Biomedical waste management (handling & treatment)

Biomedical waste management (handling & treatment)
NEED FOR BMW MANAGEMENT
BIO-MEDICAL WASTE MANAGEMENT & HANDLING �RULES NOTIFICATIONS AND AMENDMENTS

1. Biomedical waste management (handling & treatment) 1 Presented By Dr. Mukesh Kumar M.D. Scholar DEPARTMENT OF SWASTHVRITTA & YOGA Rani Dulliaya Smriti Ayurved PG College & Hospital, Bhopal (M.P.)

2. “Bio-Medical waste” is the waste that 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 BMW rules 2016” “Any solid and/ liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals”. 2 INTRODUCTION

3. Continue According to the environment protection act 1986, Biomedical Waste (Management and Handling) Rules, 28 July 1998 And it was amended in 2000 & 2003. the bio medical waste rules in July 1998, subsequently revised in 2011 & now the “bio medical waste management rules in 2016” are in the attestation to the commitment of the Gov. of India. Waste in India - 484 tonnes /day of bmw from 1,68,869 health care centres Average 1-2kg/bed/day. https://www.thebetterindia.com/50225/biomedical-waste-treatment/(seen 11-3-2018) 3

4. NEED FOR BMW MANAGEMENT TYPE OF WASTE Health HAZARD Human/ Anatomical waste/ soiled waste HIV, HBV, Cholera, T.B, Pneumonia Rabies e.t.c . Sharps HIV, HBV, HCV, Injuries Cytotoxic / radioactive Cancer, Birth defect Chemical waste Poisning , dermatitis, conjuctivitis 4 The hospital waste, in addition to the risk for patient & personal who handle these waste poses a threat to public health & enviroment .

5. 5 Need of BMW Management

6. PRESENT SENERIO Acc. To the M.O.E.F. & CC (Ministry of Environment and Forests )- Gross generation of BMW in india is 484 tone/ day from 1,68,869 health care facilities ( hcf ), out of which 447 tone/ day is treated, which means that almost 38 tone/ day of the wastes is left untreated & not disposed finding its way in dumps or water bodies & re-enters our system. 6

7. BIO-MEDICAL WASTE MANAGEMENT & HANDLING RULES NOTIFICATIONS AND AMENDMENTS On 20th July 1998 Ministry of Environment and Forests ( MoEF ), Govt. of India, Framed a rule known as ‘Bio-medical Waste (Management and Handling) Rules, 1st Amendment Dated 06/03/2000 2nd Amendment Dated 17/09/2003 The MoEF&CC has notified the new BMW (M) Rules, 2016 on 28TH March, under the Environment (Protection) Act, 1986 to replace the earlier Rules (1998) and the amendments thereof. 7

8. WHO ESTIMATES 85% of hospital waste is non hazardous 10% is infectious 5% is non-infectious 8

9. 9

10. BIO HAZARDOUS WASTE Infectious waste – 10% (sharp, non sharp, plastics, disposables, liquid waste) Non infectious waste – 5% (radioactive waste, discarded glass, chemical waste, incinerated waste) WHO has estimated that 16 billion injection are administered every year. Not all needles & syringes are disposed properly. Despite this progress, In the year 2010, unsafe injection were still responsible for as many as 33,800 new HIV infections, 1.7 million hepatitis B infections & 3,15,000 hepatitis C infections. Any infectious or non infectious Bio hazardous waste mixed with general waste renders the whole bio hazardous waste . 10

11. Who’s At Risk 11 Doctor’s & Nurses Patients Hospital support staff support staff Waste collection & disposal staff General public and the Environment

12. Sources of Bio-Medical Waste Major Sources Minor Sources All Hospitals Clinics (Dental & Ayu .) Labs Cosmetic clinics Research centers Home care Animal research Paramedics Blood banks Funeral services Nursing homes Mortuaries Autopsy centers 12

13. HOSPITAL WASTE DISPOSAL Basic principal is that the wastes are disposed in most hygienic & cost effective manner, by methods which at all stages, minimize risk to healthy environment, Gov, of India has prescribed certain procedures and guidelines as follows: 13 Source Segregation Collection of wastes Storage Transport Treatment Disposal

14. Bio medical waste management rules Acc. To BMW Rules of 1998 The duty of every “occupier” i.e. A person who has the control over the institution or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health & environment. It consists of six schedule- Schedule – 1 Schedule – 2 Schedule – 3 Schedule – 4 Schedule – 5 Schedule – 6 14

