Bio Medical Waste management microbiology.pptx

Bio Medical Waste management

1. Biomedical Waste Management Competency Covered MI 8.5, 8.6

2. Chapter Preview Biomedical Waste Rule Waste Segregation in Hospitals Treatment and Disposal Methods 2

3. Definition 3 Wastes that are generated during the laboratory diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production of biologicals.

4. Waste Generated in Hospitals 4 T he quantity of solid waste generated in hospitals varies from 1/2 to 2 kg/bed. BMW accounts for a minor proportion of the total waste generated in hospitals ( ̰ 250gms/bed/day )

5. Waste Generated in Hospitals 5 In developing countries, the waste generated falls into two categories: General (non-hazardous solid waste, 80 % ) A large amount of waste falls in the general waste category which may be disposed of with the usual domestic and urban waste management system. They are not considered as BMW and should not be mixed BMW. Biomedical waste: includes infectious waste ( 10% ) and chemical/radioactive waste ( 5% )

6. Hazards Associated with BMW 6 Inappropriate and inefficient disposal of BMW can lead to infectious hazards, malignancies, malformations and environmental pollution not only to the current generation but also for future generations. The various hazards are:

7. Hazards Associated with BMW 7 Hazards from infectious wastes- T his is the component of hospital waste that produces maximum hazards. Pathogens in Infectious waste may infect HCWs by entering through ingestion, inhalation or direct skin-to-skin contact and can cause various types of infections such as gastrointestinal, respiratory, skin infections etc. Hazards from infectious sharps – leads to transmission of blood borne viruses.

8. Hazards Associated with BMW 8 Hazards from chemical wastes- They include laboratory reagents, disinfectants and waste with high content of heavy metals e.g mercury from broken thermometers. Most chemicals are toxic, corrosive, explosive, and flammable and some may cause physical injuries and chemical burns. Pharmaceutical waste- They include expired, unused and contaminated drugs, vaccines, sera etc. Exposure to these agents may cause several adverse effects depending upon the nature of the pharmaceutical waste.

9. Hazards Associated with BMW 9 Hazards from cytotoxic waste- C ytotoxic drugs used in the treatment of cancers and autoimmune diseases are extremely hazardous to the environment and human health, owing to their mutagenic , teratogenic or carcinogenic properties. Hazards from radioactive waste- They include materials contaminated with radionuclides. They are produced as a result of procedures performed by radiology and nuclear medicine departments. They are genotoxic , in higher doses can cause severe injuries, including tissue destruction, necessitating the amputated body parts.

10. Situation in India 10 According to the Ministry of Environment and Forests, gross generation of BMW in India is about 484 TPD ( only 447 TPD is treated) Karnataka tops the chart among all the states in generation of BMW followed by Maharashtra.

11. Waste management Hierarchy 11 Waste management hierarchy is largely based on the concept of the “3Rs ” Reduce Recycle Recover If none of these methods is available, then the last method opted is disposal.

12. Prevent and reduce: The most preferable approach, is to prevent or reduce the production of waste as far as possible. Reuse and recycle: T he next best option is to reuse the waste as such if possible or after recycling. 12 Waste management Hierarchy

13. Recover: W here practicable, recovering waste items for secondary use can be done. It is of two types: Energy recovery, whereby waste is converted to fuel for generating electricity or for direct heating. Waste recovery, is a term used for composting of organic waste matter to produce compost or soil conditioner which can be used in agriculture. 13 Waste management Hierarchy

14. Treatment 14 Wastes that cannot be recycled or recovered, can be subjected to treatment by various methods such as incineration. Note: Treatment is also necessary for the biomedical waste before sending for recycling or recovery as these wastes are potentially infectious. This is usually carried out by the autoclave or microwave (explained later) • Disposal: It involves disposal of the waste in landfill or dump yard. This is the least preferable option among all waste management strategies.

15. BIOMEDICAL WASTE RULE, INDIA 15

16. BIOMEDICAL WASTE RULE, INDIA 16 MoEF - formulated BMW rule in 1998 , which had classified the waste into 10 categories - segregated into five color coded containers. Considerable overlapping between categories - created ambiguity and confusion. New BMW guideline - published in 2016 - amendment added in 2018 and 2019

17. BMW It was implemented with a vision of simplifying categorization of BMWs, while improving the ease of segregation, transportation and disposal methods to decrease environmental pollution According to this new rule, there are four categories of BMWs, each is segregated by a single color-coded container. 17

18. Steps of BMW Management 18 Waste segregation (at the point of generation) into color coded containers Pre-treatment for laboratory liquid waste Transport of waste from generation site to central storage area of the hospital Transport of waste from central storage area to common bio-medical waste treatment facility (CBMWTF) Treatment and/or disposal (within 48 hours of generation).

