Biomedical waste edited

Biomedical waste is very important to every person involved in the medical field and for normal lay person too. Without it's knowledge any treatment is incomplete.

1. Biomedical Waste Management Moderator Dr A.K.Srivastava Professor Department of General Surgery MIMS,Barabanki Dr Pooja Pandey PG JR-1 Department of General Surgery MIMS,Barabanki

2. Let the wastes of "the sick" not contaminate the lives of "the healthy"

3. On an average, the hospital waste generation rate ranges from 0.5 to 2.0 kg/bed/day which amounts to about 0.33 million tons annually. Introduction medical journal armed forces india 7 5 ( 2 0 1 9 ) 2 4 0 -2 4 5

4. 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 biological.

5. Total biomedical waste 75-90% 10-25% Non hazardous waste Hazardous waste Introduction contd….

6. Health-care waste generation 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.

7. 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

8. 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 : 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.

9. The main advantages and disadvantages of various treatment and disposal options

10. The main advantages and disadvantages of various treatment and disposal options contd…. Treatment advantages disadvantages

11. 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.

12. 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 . The bio-medical waste should be segregated into containers/bags at the point of generation of the waste.

13. Option waste category treatment /disposal

14. Schedule II

15. STEP 1 • Segregation and pretreatment of waste at the site of generation. Step 2 • Collection of segregated waste from all areas of hospital . Step 3 • Transportation of waste from various areas of the hospital to storage site. Step 4 • Weighing of bags at storage site . Step 5 • Transportation for final disposal

16.    As per BMW (amendment) rules, 2018, 1% to 2% sodium hypochlorite should be used.  There is no need of chemical pre-treatment before incineration, except for microbiological, lab and highly infectious waste.  Syringes should be either mutilated or needles should be cut and or stored in tamper proof, leak proof and puncture proof containers for sharps storage.  Mrs . Sakshi Chaturvedi Assistant professor Banasthali vidyapith, Jaipur,Rajasthan 

17. The frequency of waste collection is:  Emergencies- 3 times/day.  OPDs and Laboratories- 2 times/day.  Wards- Once or twice per day depending on waste generated.  Administrative area, Offices and Support services- Once a day.

18.  At the collection/ storage site, bags are weighed before transportation for final disposal. Waste collected per day from all over the hospital is approximately:  Yellow waste: 300-400 Kg  Red waste: 80-110 Kg  White waste: 7-8 Kg  Blue waste: 2-3 Kg  General waste: 1500-2000 Kg (3-4 municipal bins) 

19. Differences in Biomedical waste management rule guidelines 1998 ,2016

20. Points 1998 2016

21. Points 1998 2016

22. Conclusion By means of BMW Management Rules, 2016, the Government of India has tried to simplify the BMW management in our nation . Final disposal of BMW requiring high-maintenance infrastructure was a vexation for health-care facilities, which has been done away with by the provision of CBMWTF . With simpler color-coded categories, updating the knowledge on the same, and on-ground implementation of BMW, segregation at source by the health-care workers still remains the biggest challenge . Widespread publicity, continuous training programs , and audits must be encouraged to increase the awareness regarding the threats posed by the mismanagement of BMW and to bring uniformity in practices through all echelons of health-care facilities .

23. Thank you

24. Treatment and disposal technologies for healthcare waste (2) 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. I. 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.

25. 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 (2). 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 (2). 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. 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.

26. 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. III. 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. 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. 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.

27. 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. 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.

28. 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. The main advantages and disadvantages of various treatment and disposal options are listed in Table 3. 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.