Biomedical waste management

Waht is biomedical waste?
Where it is generated?
How it should be collected?
How it should be segregated?
How it should be treated?
what are the hazardous of mixing of this waste with community waste?
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1. Biomedical Waste Management Mr. Gunjal Prasad N. Assistant Professor Dept. of Microbiology

2. Introduction What is Biomedical Waste ? Infectious wastes (also called biomedical waste) include – Human waste, Animal waste and Objects and materials contaminated with blood and body fluids containing disease-causing micro-organisms or viruses. OR 26/08/2015 2

3. What is Biomedical Waste ? It is defined as “A ny solid and/or liquid waste including its container and any intermediate product, 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 biologicals and including categories mentioned ”. 26/08/2015 3

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5. WHO GENERATES BMW? 5 Waste generated by – Healthcare facilities Research facilities Laboratories 26/08/2015

6. What is Infectious Medical Waste Infectious Medical Waste is defined as medical waste capable of producing an infectious disease. Waste is considered Infectious when it is: Contaminated by an organism that is pathogenic to healthy humans; The organism is not routinely available in the environment; and The organism is in significant quantity and capable of transmitting the disease to community. 26/08/2015 6

7. India to Relook into Safe Practices Bio-medical or infectious waste has not received its due attention in developing countries like India. It is being collected and disposed off along with the municipal solid waste (MSW). Therefore, infectious waste management schemes should be designed carefully by taking in account the correct factors and giving them due weight age. 26/08/2015 7

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9. HEALTHCARE WASTE CHARACTERIZATION 9 26/08/2015

10. CLASSIFICATION OF HOSPITAL WASTE 10 26/08/2015

11. 26/08/2015 11 According to Ministry of Environment and Forests ( MoEF ) – Biomedical waste generated in India / day = 4,05,702 kg. Off which properly disposed waste is only = 2,91,983/kg/day. Almost 28% waste is left untreated and not disposed and mixed with community waste ( dump, water bodies). Karnataka tops the chart in generating Biomedical waste.

12. Categories of Persons Exposed to Risk of Infection 12 26/08/2015

13. Diseases Caused by Blood borne Pathogens Malaria Rabies Syphilis Tularemia Viral Hemorrhagic Fevers Arbovirus infections Brucellosis Creutzfeldt-Jakob Disease Leptospirosis HIV / AIDS Hepatitis B & C 13 26/08/2015

14. Can we handle ??? 14 26/08/2015

15. Blood borne Pathogen Standard Defines Infectious Medical Waste as: Liquid or semi-liquid blood or other potentially infectious materials (OPIM), Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed, Items caked with dried blood or OPIM that would dislodge during handling, Contaminated sharps, and Pathological and microbial wastes containing blood or OPIM 15 26/08/2015

16. Other Potentially Infectious Material OPIM Any body fluid with visible blood Amniotic fluid Cerebrospinal fluid Pericardial fluid Peritoneal fluid Pleural fluid Saliva in dental procedures Semen/vaginal secretions Synovial fluid 16 26/08/2015

17. Routes of Transmission 17 26/08/2015

18. Transmission of Blood and Fluid Borne Pathogens An exposure incident does not guarantee disease transmission. Several factors affect transmission: Infected Source – the disease stage of the source. Means of Entry - severity or depth of the: puncture wound, broken skin, or direct contact with mucus membrane. Infective Dose - the amount and type of fluid, as well as the amount of infectious agent in the fluid Blood is the fluid of greatest concern. Susceptible Host - immunocompromised 18 26/08/2015

19. Blood-borne Pathogens (BBP) Blood-borne pathogens (BBP) are specific microorganisms transmitted in human blood or bodily fluids, which can cause disease in people. There are three major BBPs: Hepatitis B (HBV) causes inflammation of the liver that might lead to liver failure completely preventable by a vaccine Hepatitis C (HCV) also causes inflammation of the liver, no vaccine to prevent infection Human Immunodeficiency Virus (HIV) HIV is a human retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome). There is no vaccine to prevent HIV infection. 19 26/08/2015

20. Routes of exposure Blood-borne Pathogens such as HBV, HCV and HIV are transmitted through contact with human blood and bodily fluids. Contacts include: “Sharps” exposures in occupational settings. Sexual activity Sharing of needles Mother-to-child exposures at birth 20 26/08/2015

21. Never forget to take Hepatitis B Vaccine if You are a HCW

22. Universal (Standard) Precautions “Precautions to protect against exposure must be taken when there is any potential for exposure to bodily fluids. It is assumed that all bodily fluids have the potential to transmit disease” The Universal Precaution Rule: Treat all human blood, bodily fluids and other potentially infectious materials as if they are infectious. 22 26/08/2015

23. Universal Safety Precautions 26/08/2015 23

24. Universal Safety Precautions 24 26/08/2015

25. BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment. 25 26/08/2015 BIO-MEDICAL WASTE (MANAGEMENT & HANDLING) RULES 1998

