Biomedical waste management

For Laboratory staff & students, BMW rule, 2016

1. Biomedical waste management Dr. Hemali Parmar MBBS, MD (Microbiology) Tutor Microbiology Medical College, Vadodara

2. objectives Various BMW rules (1998, 2011, 2016) Classification of biomedical waste (various waste categories) Segregation of waste ( colour coding system for waste disposal) Pre treatment & decontamination Final disposal 2

3. Introduction of waste management Hospital waste is a potential reservoir of pathogenic micro-organisms. Decontamination of waste and their ultimate disposal are closely interrelated. Laboratory wastes are of different category. 3

4. Definition “Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps, including the categories mentioned in Schedule-I appended to these rules; 4

5. Application These rules shall apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form including Hospitals, nursing homes, clinics, Dispensaries, veterinary institutions, animal houses, slaughter house Pathological laboratories, blood banks, Ayush hospitals, clinical establishments, Research or educational institutions, Health camps, medical or surgical camps, vaccination camps, blood donation camps, First aid rooms of schools, Forensic laboratories and research labs. Mortuaries/autopsy centers 5

6. These rules shall not apply to (a) radioactive wastes as covered under the provisions of the Atomic Energy Act, 1962(33 of 1962) and the rules made there under; (b) hazardous chemicals covered under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 made under the Act; (c) solid wastes covered under the Municipal Solid Waste (Management and Handling) Rules, 2000 made under the Act; (d) the lead acid batteries covered under the Batteries (Management and Handling) Rules, 2001 made under the Act; (e) hazardous wastes covered under the Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008 made under the Act; (f) waste covered under the e-Waste (Management and Handling) Rules, 2011 made under the Act; and (g) hazardous micro organisms, genetically engineered micro organisms and cells covered under the Manufacture, Use, Import, Export and Storage of Hazardous Microorganisms, Genetically Engineered Micro organisms or Cells Rules, 1989 made under the Act. 6

7. People at risk Doctors, Nurses & hospital staff Patients & visitors of hospital Veterinary staff Health workers Laboratory staff Research staff Slaughter house persons Servants handling BMW Disposal facility staff Animal handling persons 7

8. Health hazards associated with poor management of BMW Injury from sharps Hospital acquired infections Risk of infection outside the hospital for waste handlers/scavengers & eventually general public Occupational risk associated with hazardous chemicals, drugs etc. Unauthorized repackaging & sale of disposable items & unused/expired drugs 8

9. Environment concern Spread of infection and disease through vectors (fly, mosquito, insects etc.) which affect the in -house as well as surrounding population. Spread of infection through contact/injury among medical/non-medical personnel and sweepers/rag pickers, especially from the sharps (needles, blades etc.). Spread of infection through unauthorised recycling of disposable items such as hypodermic needles, tubes, blades, bottles etc. Reaction due to use of discarded medicines. Toxic emissions from defective/inefficient incinerators. Indiscriminate disposal of incinerator ash / residues 9

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11. Problems relating to biomedical waste The implementation of Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard, improper and indiscriminate manner. Lack of motivation for proper BMW management. Lack of segregation practices, results in mixing of hospital wastes with general waste making the whole waste stream hazardous. Inappropriate segregation ultimately results in an incorrect method of waste disposal. Inadequate Bio-Medical waste management ------- environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms. 11

12. Benefits of Biomedical Waste Management Cleaner and healthier surroundings. Reduction in the incidence of hospital acquired and general infections. Reduction in the cost of infection control within the hospital. Reduction in the possibility of disease and death due to reuse and repackaging of infectious disposables. Low incidence of community and occupational health hazards. Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste. Improved image of the healthcare establishment and increase the quality of life. 12

