Double Chambered Incinerator

53. Details of Double Chambered Incinerator

54. Incinerator Ash Disposal

55. Emission Standards Parameters Concentration mg/Nm 3 at (12% CO 2 correction) Particulate Matters 150 Nitrogen Oxide 450 HCl 50 Minimum stack height shall be 30 meters above ground Volatile organic compounds in ash shall not be more than 0.01%

56. Autoclave A temperature of not less than 121 C and pressure of 15 pounds per square inch (psi)for an autoclave residence time of not less than 60 minutes Validation test : Spot testing by Bacillus steareo-thermophilus spores on a spores strip with at least 1 x 10 4 Spores/ml Routine test : Chemical indicator strip/tape

57. Standard for Microwaving Should kill bacteria and other pathogenic organism Biological indicator bacillus subtilis CHEMICAL PROCESSES Dissolved chlorine dioxide, bleach (sodium hypochlorite), peracetic acid, or dry inorganic chemicals. To enhance exposure of the waste to the chemical agent, chemical processes often involve shredding, grinding, or mixing.

58. Treatment Technologies Treatment Technologies Incineration Autoclave Microwave Chemical Disinfection Plasma Pyrolysis Investment/ Operating Cost High Moderate High Low High Suitability of the Waste Not for Radioactive All except Pathological All Except Cytotoxic, Radioactive Liquid Waste All Ease of Operation No Yes Yes Yes No Waste Volume Reduction Significant Less Significant - Significant Odour Problems Yes Slight Slight Slight - Environmental Friendly No Yes Yes No Yes

59. Authorization Every occupier of an institution generating, collecting, receiving, storing, transporting, treating and /or handling Biomedical Waste shall apply on Form 1 for Authorization to the Board . The State Pollution Control Board are declared as prescribed Authority for grant of Authorization. The Board grants authorizations after satisfying itself.

60. Application for Authorization To The Prescribed Authority (Name of the State Govt./ UT Administration) Address: Particulars of Applicant Name of the Applicant (In block letters & in full ) Name of the Institution: Address : Tele No., Fax No. Telex No . Activity for which authorisation is sought: Generation Collection Reception Storage Transportation Treatment Disposal Any other form of handling Please state whether applying for rash authorisation or for renewal: (In case of renewal previous authorisation-number and date)

61. Cont. Address of the institution handling bio-medical wastes: Address of the place of the treatment facility: Address of the place of disposal of the waste : Mode of transportation (in any) of bio-medical waste: Mode(s ) of treatment : Brief description of method of treatment and disposal (attach details ): Category (see Schedule 1) of waste to be handled Quantity of waste (category-wise) to be handled per month Declaration I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information. I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfil any conditions stipulated by the prescribed authority . Date : Signature of the Applicant Place : Designation of the Applicant

62. Annual Report Every occupier/operator submit an annual report to the prescribed authority in Form II by 31 January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. The prescribed authority shall send this information in a compiled form to the Central Pollution Control Board by 31 March every year.

63. Maintenance of Records and Accident Reporting Every authorized person shall maintain records related to BMW All records shall be subjected to inspection and verification by the prescribed authority at any time In any accidents, the authorized person shall report the accident in Form III along with the remedial action taken to the prescribed authority forth with Setting Up A Cell or Unit for BMW Management The BMW 2011, Rules have also made mandatory for all the HCEs with 30 or more beds to set up a cell or unit to deal with the BMW management. The cell has to meet every six months and minutes of the meeting have to be submitted along with the Annual Report to the prescribed authority

64. Do’s and Don'ts Do’s The used product should be segregated The used product should be mutilated The used product is treated prior to disposal Use protective gear when handling waste Collect waste when the bin is 3/4 the full Clean spills with disinfectant Use trolleys & do not drag waste bags Don’ts Reuse plastic equipment Mix plastic equipment with other wastes Burn plastic waste Avoid needle stick injuries Avoid using common lift to move waste Avoid spillage