15. Schedule – 1 New 8 Categories of BMW in 1998 CATEGORY TYPE OF WASTE PANCHA-KARMA WASTE TREATMENT & DISPOSAL Category 1 Human anatomical wastes Vomitus Incineration/ deep burial Category 2 Animal wastes Incineration/ deep burial Category 3 Microbiology & biotechnology waste, Liquid wastes, waste from Laboratory, blood banks, hospitals, house etc. Blood Local autoclaving/ microwaving/ incineration/ Disinfection by chemicals Category 4 Waste sharps like needles, syringes, scalpels, blades, glass etc . Needle Disinfection (Chemical/autoclaving/ micro waving & mutilation/shredding) 15

16. CATEGORY TYPE OF WASTE PANCHA-KARMA WASTE TREATMENT & DISPOSAL Category 5 Discarded Medicines & cytotoxic drugs Incineration/ destruction & disposal in land fills Category 6 Soiled wastes Items contaminated with blood, body fluids including cotton, dressings etc Cotton, Dressing material Incineration, autoclaving, microwaving Category 7 Solid wastes like catheters, IV sets etc Catheter Disinfection by chemical treatment/autoclaving/micro waving and mutilation & shredding Category 8 Liquid Waste Disinfecting by chemical T/t and discharge into drains 16

17. CATEGORY TYPE OF WASTE PANCHA-KARMA WASTE TREATMENT & DISPOSAL Category 9 Incineration Ash Disposal in municipal landfill Category 10 Chemical wastes Oil Chemical treatment & discharge into drains for liquid and secured land fills for solids. 17

18. Schedule–2 segregation & colour coding Colour Coding Type of container to be used Waste Category Number Treatment Yellow plastic bags Category 1,2,3,6 Incineration, Deep burial Red Disinfected container / plastic bags Category 3,6,7 Autoclaving, Microwaving, Chemical T/t Blue / white plastic bags/ puncture proof container Category 4&7 Autoclaving, Microwaving, Chemical T/t & Shredding Black plastic bags Category 5,9,10 Disposal in secured landfill 18

19. 19

20. 20

21. 21

22. 22

23. 23

24. If you are not measuring it, you are not managing it. 24

25. 25

26. 26

27. Schedule- 3 LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS (PART- A) 27 BIO HAZRDS SYMBOL CYTOTOXIC SYMBOL BIO HAZARDS WASTE WITH CARE NOTE - LABLE SHALL BE NON WASHABLE & PROMINANTELY VISIBLE

28. SCHEDULE- 4 (PART- B) Day ............ Month .............. Year ........... Date of generation ................... Waste category No ........ Waste class Waste description Sender's Name & Address - Phone No...........Telex No .... Fax No ................. Receiver's Name & Address - Phone No ……..Telex No ...........Fax No ............... Contact Person ........ In case of emergency 28

29. SCHEDULE - 5 Standards for T/t & disposal of bio medical wastes standards for incinerators. 29

30. SCHEDULE - 6 Schedule for waste T/t facilities like incinerator/ autoclave/ microwave system. 30

31. PRECAUTIONS Medical, Paramedical & Sanitation staff should be vaccinated against Hepatitis B Using especially heavy duty gloves, Aprons, Masks, Boots while dealing with infectious wastes Recapping needles should be discouraged. In case, if unavoidable single handed method should be used Segregation of Biomedical Waste & Safe disposal. 31

32. HANDLING DEVICES 32 Trolleys Wheelbarrows

33. 33 BAD- Don’t carry waste in open bag’s & never carry it through crowded area GOOD- Always carry the waste in secure sealed container/ bags

34. TRANSPORTATION Untreated bio medical waste should be transported in specially designed vehicles Trolley or in covered wheel barrows. Manual loading should be avoided as far as possible. The bags /container containing biomedical waste should be tied /lidded before transportation. Before transportation, signed document by doctor /nurse maintaining date, shift, quantity & destination. Special vehicle must be used to prevent access direct contact with the transportation operators, the scavengers & the public. 34

35. The transport containers should be properly enclosed. Driver must be trained regarding the procedures followed during the accidental spillage. Wash the interior of the containers thoroughly. Biohazard symbol should be painted on the trolley. 35