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14. GENERATION OF WASTE Types Site of Generation Disposal by Non hazardous (general waste 85%) Office, kitchen, cafeteria billing, cashier, rooms, hostels, residential area, rest room, pantries in Wards, stores. In black / green bag- Municipal waste Hazardous (infectious & toxic 15%):- -Hazardous but not infectious- 5% -Hazardous and infectious- 10% Wards, treatment room, nursing station, isolation room, operation theaters, intensive care unis & recovery room, labour room & clinics, dental suites, minor OT, blood bank, pharmacy & medical stores, laboratories, animal house, experimental centers, OPD treatment room, injection & procedures rooms As per biomedical waste management Rule 2016. 14

15. As per WHO, the biomedical wastes could be classified into eight categories on the basis of the type of waste and the risk of transmission of infectious material in them. 1. General waste (domestic) 2. Pathological 3. Radioactive 4. Chemical 5. Infectious 6. Pharmaceutical wastes 7. Sharps and 8. Pressurized containers 15

16. Notification & Amendantment On 20 th July 1998, Ministry of Environment & forests, Govt. of India, formed a rule known as Biomedical waste management and handling rule 1998. 1 st amendment dated on 06/03/2000 2 nd amendment dated on 17/09/2003 BMW 2011 rule BMW 2016 rule 16

17. Classification of waste To streamline over all handling of hospital waste, it has been classified into several categories . Each laboratory should have a working estimate of non-hazardous and hazardous waste produced there on day-to-day basis. The waste segregation with an ultimate aim of safe handling and disposal has been classified into various categories. They have been given colour coding for collection i.e. in a specified container only a specified type of waste should be collected. Segregation at the point of generation of waste must be in accordance with this colour coding. Categories waste segregation and collection is a mandatory legal requirement . 17

18. BMW rules, 1998 Category no . Waste category Disposal   1 Human Anatomical Waste Incineration @@ 2 Animal waste Incineration @@ 3 Microbiology & Biotechnology waste and other laboratory waste Disinfection at source by chemical treatment @ or by autoclaving/microwaving followed by mutilation/shredding ## and after treatment final disposal in secured landfill or disposal of recyclable wastes (plastic or glass) through registered or authorized recyclers 4 Waste sharps Disinfection by chemical treatment @ or destruction by needle and tip cutters, autoclaving or microwaving followed by mutilation or shredding ## , whichever is applicable and final disposal through authorized CBWTF or disposal in secured landfill or designated concrete waste sharp pit 5 Discarded medicines and cytotoxic drugs Secure landfill or incineration @@ 6 Soiled waste Incineration @@ 7 Infectious solid waste Disinfection by chemical treatment @ or autoclaving or microwaving followed by mutilation or shredding ## and after treatment final disposal through registered or authorized recyclers 8 Liquid waste Chemical treatment @ and discharge into drains 9 Incineration Ash disposal in municipal landfill 10 Chemical waste Chemical treatment @ and discharge into drains meeting the norms notified under these rules and solid disposal in secured landfill 18

19. BMW rules, 1998 19

20. Cont … There is lots of confusion about category & color coding, few categories can be discarded in more than 1 bag, no special description of waste etc. The table in next slides comes as product of schedule I of Rule 4 and 7 of Bio-medical waste (Management and handling) Rules 2011 . 20

21. Cont … Category no. Waste category Disposal   1 Human Anatomical Waste (human tissues, organs, body parts) Incineration @@ 2 Animal waste (animal tissue, organs, body parts, carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals/ colleges, discharge from hospitals, animal house) Incineration @@ 21

22. Category no. Waste category Disposal   3 Microbiology & Biotechnology waste and other laboratory waste (wastes from clinical samples, pathology, biochemistry, haematology, blood bank, laboratory cultures, stock or specimen of microorganisms, live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, waste from production of biological toxins, dishes and devices used for transfer of cultures) Disinfection at source by chemical treatment @ or by autoclaving/microwaving followed by mutilation/shredding ## and after treatment final disposal in secured landfill or disposal of recyclable wastes (plastic or glass) through registered or authorized recyclers 22