65. BMW Management Committee Head of the hospital : chairman Waste Mix officer (dev. and implementation plan) Members : HOD ’ s of all department Nursing superintendent, Head nurse, Sanitary inspector Chief pharmacist, Radiation officer Supply officer, Financial officer

66. Responsibility of BMC Day to day control of segregation, transport & disposal of BMW Co-ordinate with the store officer for continuous supply of basic items for BMWM Prepare guidelines for BMWM & distribute to all department Prepare BMW posters to raise awareness Arrange training programs on BMWM & safety measures for all categories of HCW Co-ordinate with HOD/In-charge of Dept . where deficiencies are pointed out Co-ordinate with Chhattisgarh Environment Conservation Board)

67. BMW Spills and Surface Disinfection Proper spill handling : Notify people in the area Don appropriate PPE Place absorbent material on spill Apply appropriate disinfectant – allow sufficient contact time (30 min ) Pick up material (watch for glass – use tongs or dust pan); dispose of material into biomedical waste Reapply disinfectant and wipe For large/high hazard spills use 10% hypochlorite For routine disinfection of surfaces where BMW is handled, use a 1:10 solution of freshly diluted bleach or 1% hypochlorite (ethanol evaporates too quickly!)

68. Hand Washing Hand washing is the single most effective way to stop the spread of disease. Make certain that jewelry is limited to wedding rings , certain areas such as OR < C-section , Cath Lab and NBN allow no jewelry. Nails should be kept short and clean . Gloves do not replace hand washing . Hand sanitizer may be used if no visible soiling is present and the sinks cannot be readily accessed. This is in every patient room. It can also be used when the water is out of service. Inspect your hands each time they are washed. Only use hospital approved soaps and lotions, do not bring in any from home Alcohol based hand rubs at point of care Sinks and clean running water Training

69. Steps to Effective Hand washing Thorough hand washing after any procedure involving nursing care or close contact with the patient is essential. Alcohol based hand antiseptics gaining importance where washing with water and soap are not practicable.

70. Bio-Medical Waste Management - Issues Not considered important Lack of interest from senior management No ownership of the process Awareness of problems Appreciate the need for constant monitoring Segregation of waste not taken seriously at user level Non compliance with color coding Monitoring segregation at source – low budgets allocated – costs are not always known/nor worked out properly Cost of color coding, staff, transport and disposal is a major deterrent Quantification of waste generated is not accurately done

71. Bio-Medical Waste Management – Challenges Establishing robust waste management policies within the Health Care Facility/organization Organization wide awareness about the health hazards Sufficient financial and Trained human resources needed Monitoring and control of waste disposal Clear responsibility and traceability for appropriate handling and disposal of waste.

72. Addressing the Issues Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal This is a long-term process, sustained by gradual improvements. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital . Man power needs and other resources for the BMWM of hospital to be addressed . Quality assessment of bio-medical waste management should be done from time to time. Segregated collection and transportation – need for Non-ambiguous color coding and labeling of wastes. Containers should be robust and leak proof Tracking of Bio Medical Waste up to point of Disposal . Proper treatment and final disposal.

73. Cont. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages . Safety of handlers is a big concern that is still not addressed adequately . Raising Awareness about risks related to health-care waste; training staff & Waste handlers on safe practices . Selection of safer & environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing waste . Issue of all protective clothing such as, gloves, aprons, masks etc. to all HCW & Waste handlers . Regular medical check-up (half-yearly) of staff associated with BMWM. Maintenance of Record registers for this purpose.

74. Conclusion Bio-medical waste programme cannot be successfully implemented without the willingness , self-motivation, and co-operation from all sections of employees of any health care setting . If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community. Individual participation is required . Municipality and government should pay importance to disposal of waste economically . Thus educating and motivating oneself first is important and then preach others about it.

75. Lets Make This World A Better Place to Live I n

76. THANK YOU