BIO MEDICAL WASTE MANAGEMENT for bsc students.pptx

biomedical waste management

1. BIO MEDICAL WASTE MANAGEMENT INTRODUCTION Biomedical or hospital waste is any kind of waste containing infections materials. It may also include waste associated with the generation of biomedical waste that visually appears to be medical. Biomedical waste management is a crucial aspect of public health and environmental protection. It refers to the proper handling, collection, transportation, treatment and disposal of waste generated from healthcare facilities, biomedical research laboratories and other medical related activities.

2. DEFINITION Biomedical waste is any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining to, or in the production or testing of biological products. - Samta Soni 2013

3. CLASSIFICATION OF BIO-MEDICAL WASTE Infectious waste Pathological waste Sharps Pharmaceutical waste Genotoxic waste Chemical waste Wastes with high content of heavy metals Pressurized containers Radio active waste.

4. INFECTIOUS WASTE Infections waste suspected to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient quantity to cause diseases in susceptible hosts. THIS CATEGORY INCLUDES Cultures and stocks of infectious agents from laboratory work. Waste from surgery on patients with infectious diseases. Infected animals from laboratories.

5. PATHOLOGICAL WASTE Pathological waste is a type of biomedical waste that includes human or animal tissue, organs, body parts, or fluids removed during surgery, autopsy or other medical procedures. This category of waste is highly infectious and poses significant health and environmental risks if not managed properly.

6. SHARPS These are items that could cause cuts or puncture wounds including, Needles Scalpel and other blades Knives Infusion sets Saws Broken glass and nails

7. PHARMACEUTICAL WASTE Expired or unused medications and drugs. It also includes Vaccines and sera GENOTOXIC WASTE Genotoxic waste is highly hazardous and may have Muto genic, teratogenic or carcinogenic properties. It raises serious safety problems both inside hospitals and after disposal, and should be given special attention. It includes certain cytostatic drugs, vomit, urine, or feces from patients treated with cytostatic drugs, chemicals, and radio-active material.

8. CHEMICAL WASTE It consists of discarded solid, liquid and gaseous chemicals used in medical laboratories, research and other medical practices. Chemical waste may be hazardous or non hazardous. It is considered to be hazardous if it has at least one of the following properties. Toxic Corrosive(acids of PH <2 and bases of PH>12) Inflammable Reactive Genotoxic.

9. WASTES WITH HIGH CONTENT OF HEAVY METALS It represents the subcategory of hazardous chemical waste and is usually highly toxic. It includes Batteries Broken thermometer Blood- pressure gauges.

10. PRESSURIZED CONTAINERS Many type of gas are used in health care, and are often stored in pressurized cylinders, cartridges and aerosol cans Most common gases used in health care includes, Anesthetic gases Ethylene oxide Oxygen Compressed air.

11. RADIO-ACTIVE WASTE Materials contaminated with radioactive substances used in medical imaging and therapy. It includes the x-rays, alpha and beta particles and r-rays emitted by radio active substances. Positively charged electrons with significantly ability to penetrate human skin, they affect health through ionization of intracellular proteins and its components. r- rays, are electromagnetic radiations similar to X- rays but to shorter wave length. Their penetrating power is high and lead shielding is required to reduce intensity.

12. DISTRIBUTION OF BIO-MEDICAL WASTE(WHO) Non- infectious waste – 85% Radioactive, cytotoxic and heavy metals – 1% Sharps – 1% Chemical and pharmaceutical waste – 3% Pathological and infectious waste – 10% General waste generated – 0.5 to 2kg/ bed/ day. Bio medical waste – 100 – 150gm/ bed/ day.

13. BMW MANAGEMENT – 3 CONCEPT Reuse Reusing an item for the same or another purpose as well as passing on things to others instead of throwing them away. Recycling Whatever waste cannot be reused should be recycled. This is a process that transforms waste into raw materials that can be used to make new products.

14. STEPS IN THE MANAGEMENT OF BIO-MEDICAL WASTE

15. SEGREGATION Waste should be separated at the point of generation into different categories based on its type, such as sharps, infectious wastes, chemicals wastes etc.. This segregation ensures safer handling and proper treatment.

16. COLLECTION AND STORAGE Collected waste should be stored in colour- coded and labelled containers that are leak proof, puncture – resistant, and sturdy. Each category of waste requires specific containers to prevent cross- contamination.

17. TRANSPORTATION Biomedical waste should be transported from healthcare facilities to treatment or disposal facilities using authorized and registered vehicles that comply with safety standards.

18. TREATMENT Biomedical waste undergoes various treatment processes depending on its classification common treatment methods include incineration, autoclaving microwaving, chemicals disinfection and shredding. The goal is to destroy pathogens and reduce the volume of waste before final disposal.

19. DISPOSAL After treatment the waste is disposed of according to local regulations and guidelines. Final disposal methods may include landfilling for non- hazardous waste and special sanitary landfills for treated and safe bio-medical waste.

20. RECORD KEEPING AND TRAINING Proper documentation of waste generation, collection, treatment, and disposal activities are essential. Healthcare staff should receive regular training on bio-medical waste management protocols to ensure compliance and safety.