23. Cont … Category no. Waste category Disposal   4 Waste sharps (needles, glass syringes or syringes with fixed needles, scalpels, blades, glass etc. that may cause puncture and cuts. This includes both used and unused sharps) Disinfection by chemical treatment @ or destruction by needle and tip cutters, autoclaving or microwaving followed by mutilation or shredding ## , whichever is applicable and final disposal through authorized CBWTF or disposal in secured landfill or designated concrete waste sharp pit 5 Discarded medicines and cytotoxic drugs (wastes comprising of outdated , contaminated and discarded medicines) Disposal in secure landfill or incineration @@ 23

24. Cont … Category no. Waste category Disposal   6 Soiled waste (Items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, linen, beddings, other material contaminated with blood) Incineration @@ 7 Infectious solid waste (Wastes generated from disposable items other than the waste sharps such as tubings , hand gloves, saline bottles with IV tubes, catheters, glass, intravenous sets etc.) Disinfection by chemical treatment @ or autoclaving or microwaving followed by mutilation or shredding ## and after treatment final disposal through registered or authorized recyclers 24

25. Cont … Category no. Waste category Disposal   8 Chemical waste (Chemical used in production of biologicals , chemicals used in disinfection, as insecticides, etc.) Chemical treatment @ and discharge into drains meeting the norms notified under these rules and solid disposal in secured landfill 25

26. Segregation of waste Colour coding and type of container for disposal of bio medical wastes : Colour Coding Type of container to be used Waste category number Old category number Treatment options as per schedule I Yellow Non-chlorinated plastic bags Category 1,2,5,6 1,2,3,6 Incineration Red Non-chlorinated plastic bags/puncture proof container for sharps Category 3,4,7 (4-waste sharps) (in the earlier Rules, soiled waste are for red colour) 3,6,7 As per schedule I (Rule 7) Blue Non-chlorinated plastic bags container Category 8 (chemical waste) 4,7 As per schedule I (Rule 7) Black Non-chlorinated plastic bags Municipal waste 5,9,10 Disposal in Municipal dump sites 26

27. Latest rule GOVERNMENT OF INDIA MINISTRY OF ENVIRONMENT, FOREST AND CLIMATE CHANGE, 28th March, 2016 Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options 27

28. BMW 2016 rule Schedules: 1-4 Forms: 1-5 Rules:1-18 28

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31. Occupier ,operator Occupier - a person having administrative control over the institution and the premises, generating biomedical waste. Operator of common biomedical waste treatment facility- a person who owns or controls a common Biomedical Waste Treatment facility (CBMWTF) for collection, reception, storage, transport, treatment, disposal or any other form of handling of biomedical waste. The occupier or operator of common biomedical waste treatment facility shall be liable for action under section 5 & section 15 of the Act, in case of any violation . 31

32. Duties of occupier Take necessary steps to ensure BMW is handled without adverse effect to human health & environment Make provision for central collection zone of segregated waste within the premises acc. to color code, provide safe, ventilated and secured location for storage. On site pretreatment of the laboratory waste, microbiological waste, blood samples, blood bags through disinfection or sterilization acc.to WHO/NACO guideline then sent to final disposal Phase out use of chlorinated plastic bags, gloves and blood bags within 2 years from the date of notification of these rules.- 32

33. Contd … Dispose solid waste other than BMW acc. to municipal waste law Do not give treated biomedical waste with municipal waste Provide training to all staff regarding handling of the BMW and refresher training every year Immunize all healthcare workers & others handling BMW especially hepatitis B & Tetanus acc. to national immunization guideline Establish Bar-Code System for bags or containers containing BMW to be sent out of the premises within 1 year of notification of the rule Provide adequate PPE Ensure segregation of liquid chemical waste at source and ensure pretreatment or neutralization prior to mixing with other effluent generated from health care facilities.( Effluent drainage system ) Conduct health check up at the time of induction and least once in year 33