19. Waste Segregation in Hospitals 19 According to BMW Rule (2016), segregation should be done by using containers of four different colors , each is designated for segregation of a particular waste category. Yellow bag —for infectious non-plastic waste Red bag —for infectious plastic waste White or translucent sharp container (puncture-proof box)—for metal sharps Blue container (puncture-proof box)—for broken glass items and metal implants

20. Biomedical Waste Management Rule, India, 2016 (including the amendment added in 2018 and 2019) 20

21. Biomedical Waste Management Rule, India, 2016 (including the amendment added in 2018 and 2019 ) 21

22. 22 Biomedical Waste Management Rule, India, 2016 (including the amendment added in 2018 and 2019 )

23. 23 Biomedical Waste Management Rule, India, 2016 (including the amendment added in 2018 and 2019 )

24. G eneral principles of segregation, transport and storage of BMW. Waste receptacles: The waste receptacles should have the following properties- Plastic bags must be labelled with biohazard logos and should be non inflammable, autoclave stable and non chlorinated with a thickness of ≥ 50µm. Containers should have well-fitting lids either removable by hands or operated by a foot pedal. Sharp box should be puncture-proof, leak-proof and tamper-proof impermeable container. 24

25. Importance of segregation: S egregation is the most crucial step in BMW management. Wrong segregation may lead to serious consequences such as: Needle stick injury transmitting hepatitis B or HIV(if sharp items are segregated into yellow or red bags ). Production of carcinogens(if plastic items are wrongly segregated into yellow bags and subjected to incineration, leads to production of carcinogenic furans) . 25 G eneral principles of segregation, transport and storage of BMW

26. Securement: All the bags used for waste collection need to be sealed once they are filled to ¾ of their capacity. Labelling: B ags and containers should be labelled properly with the date and place. Pre-treatment: T he laboratory liquid waste should always be pre- treated either with chemical (1-2% hypochlorite) or autoclave before segregating into appropriate containers. 26 G eneral principles of segregation, transport and storage of BMW

27. Transport: The waste should be transported within 24 hrs by dedicated trolley to the centre BMW storage facility of the hospital. Separate routes should be used for transport to prevent exposure to staff and patients and to minimize the passage of loaded cards through patient care and other clean areas. Interim storage of the waste at ward is strongly discouraged. 27 G eneral principles of segregation, transport and storage of BMW

28. Central storage area: This is a temporary storage facility present within a hospital where different types of wastes should be brought for safe retention until it is treated or collected for transport to CBMWTF. PPE: HCWs handling BMW during transport or in storage area should wear appropriate personal protective equipment such as heavy duty gloves, 3 – ply mask, gowns and gumboots. 28 G eneral principles of segregation, transport and storage of BMW

29. Logos used for segregation of biomedical waste 29

30. Treatment and Disposal Methods 30 As per the mandate of the BMWM rules, 2016, the final disposal and recycling must be performed at common biomedical waste treatment facility (CBMWTF). Only when there is no CBMWTF within 75 km , the hospital can create its own the disposal facility. The following are the methods used for treatment and disposal of waste:

31. Incineration 31 High temperature (800-1200°C) dry oxidation process that reduces organic and combustible waste into nonorganic incombustible matter, resulting in a very significant reduction of waste volume and weight. Done for those wastes that cannot be reused, recycled or disposed of in a landfill site.

32. Incineration 32 Example - human and animal anatomical waste, microbiological waste, solid non-plastic infectious waste. Halogenated plastics such as PVC should never be incinerated as it generates furans which are carcinogenic.

33. Autoclave 33 Thermal process - steam is brought into direct contact with waste in a controlled manner and for sufficient duration to sterilize the wastes. It is mainly used for the treatment of infectious plastic and sharp waste .

34. Chemical Disinfection 34 A chemical such as hypochlorite 1-2% is mixed to waste which results in disinfection. More suitable for liquid waste such as discarded blood and body fluid and also for hospital sewage.

35. Effluent Treatment Plant 35 The liquid waste (effluent) generated in the hospital if mixes directly with groundwater it can create significant health risks. Therefore, it is first subjected to chemical treatment and then is drained into effluent treatment plant (ETP). ETP removes the suspended solids and organic matter in wastewater and then disinfects the wastewater (with hypochlorite) and finally drain the water to municipal drainage.

36. Microwaving 36 Microwaves are radio-frequency waves, used at a frequency of 2450 MHz. They produce friction of water molecules which generates heat. Large size microwaves are used for disposal of BMW, mainly infectious plastic and sharp wastes.

37. Hydroclaving 37 Low-temperature steam sterilizer, involving steam treatment with fragmentation and drying of waste. It breaks up the waste into small pieces of fragmented material; thus obviates post cycle shredding (unlike autoclave).

38. Shredder 38 Process by which wastes are de-shaped or cut into smaller pieces so as to make the wastes unrecognizable. It helps in prevention of reuse of BMW and also helps to reduce the waste volume.