21. DISPOSAL TECHNIQUES CHEMICAL DISINFECTION Solid waste must be disinfected before they are sent for final disposal. Chemical disinfection is most appropriate method for to treat the liquid waste such as blood, urine and stool or hospital sewage. By using chemical disinfectants such as bleaching powder, glutaraldehyde, alcohols or quaternary ammonium compounds.

22. THERMAL MEASURES WET THERMAL TREATMENT (Autoclave) It is effective method of sterilization for microbiology and biotechnology waste. The infectious wastes are steam heated at specified temperature and pressure for specific period of time. Decontamination occurs when steam penetrates the waste.

23. DRY THERMAL TREATMENT (HYDROCLAVE) In this method shredded infectious waste is exposed to high temperature high pressure steam like auto clawing. The wastes are treated in a rotating auger. Waste is reduced by 80% in volume and 20-30% in weight. Suitable for treating infectious wastes and sharps. Not used to process pathological, cytotoxic, or radio active waste.

24. INCINERATION It is a high temperature dry oxidation process that reduces organic, incombustible matter. It also reduces the volume and weight of waste. Burning the waste in simple kiln up to 1000* c Organic and combustible waste is changed to inorganic and in combustible and finally to fly ash. Ash is collected in thick puncture proof bags and stored for periodic dump into community landfill.

25. IRRADIATION This method involves waste sterilization by exposing waste to cobalt sources cobalt emits gamma rays that kill all the microbes in wastes.

26. INERTIZATION In this process cement and other substances are mixed with waste before disposal. Mixing of cement etc.. Reduces risk migrating toxic substances into surface water or ground water. After making homogenous mixture, cubes are prepared at site, and then transported to final disposable site.

27. SHREDDING It is a process by which waste are deshaped or cut into smaller pieces so as to ,make the wastes unrecognizable. It helps in prevention of reuse of bio-medical waste and also acts as an identifier that the wastes have been disinfected and are safe to dispose-off.

28. LANDFILL Landfill means disposal of residual solid wastes on land in a facility designed with protective measures against pollution of ground water, surface water, air and ground. Sanitary landfills are specially constructed for disposal of nonbiodegradable infectious hospital wastes. It should have an impermeable day and pebble base Stored earth for covering at the end of each disposal operation Frequent spray of insecticide is done.

29. DEEP BURIAL Wastes belonging to category 1,3,6 collected in yellow containers are disposed by this method.

30. METHODS OF DISPOSAL OF BIO-MEDICAL WASTE AND THEIR SEGREGATION WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOAL OPTION CATEGORY 1 Human Anatomical waste(Human tissues, Organs, Body parts) Incineration / deep burial. CATEGORY 2 Animal waste Animal tissues, organs, body parts, car cases, bleeding parts, fluid, blood and experimental animals used in research waste generated by veterinary hospitals and colleges discharge from hospitals. Incineration / deep burial.

31. WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOAL OPTION CATEGORY 3 MICROBIOLOGY & BIO-TECHNOLOGY WASTE Wastes from laboratory cultures, stocks or specimen of live micro-organism, 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 transfers of culture. Local autoclaving microwaving incineration. CATEGORY 4 WASTES 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 and mutilation shredding.

32. WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOAL OPTION CATEGORY 5 DISCARDED MEDICINE AND CYTOLOXIC DRUGS Wastes comprising of outdated, contaminated and discarded medicines. Incineration/ destruction and drugs disposal in secured. CATEGORY 6 SOLID WASTE Items contaminated with body fluids including cotton, drevings , solid plaster crests, lines bedding and other material contaminated with blood. Incineration/ autoclaving microwaving

33. WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOAL OPTION CATEGORY 7 SOLID WASTE Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous etc… Disinfecting by chemical treatment / autoclaving microwaving and mutilation / shredding. CATEGORY 8 LIQUID WASTE Waste generated from the laboratory and washing, cleaning, housekeeping and disinfecting activities. Chemical treatment and discharge into drains.

34. WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOAL OPTION CATEGORY 9 INCINERATION ASH Ash from incineration of any biomedical waste. Disposal in municipal landfill CATEGORY 10 CHEMICAL WASTE Chemical 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.

35. COLOUR CODING GREEN General wastes ( paper, food items, clothes etc..) BLACK Non-biodegradable wastes( water bottles, plastic covers etc…) RED(Recyclable Infected Plastic) Tubings , bottles, IV tubes/ sets/ catheters, urobags , syringes/ gloves etc…

36. YELLOW- INFECTED WASTES Human and animal anatomical wastes Solid wastes( contaminated with blood and body fluids-dressing, swabs, plaster, casts, linen, pads, mask and gowns etc..) Blood bags Chemical wastes Lab wastes Expired/ discarded medicines Discarded linen/ mattresses.

37. CYTOTOXIC DRUGS Cytotoxic drugs contaminated items E.g. anti cancerous drugs. BLUE COLOUR Waste glass ware Broken glass Medicine vials/ ampules Metallic body implants.