34. Contd … Monthly record on websites according to the biomedical waste generated in terms of category and color coding . Report major accidents including accidents caused by fire hazards, blast during handling of BMW & remedial action taken and relevant records in form-I to prescribed authority and also along with annual report. Make available annual report on its web site and all healthcare facilities shall make own website within 2 years from the date of notification of these rules. Establish system to review & monitor the activities regarding BMW through committee-meets every six month & record MOM submitted along with annual report to prescribed authority. Maintain all records of incineration /autoclaving for minimum 5 years. Existing incineration meets standard for treatment & disposal of BMW.(Dioxin and furans) 34

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37. Bio-waste treatment and disposal- operator responsibility No occupier shall establish on site treatment & disposal facility, if a service of common biomedical waste treatment facility (CBMWTF) is available at a distance of 75 km . In cases where BMW treatment facility is not available, occupier shall set up requisite equipments like incineration, autoclave, shredder prior to commencement of its operation as per authorization given by prescribed authority. After treatment, the recyclable waste such as plastic & glassware shall be given to such recyclers having valid authorization or registration from respective prescribed authority. Also maintain records 37

38. Steps to manage biomedical waste Segregation – at point of generation Transportation – within hospital premises, and from central storage to the point of final treatment Pretreatment – for microbiolgical waste, blood bags, blood samples, vaccines Storage Final treatment Documentation 38

39. Segregation, transport, storage of waste Segregation is carried out at the point of generation to keep general waste from becoming infectious Segregation is according to color coding system and BMW rule 2016 39

40. Bio-Medical Waste Management Rules, 2016 Category Type of waste Type of bag or container to be used Treatment & disposal options Yellow Human anatomical waste ( Human tissues, organs, body parts and fetus below the viability period) Yellow coloured non-chlorinated plastic bags Incineration or plasma pyrolysis or deep burial* (only in rural & remote areas) Animal anatomical waste ( Experimental animal carcasses, body parts, organs, tissues, including the waste generated from animals used in experiments or testing in veterinary hospitals or colleges or animal houses. ) Soiled waste ( Items contaminated with blood, body fluids like dressings, plaster casts, cotton swabs and bags containing residual or discarded blood and blood components. ) Incineration or plasma pyrolysis or deep burial*. Autoclaving or microwaving/ hydroclaving followed by shredding or mutilation . Sent for energy recovery 40

41. Bio-Medical Waste Management Rules, 2016 Category Type of waste Type of bag or container to be used Treatment & disposal options Yellow Expired or discarded medicines ( Pharmaceutical waste like antibiotics, cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc. ) Yellow coloured non-chlorinated plastic bags or containers Expired ` cytotoxic drugs and items contaminated with cytotoxic drugs to be returned back to the manufacturer or supplier for incineration at temperature >1200°C or to common bio-medical waste treatment facility or hazardous waste treatment, storage and disposal facility for incineration at >1200°C or Encapsulation or Plasma Pyrolysis at >1200°C. All other discarded medicines shall be either sent back to manufacturer or disposed by incineration. Chemical waste ( Chemicals used in production of biological and used or discarded disinfectants. ) Yellow coloured non-chlorinated plastic bags Incineration or plasma pyrolysis or encapsulation Chemical liquid waste ( Liquid waste generated due to use of chemicals in production of biological and used or discarded disinfectants, Silver X-ray film developing liquid, discarded Formalin, infected secretions, aspirated body fluids , liquid from laboratories and floor washings, cleaning, house-keeping and disinfecting activities etc. ) Separate collection system leading to effluent treatment system After resource recovery, the chemical liquid waste shall be pre-treated before mixing with other wastewater. The combined discharge shall conform to the discharge norms given in Schedule- III. 41

