Bio-Medical Waste Management.pptx

types of biomedical waste, segregation, classification, sources, hazards and treatment like incineration, inertization, chemical treatment, biomedical waste rule

1. Bio-Medical Waste Management

2. The waste produced in the course of health-care activities carries a higher potential for infection and injury than any other type of waste. Therefore, it is essential to have safe and reliable method for its handling. Inadequate and inappropriate handling of health-care waste may have serious public health consequences and a significant impact on the environment. Appropriate management of health- care waste is thus a crucial component of environmental health protection, and it should become an integral feature of health-care services.

3. Definition According to Bio-Medical Waste (Management and Handling) 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 biologicals , and including categories as mentioned in schedule I in Table 4 (1).

4. Between 75 to 90 per cent of the waste produced by the health-care providers is non-risk or “general” health-care waste, comparable to domestic waste. It comes mostly from administrative and house keeping functions of the health- care establishments, and may also include waste generated during maintenance of health-care premises. The remaining 10—25 per cent health-care waste is regarded as hazardous and may create a variety of health risk. The classification of health-care waste is summarized in Table 1.

5. Sources of health-care waste The institutions involved in generation of bio-medical waste are: — Government hospitals. — Private hospitals. Nursing homes. Physician’s office/clinics. Dentist’s office/clinics. Dispensaries. Primary health centres . — Medical research and training establishments. — Mortuaries. — Blood banks and collection centres . — Animal houses. — Slaughter houses. Laboratories. Research organizations. Vaccinating centres , and Bio-technology institutions/production units. All these health-care establishments generate waste and are therefore, covered under Bio-Medical Waste (BMW) Rules .

6. Health-care waste generation Several surveys have provided an indication of typical health-care waste generation, and it shows that this differs not only from country to country but also within the country. Waste generation depends on numerous factors such as established waste management methods, type of health-care establishment, hospital specializations, proportion of reusable items employed in health-care, and proportion of patients treated on a day-care basis.

7. In middle and low income countries health-care waste generated is lower than in high-income countries. Developing countries that have not performed their own surveys of health-care waste, find the following estimates for an average distribution of health-care wastes useful for preliminary planning of waste management.

8. 80 per cent general health-care waste, which may be dealt with by the normal domestic, and urban waste management system; — 15 per cent pathological and infectious waste; — 1 per cent sharps waste; — 3 per cent chemical and pharmacological waste; — Less than 1 per cent special waste, such as radioactive or cytotoxic waste, pressurized containers, or broken thermometers and used batteries.

9. Table 2 shows average composition of waste obtained from 10 large hospitals in Mumbai, Kolkata, Delhi, and Nagpur during the period 1993—1996.

10. A survey done in Bangalore revealed that the quantity of solid wastes generated in hospitals and nursing homes generally varies from 1/2 to 4 kg per bed per day in Govt. hospitals, 1/2 to 2 kg per bed per day in private hospitals, and 1/2 to 1 kg per bed per day in nursing homes. The total quantity of hospital wastes generated in Bangalore is about 40 tonnes per day. Out of this nearly 45 to 50 per cent is infectious. Segregation of infectious wastes from non- infectious wastes is done only in about 30 per cent of hospitals.

11. Health hazards of health-care waste Exposure to hazardous health-care waste can result in disease or injury due to one or more of the following characteristics (a) it contains infectious agents; (b) it contains toxic or hazardous chemicals or pharmaceuticals; (c) it contains sharps; (d) it is genotoxic ; and (e) it is radio-active.

12. All individuals exposed to such hazardous health-care waste are potentially at risk, including those who generate the waste or those who either handle such waste or are exposed to it as a consequence of careless management. The main groups at risk are — medical doctors, nurses, health-care auxilliaries , and hospital maintenance personnel; patients in health-care establishments; — visitors to health-care establishments; — workers in support service allied to health-care establishments such as laundries, waste handling and transportation; and — workers in waste disposal facilities such as land-fills or incinerators including scavengers.

13. 1. Hazards from infectious waste arid sharps Pathogens in infectious waste may enter the human body through a puncture, abrasion or cut in the skin, through mucous membranes by inhalation or by ingestion. There is particular concern about infection with HIV and hepatitis virus B and C, for which there is a strong evidence of transmission vo health-care waste. Bacterias resistant to antibiotics and chemical disinfectants, may also contribute to the hazards created by poorly managed waste.