39. Deep Burial 39 Deep burial is a pit dug about two meters deep. It needs to be half filled with waste, and then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil. The ground water level should be a minimum of six meters below the lower level of deep burial pit.

40. Sharp Pit 40 Constructed within the hospital premises. Provides an alternative method for disposal of the sharp waste generated from the facility.

41. Encapsulation 41 Involves filling the containers with waste, adding immobilizing material and sealing the containers, to prevent the access to unscrupulous activities. The process uses cubic boxes made up of metallic drums which are three quarters filled with sharps or chemicals or pharmaceutical wastes  then filled with a medium such as plastic foam, cement mortar or clay material.

42. Inertization 42 Involves mixing waste with cement and other substances before disposal to minimize the risk of toxic substances contained in the waste migrating to surface or ground water. It is especially suitable for pharmaceuticals and for incinerated ashes with a high metal content.

43. Plasma Pyrolysis 43 Uses ionized gas in the plasma state to convert electrical energy to temperatures of several thousand degrees using plasma arc torches or electrodes. The system provides high temperatures combined with high UV radiation flux which destroys pathogens completely.

44. Disposal of Cytotoxic Drug Waste 44 Expired cytotoxic drugs to be returned back to the manufacturer or supplier or CBMWTF for incineration at >1,200°C or encapsulation or plasma pyrolysis at >1,200°C.

45. Disposal of General Waste (Solid Waste) 45 Constitute the large component of hospital waste (80%). They are not biomedical waste - their disposal can be carried out by several strategies. Composting: It is the decomposition of organic matter by microorganism in warm moist environment.

46. Disposal of General Waste (Solid Waste ) 46 Waste-to-energy - by various methods such as incineration, pelletisation , biomethanation etc. Recycling of the waste Landfilling in dump yard (least preferred method)

47. MONITORING OF BMW MANAGEMENT 47

48. MONITORING OF BMW MANAGEMENT 48 Monitoring is an essential component of managing biomedical waste in the hospital. BMW management committee should be formed, which serves several functions: (1) to oversee the implementation of BMW practices, (2) to educate HCWs about BMWM practices, and (3) to monitor BMW management in a hospital.

49. 49 Monitoring of BMW management practices can be carried out through following ways: Biomedical waste segregation audit by direct observation Biomedical waste segregation audit by CCTV camera Onsite inspection of BMW segregation at common storage area Conducting surveys through structured questionnaires Barcoding -based tracking of BMW, starting from segregation to disposal. MONITORING OF BMW MANAGEMENT

50. EXPECTED QUESTIONS I. Write short notes on: 1 . Categories of biomedical waste. 2 . Disposal methods available for biomedical waste. 3 . Type of containers used for disposal of biomedical waste . 50

51. 51

52. II. Multiple Choice Questions ( MCQs ): 1 . Anatomical waste should be segregated in which color bags? a . Yellow b . Red c . Blue d. Black 52

53. 2. Microbiological waste should be segregated in which color bags? a . Yellow b. Red c . Blue d . Black 53

54. 3 . Sharps should be segregated in which color box? a. Yellow b . Red c . Blue d . White 54

55. 4 . Solid waste (items contaminated with blood and body fluids including cotton, dressings) belong to which category of biomedical waste? a. Yellow b. Red c . Blue d . White 55

56. 5. Plastic infectious items should be segregated in which color bag? a . Yellow b. Red c . Blue d . White 56

57. 6 . Before segregation of microbiological wastes, pretreatment with what concentration of hypochlorite is recommended? a . 1–2% b . 5% c . 10% d . 15% 57

58. 7. Cytotoxic drugs used in the treatment of cancers and autoimmune disorders are extremely hazardous to the environment and human health owing to their mutagenic, teratogenic, or carcinogenic properties. All of the following are the recommended methods for the disposal of cytotoxic drug waste, except : a . Incineration b . Encapsulation c . Autoclave d . Plasma pyrolysis 58

59. 8 . Gloves should be segregated in which color bags? a. Yellow bag b. Red bag c . Blue bin d . White/translucent bin 59

60. 9 . Which of the following does biomedical segregation refer to ? a. Seperation of the waste at the point of generation b. Categorising items at the site of disposal c . C ollecting waste in a single, segregated bag to keep separately in the hospital d . Weighing each segregated item separately prior to disposal 60

61. 10 . Metallic body implants waste should be segregated in which color bags? a . Yellow b. Red c . Blue d . Black 61

62. 11 . How may categories of biomedical waste management are there? a. Five b. Seven c . eight d . four 62

63. 12 . What colour codes is used for plastic bags for segreagation of biomedical waste? a. Yellow b . Red c . blue d . all of the above 63

64. 13 . What is the most commonly used method for the treatment of microbiological waste? a. Autoclave b. Microwaving c . Plasma pyrolysis d . N one of the above 64