42. Bio-Medical Waste Management Rules, 2016 Category Type of waste Type of bag or container to be used Treatment & disposal options Yellow Discarded linen, mattresses, beddings contaminated with blood or body fluid. Yellow coloured non-chlorinated plastic bags or suitable packing material Non- chlorinated chemical disinfection followed by incineration or Plazma Pyrolysis or for energy recovery. In absence of above facilities, shredding or mutilation or combination of sterilization and shredding. Treated waste to be sent for energy recovery or incineration or Plazma Pyrolysis . Microbiology, biotechnology & other clinical laboratory waste ( Blood bags, Laboratory cultures, stocks or specimens of microorganisms, live or attenuated vaccines, human and animal cell cultures used in research, industrial laboratories, production of biological, residual toxins, dishes and devices used for cultures. ) Autoclave safe plastic bags or containers Pre-treat to sterilize with nonchlorinated chemicals on-site as per National AIDS Control Organisation or World Health Organisation guidelines thereafter for Incineration. 42

43. Category Type of waste Type of bag or container to be used Treatment & disposal options Red Contaminated Waste (Recyclable) (a) Wastes generated from disposable items such as tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles and fixed needle syringes) and vaccutainers with their needles cut) and gloves Red coloured non-chlorinated plastic bags or containers Autoclaving or micro-waving/ hydroclaving followed by shredding or mutilation or combination of sterilization and shredding. Treated waste to be sent to registered or authorized recyclers or for energy recovery or plastics to diesel or fuel oil or for road making, whichever is possible. Plastic waste should not be sent to landfill sites. 43

44. Category Type of waste Type of bag or container to be used Treatment & disposal options White (translucent) Waste sharps including metals ( Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal sharps ) Puncture proof, leak proof, tamper proof containers Autoclaving or dry heat sterilization followed by shredding or mutilation or encapsulation in metal container or cement concrete; final disposal to iron foundries or sanitary landfill or designated concrete waste sharp pit 44

45. Category Type of waste Type of bag or container to be used Treatment & disposal options Blue Glassware ( Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes. ) Cardboard boxes with blue coloured marking Disinfection or autoclaving or microwaving or hydroclaving & then sent for recycling Metallic body implants 45

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48. Good: Always fill only 3/4th bin Bad: Don’t overfill the bins

49. Good - Always carry the waste in secure sealed containers/ bags Bad - Don’t carry waste in open bags, and never carry it through crowded areas

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51. Schedule-II standards for treatment & disposal of BMW Schedule-III list of prescribed authorities and the corresponding duties 51

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56. Monthly tasks- Occupier Display of BMW report on web site Form II-Category Number of color coded bags with their weight 56

57. Biannual task Meeting of biomedical waste management committee Minutes of meeting 57

58. Annual tasks Training Health check up-immunization Submission of annual report form IV to GPCB & displayed on web before 31th January Submission of accident report in form I & MOM to GPCB with annual report.( nil report as well) 58

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60. Pre-treatment & Decontamination Autoclaving Microwaving / Hydroclaving Chemical disinfection (H 2 O 2 , Gluteraldehyde , Phenol, Per acetic acid etc. ) Mutilation & shredding 60

61. Decontamination and disposal of sharps After use, needles and syringes should be locally destroyed / cut by a needle destroyer and these should be collected in a rigid container Locate sharps disposal containers close to the point of use e.g. in patient room, on the medicine trolley and in the treatment room etc. Dispose used sharps in a puncture resistant white container. Prevent overflow by sending sharps disposal containers for autoclaving and shredding when they are three quarters full . 61

62. Final Disposal The black bags and waste therein is dispensed along with other municipal waste. The bio-medical waste is collected and disposed off. All the waste generated in the department is sent to common waste collection site after decontamination. 62

63. Burning issues Purchase of non chlorinated bags New poster, new bags & their training regarding segregation, transportation Establish bar code system for bags Establish effluent system for liquid waste Formation of biomedical waste committee Biochemistry & pathology lab should start autoclaving 121°C x 20 lbs x 60 min. of blood vaccuttee then discard in RED bag Blood bags to be autoclaved and discarded in yellow bags. To check sambremky treatment and disposal facilities for standards of incineration & for treatment 63

64. summary Bio medical waste categories are reduced from 10 to 4. Change in color coding system 64

65. Summary: Schedule- I 65

66. Thank you 66