14. 2. Hazards from chemical and pharmaceutical waste Many of the chemicals and pharmaceuticals used in health-care establishments are toxic, genotoxic , corrosive, flammable, reactive, explosive or shock-sensitive. Although present in small quantity they may cause intoxication, either by acute or chronic exposure, and injuries, including burns. Disinfectants are particularly important members of this group. They are used in large quantities and are often corrosive, reactive chemicals may form highly toxic secondary compounds.

15. 3. Hazards from genotoxic waste The severity of the hazards for health-care worker responsible for handling or disposal of genotoxic waste is governed by a combination of the substance toxicity itself and the extent and duration of exposure. Exposure may also occur during the preparation of or treatment with particular drug or chemical. The main pathway of exposure is inhalation of dust or aerosols, absorption through the skin, ingestion of food accidentally contaminated with cytotoxic drugs, chemicals or wastes etc.

16. 4. Hazards from radio-active waste The type of disease caused by radio-active waste is determined by the type and extent of exposure. It can range from headache, dizziness and vomiting to much more serious problems. Because it is genotoxic , it may also affect genetic material.

17. 5. Public sensitivity Apart from health hazards, the general public is very sensitive to visual impact of health-care waste particularly anatomical waste.

18. Treatment and disposal technologies for health- care waste Incineration, used to be the method of choice for most hazardous health-care wastes, and is still widely used. However, recently developed alternative treatment methods are becoming increasingly popular. The final choice of treatment should be made on the basis of factors, many of which depend on local conditions.

19. 1. 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. The process is usually selected to treat wastes that cannot be recycled, reused or disposed off in a land fill site. The flow diagram of incinerator is as shown in Fig. 1.

20. Incineration requires no pre-treatment, provided that certain waste types are not included in the matter to be incinerated. Characteristics of the waste suitable for incineration are (a) low heating volume — above 2,000 kcal/kg for single—chamber incinerators, and Above 3,500 kcal/kg for pryolytic double-chamber incinerators; (b) content of combustible matter above 60 per cent; (c) content of non-combustible solids below 5 per cent; (d) content of non-combustible fines below 20 per cent; and (e) moisture content below 30 per cent .

21. 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 such as PVC; (e) waste with high mercury or cadmium content, such as broken thermometers, used batteries, and lead-lined wooden panels; and (f) sealed ampules or ampules containing heavy metals.

22. TYPES OF INCINERATORS Incinerators can range from very basic combustion unit that operates at much lower temperature to extremely sophisticated, high temperature operating plants. It should be carefully chosen on the basis of the available resources, the local situation, and the risk-benefit consideration.

23. Three basic kinds of incineration technology are of interest for treating health-care waste (a) Double-chamber pyrolytic incinerators which may be especially designed to burn infectious health-care waste; (b) Single-chamber furnaces with static grate, which should be used only if pyrolytic incinerators are not affordable; and (c) Rotary kilns operating at high temperatures, capable of causing decomposition of genotoxic substances and heat-resistant chemicals.

24. II. Chemical disinfection Chemicals are added to waste to kill or inactivate the pathogens it contains, 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.

25. Ill. Wet and dry thermal treatment WET THERMAL TREATMENT: Wet thermal treatment or steam disinfection is based on exposure of shredded infectious waste to high temperature, high pressure steam, and is similar to the autoclave sterilization process. The process is inappropriate for the treatment of anatomical waste and animal carcassess , and will not efficiently treat chemical and pharmaceutical waste.

26. SCREW-FEED TECHNOLOGY: Screw-feed technology is the basis of a non—burn, dry thermal disinfection process in which waste is shredded and heated in a rotating auger. The waste is reduced by 80 per cent in volume and by 20—35 per cent in weight. This process is suitable for treating infectious waste and sharps, but it should not be used to process pathological, cytotoxic or radio-active waste.

27. IV. 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. The efficiency of the microwave disinfection should be checked routinely through bacteriological and virological tests.

28. V. Land disposal MUNICIPAL DISPOSAL SITES: If a municipality or medical authority genuinely lacks the means to treat waste before disposal, the use of a landfill has to be regarded as an acceptable disposal route. There are two types of disposal land—open dumps and sanitary landfills. Health-care waste should not be deposited on or around open dumps. The risk of either people or animals coming into contact with infectious pathogens is obvious.