26. Steps for Effective BMW Management 26 26/08/2015

27. Waste Survey Waste survey is an important component of the waste management scheme. A survey helps in evaluation both the type and quantity of waste generated in hospitals. Aims: Differentiate the types of waste. Quantify the waste generated. Determine the points of generation & type of waste generated at each point. Determine the level of generation & disinfection within the hospital. To find out the type of disposal carried out. 27 26/08/2015

28. Waste & Segregation Collection According to color code 26/08/2015 28 COLOR CODE TYPE OF CONTAINER Yellow Plastic bags Red Disinfected container/plastic bag Blue/white transparent Plastic bags/ puncture proof container Black Plastic bag Color code subject to change according to guidelines by various Biomedical waste disposal companies / WHO / CDC / National Policies / State Polices

29. Segregation Segregation refers to the basic separation of different categories of waste generated at source and thereby reducing the risks as well as cost of handling and disposal. Segregation is the most crucial step in bio-medical waste management. Effective segregation alone can ensure effective bio-medical waste management. The BMWs must be segregated in accordance to guidelines laid down under schedule 1 of BMW Rules, 1998. 29 26/08/2015

30. Collection of Infectious Waste Infectious medical wastes must be collected at the point of generation in the appropriate color coded bags. Biohazard bags must be labeled with the international biohazard symbol and appropriate wording; “biohazard,” “biomedical waste,” “infectious medical waste,” or “regulated medical waste”. 30 26/08/2015

31. Storage 31 Once collection occurs then biomedical waste is stored in a proper place. Segregated wastes of different categories need to be collected in identifiable containers. The duration of storage should not exceed for 8-10 hrs in big hospitals (more than 250 bedded) and 24 hrs in nursing homes. Each container may be clearly labeled to show the ward or room where it is kept. 26/08/2015

32. Handling Devices Trolleys Wheelbarrows Channels / Chute - sloping channel through which things can descend. 32 26/08/2015

33. Transport 33 26/08/2015 The waste should be transported for treatment either in trolleys or in covered wheelbarrow. Manual loading should be avoided as far as for as possible . The bags / Container containing BMWs should be tied/ lidded before transportation. Before transporting the bag containing BMWs, it should be accompanied with a signed document by Nurse/ Doctor mentioning date, shift, quantity and destination .

34. Transport 34 Special vehicles must be used so as to prevent access to, and direct contact with, the waste by the transportation operators, the scavengers and the public. The transport containers should be properly enclosed and the driver must be trained in the procedures he must follow in case of an accidental spillage. It should also be possible to wash the interior of the containers thoroughly.

35. Chemical Processes 26/08/2015 35 These processes use chemical that act as disinfectants. Sodium hypochlorite, dissolved chlorine dioxide, per acetic acid, hydrogen peroxide, dry inorganic chemical and ozone are examples of such chemical.

36. Thermal Processes 36 26/08/2015 Autoclaving, Microwaving, Incinerator & Hydroclaving

37. Mechanical Processes 37 26/08/2015 These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste. The two primary mechanical processes are – Compaction - used to reduce the volume of the waste. Shredding - used to destroy plastic and paper waste to prevent their reuse. Only the disinfected waste can be used in a shredder.

38. Irradiation Processes Exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber. These systems require post shredding to render the waste unrecognizable. 38 26/08/2015

39. Categories of BMW CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL Category 1 Human anatomical wastes Incineration/ deep burial Category 2 Animal wastes Incineration/ deep burial Category 3 Microbiology & biotechnology waste Local autoclaving/ microwaving/incineration Category 4 Waste sharps like needles, syringes, scalpels, blades, glass etc Disinfection (Chemical/autoclaving/micro waving & mutilation/shredding) Category 5 Discarded Medicines & cytotoxic drugs Incineration/destruction & disposal in land fills 39 26/08/2015

40. CATEGORY TYPE OF WASTE TREATMENT & DISPOSAL Category 6 Soiled wastes Items contaminated with blood, body fluids including cotton, dressings etc Incineration, autoclaving,microwaving Category 7 Solid wastes like catheters, IV sets etc. Disinfection by chemical treatment/autoclaving/micro waving and mutilation & shredding Category 8 Liquid wastes Laboratory, blood banks, hospitals, house etc. Disinfection by chemicals and discharge into drains Category 9 Incineration ash Disposal in municipal land fills Category 10 Chemical wastes Chemical treatment & discharge into drains for liquid and secured land fills for solids. 40 26/08/2015

41. COLOR CODE TYPE OF CONTAINER WASTE CATEGORY TREATMENT OPTIONS Yellow Plastic bags 1, 2, 3 and 6 Incineration/deep burial Red Disinfected container/plastic bag 3, 6 & 7 Autoclaving/Micro Waving/Chemical treatment Blue/white transparent Plastic bags/ puncture proof container 4 & 7 Autoclaving/Micro waving/chemical treatment, Destruction & shredding Black Plastic bag 5, 8 & 9 Disposal in secured land fills 41 26/08/2015

42. Hopefully as these environmental health hazards are exposed, changes will be made to protect the future of our 'Earth' and the living beings that inhabit it! 42 26/08/2015