36. 36

37. Waste treatment process categories Five broad categories: (1) Mechanical processes (2) Thermal processes (3) Chemical processes (4) Irradiation processes (5) Biological processes. 37

38. Mechanical processes Used to change the physical form or characteristics of the waste To facilitate waste handling or to process the waste in conjunction with other treatment steps. Includes- compaction - shredding - land fill and burial 38

39. continue Compaction- compressing the waste into containers to reduce its volume. Shredding – includes granulation, grinding, pulping & the like, is used to break the waste into smaller pieces. Health & safety reasons and good practice prohibit compacting/shredding untreated medical waste, because of concerns of aerosoling /spilling of micro-organisms. However, there are no ill effects if waste is sheredded after it has been decontaminated in order to make it unrecognisable . 39

40. Sanitary & secured land filling Deep burial of human anatomical waste, when the facility of proper incineration is not available. Disposal of autoclaved / hydroclaved / microwaved waste. Disposal of sharps. Disposal of incineration ash. 40

41. Pit for deep burrial Depth 2 meter Waste fill 1 meter from bottom Cover of lime- 50 cm Galvanized iron/ wire mesh at the top Secure the area 41

42. Thermal processes Sterilize or destroyes medical waste. Two categories-low heat systems & high heat systems Low heat systems-use steam, hot water or electromagnetic radiation to heat & decontaminate the waste. High heat systems-combustion, pyrolysis & high temp. plasmas to decontaminate & destroy the waste. 42

43. Cont. Hot air oven: Temp. OF 160 degree for 2 hour or 170 degree for 1 hour, for glass ware, & metallic instruments. Incineration: Destruction of contaminated materials in the incinerator. Autoclave steam sterilisation under pressure by bringing the Steam into direct contact with the waste material to sterilize it. 43

44. Chemical processes Most chemical waste treatment systems use a disinfectant solution in combination with shredding to provide decontamination & disfigurement. 1% hypochlorite solution with a minimum contact period of 30 min. Pre-shredding of the waste is desirable for better contact with the waste material. 44

45. Irradiation process Ionizing- Xray , gamma ray, cosmic rays. Non ionizing- infra red, ultra violet. Swabs, plastic materials, oil, metal foils, etc. These system requires post-irradiation shredding to render the waste unrecognisable . 45

46. Autoclave Principle: When water is heated in a closed vessel under pressure, the boiling point of water rises above 100 degree. Water is heated at 2 atmospheric pressure and the boiling temperature will be 121 degree or at 3 atmospheric pressure and the boiling temperature will be 134 degree. 46

47. AUTOCLAVING IS HIGLY EFFICIENT BCOZ High temperature. High penetrating power of the steam under pressure. When steam condenses on the articles, it liberates latent heat to the articles to be sterilized. Non toxic Not time consuming. 47

48. Incineration Incineration fundamentals: -incineration comes from a greek word meaning burn to ashes. -initially incinerators were just uncontrolled single chamber fire boxes provided with smoke stocks. -now modern incineration systems are well engineered, well designed, well controlled, well monitored 48

49. Cont. Incineration is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material & gases. This can be oil fired/electrically powered/ combination. 49

50. Microwave treatment Radiations produced by the microwave are involved to break apart molecular chemical bonds & thus disinfect infectious waste. Temp-97◦-100◦C Cycle time-40-45 min. Advantage of disinfecting the waste No hazardous emissions. Can not be used to treat body parts & tissues. 50

51. Advantages : Absence of harmful air emissions- environment friendly. Absence of liquid discharges. Non-requirement of chemicals. Reduced volume of waste (due to shredding & moisture loss) Operator safety-worker friendly However, the investment costs are high at present. 51

52. RESPONSIBILITY 52 Infection control is everyone's business. You are not only protecting yourself, but also those around you

53. CONCLUSION 53 It is just not the law abide compliance but the Social RESPONSIBILITY of every Health Care Establishment to say… NO TO HAZARD OF BIOMEDICAL WASTE It will only take.. Proper planning. Spread Awareness. Involvement everyone. Segregation, Pre-treatment at first stage. Appropriate Storage Timely Disposal. All Records… And………………………….. ALL CLEAN.

54. 54 LET THE WASTE OF THE “SICK” NOT CONTAMINATE THE LIVES OF “THE HEALTHY”