29. Sanitary landfills are designed to have at least four advantages over open dumps geological isolation of waste from the environment, appropriate engineering preparation before the site is ready to accept waste, staff present on site to control operations, and organized deposit and daily coverage of waste.

30. VI. 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. A homogeneous mass is formed and cubes or pellets are produced on site and then transported to suitable storage sites.

31. National legislation is the basis for improving health-care waste disposal practices in any country. It establishes legal control, and permits the national agency responsible for the disposal of health-care waste, usually the Ministry of Health, to apply pressure for their implementation. The Ministry of Environment may also be involved. There should be a clear designation of responsibilities before the law is enacted.

32. The United Nations Conference on the Environment and Development (UNCED) in 1992 recommended the following measures (a) Prevent and minimize waste production (b) Reuse or recycle the waste to the extent possible (c) Treat waste by safe and environmentally sound methods, and (d) Dispose off the final residue by landfill in confined and carefully designed sites.

33. Bio-Medical Waste Management in India Bio-Medical Waste (Management and Handling) Rule 1998, prescribed by the Ministry of Environment and Forests, Government of India, came into force on 28th July 1998. This rule applies to those who generate, collect, receive, store, dispose, treat or handle bio-medical waste in any manner. Table 4 shows the categories of bio-medical waste, types of waste and treatment and disposal options under Rule 1998.

34. The bio-medical waste should be segregated into containers/bags at the point of generation of the waste. The colour coding and the type of containers used for disposal of waste are as shown in Table 5. Fig. 2 shows the label for bio-hazards symbol and cytotoxic hazard symbol which should be prominently visible and non-washable.

35. Bio-Medical Waste Management Rules 2016 Biomedical waste comprises human & animal anatomical waste, treatment apparatus like needles , syringes and other materials used in health care facilities in the process of treatment and research. This waste is generated during diagnosis, treatment or immunisation in hospitals, nursing homes, pathological laboratories, blood bank, etc. Total bio-medical waste generation in the country is 484 TPD from 1,68,869 healthcare facilities (HCF), out of which 447 TPD is treated

36. Scientific disposal of Biomedical Waste through segregation, collection and treatment in an environmentally sound manner minimises the adverse impact on health workers and on the environment. The hospitals are required to put in place the mechanisms for effective disposal either directly or through common biomedical waste treatment and disposal facilities. The hospitals servicing 1000 patients or more per month are required to obtain authorisation and segregate biomedical waste in to 10 categories, pack five colour bacgs for disposal. There are 198 common bio-medical waste treatment facilities (CBMWF) in operation and 28 are under construction. 21,870 HCFs have their own treatment facilities and 1,31,837 HCFs are using the CBMWFs.

37. The quantum of waste generated in India is estimated to be 1-2 kg per bed per day in a hospital and 600 gm per day per bed in a clinic. 85% of the hospital waste is non-hazardous, 15% is infectious/hazardous. Mixing of hazardous results in to contamination and makes the entire waste hazardous. Hence there is necessity to segregate and treat. Improper disposal increases : risk of infection; encourages recycling of prohibited disposables and disposed drugs; and develops resistant microorganisms.

38. Salient features of BMW Management Rules, 2016 The ambit of the rules has been expanded to include vaccination camps, blood donation camps, surgical camps or any other healthcare activity; Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years; Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilisation on-site in the manner as prescribed by WHO or NACO; Provide training to all its health care workers and immunise all health workers regularly;

39. Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal; Report major accidents; Existing incinerators to achieve the standards for retention time in secondary chamber and Dioxin and Furans within two years; Bio-medical waste has been classified in to 4 categories instead 10 to improve the segregation of waste at source; Procedure to get authorisation simplified. Automatic authorisation for bedded hospitals. The validity of authorization synchronised with validity of consent orders for Bedded HCFs. One time Authorisation for Non-bedded HCFs;

40. The new rules prescribe more stringent standards for incinerator to reduce the emission of pollutants in environment; Inclusion of emissions limits for Dioxin and furans; State Government to provide land for setting up common bio-medical waste treatment and disposal facility;

41. No occupier shall establish on-site treatment and disposal facility, if a service of `common bio-medical waste treatment facility is available at a distance of seventy-five kilometer. Operator of a common bio-medical waste treatment and disposal facility to ensure the timely collection of bio-medical waste from the HCFs and assist the HCFs in conduct of training .

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