38. WHITE COLOUR Waste metal sharps Needles, scalps, blades Syringes with fixed needles Guidewires NOTES All plastic bags should be as per BIS standard and all plastic bags should be properly sealed when 3/4 th full, labelled and recorded before disposal.

39. RULES The government of India made biomedical waste management and handling rules in July 1998 Government of India biomedical waste management rules march 2016 Government of India biomedical waste management rules revised in 2018 During covid-19 some of the changes has been made in collection and disposal of biomedical waste.

40. BIOMEDICAL WASTE RULES 2016 Barcode system for bags & containers Onsite waste management can be established if nearest CTF is 75kms away Segregated collection – four categories Prior approval for ‘deep burial’ Provision of safe ventilated & secure location for storage of segregated waste Ensure occupational safety of health care worker and provide them PPE.

41. AS PER BMW MANAGEMENT(AMENDMENT) RULE 2019 Healthcare facilities less than ten beds shall have to comply with the output discharge standards for liquid waste by 31 st December 2019 In hospital liquid efficient system be placed at Laboratory Operation theatre Labour room Wherever liquid waste is generated

42. DIFFERENTIATE OF BIOMEDICAL WASTE 2016 VS 2018 BIOMEDICAL WASTE 2016 BIOMEDICAL WASTE 2018 Expired drugs in black colour Expired drugs in yellow colour bins Cap, linen, mask in general waste Cap, linen, mask in yellow bin Pretreated in collection area itself No Pretreatment is essential Non-chlorinated bags should be used. Non-chlorinated bags should be used.

43. BIO-MEDICAL WASTE IN COVID-19 Using separate color coded and labelled bins Using double layers collection bags Should be handled by authorized staff Kept in a separate temporary storage room Use red bins for infectious plastic items like aprons, goggles and face shield Use yellow bins for cap, mask and non plastic infectious items.

44. PENALTY OF NON COMPLAINCE OF BIOMEDICAL WASTE Any violator of the biomedical waste management rules 2016 “shall be liable for action under section 5 and section 15. This involves imprisonment up to 5 years or penalty up to rupees 1 lakh or both of the act in case of any violation.

45. CONCERNS WITH BIOMEDICAL WASTE LAND POLLUTION If not treated and dumped into landfills then is a high chance for heavy metals like cadmium, lead, mercury etc.. Get released. Further there is a chance these metals get absorbed by plants and can then enter the food chain also. AIR POLLUTION Pathogens presents in the waste can enter and remain in the air for a long period in the form of spores or pathogens.

46. RADIOACTIVE POLLUTION Hospitals are increasingly using radioactive isotopes used in hospitals for diagnostic and therapeutic applications. The main radio isotopes used in hospitals are technetium – 99m iodine – 131 etc.… these have carcinogenic properties. EPIDEMIC According to WHO study improper waste management is one of the major causes of an increase in infectious diseases globally.

47. OPERATIONAL HEALTH HAZARDS Improper handling of biomedical waste might lead to injuries from sharps and exposure to harmful radioactive wastes. INCREASED ANTIMICROBIAL RESISTANCE (AMR) Biomedical wastes aggravate the problem of AMR. Ever since the pandemic the use of biocides( sanitizers, disinfectants and antibiotics) increased manifold.

48. CHALLENGES IN INDIA Increase in waste Poor compliance of BMW rules Non segregation Improper disposal Lack of infrastructure.

49. GOOD PRACTICES OF HANDLING BIOMEDICAL WASTE Biomedical waste covered will be packed once filled 2/3 rd of container. Bags once tied should not be reopened Labeling of biomedical waste cover is must with date, station of category of waste Weighing of biomedical waste done at the point of waste generation and documented of for statistical Purpose and billing Specially designated waste transport routes Special timing for transportation of biomedical waste

50. Dedicated trolleys to transport biomedical waste All bins, bags and trolleys used for transport of biomedical waste should contain biohazard symbols. Waste collection bins should be covered with lid Segregated biomedical waste shall be stored in a designated area inside the hospital campus in a safe and secure manner Linkage with common treatment facility if located within 75kms or approval for deep burial pit Good lighting, ventilation, adequate water supply, hand wash and drainage facility. Health care personnel shall use appropriate and adequate personal protective equipment's when handling biomedical waste Blood spills mercury has to be discarded in yellow color bin Time limit of biomedical waste stored in hospital 48hours after generation.

51. RESPONSIBILITIES OF NURSES IN BIIOMEDICAL WASTE MANAGEMENT Nurses are the one at first level professional who provide direct patient care During the all nursing activities generated biomedical waste must be taken care of and handled properly Keep inventory of material such as bags, containers and protecting aids Waste bags must be tightly closes or sealed Training of new nurses Nurses has to monitor adaption of proper biomedical waste management practice in OT, labour room, wards, OP departments etc.…

52. Recording of the generation and disposal of the waste to be maintained Nursing superintendent and ward incharges should be over all incharge of biomedical waste management Ensure supply of all items required for the biomedical waste and its proper management Ensure proper segregation of waste Ensure that injections after use never recapped the needle must be mutilated and disinfected and put in white transparent puncture proof containers.