Biomedical waste management - Recent updates

Thanks to Dr J Jayalakshmi mam, Professor of Microbiology, KMCH, Coimbatore

2. 9/8/2021

ni, KMCH-IHSR 2

3. Biomedical Waste Management

8' Sep 2021 — CAHO -Young IMA - Webinar Dr J.Jayalakshmi
Professor & HOD , Microbiology
KMCH Institute of Health Sciences & Research , Coimbatore

4. Objectives...

+ Biomedical waste (BMW)

+ Classification & Types of BMW

+ Lifecycle of Biomedical waste

+ Risks associated with BMW

+ Safety of personnel handling BMW
+ Monitoring BMW handling

+ COVID waste guidelines

9/8/2021 Dr JJayalakshmi , KMCH-IHSR

5. Biomedical waste (BMW)

Any waste that is generated during Diagnosis,
Treatment or Immunization of human beings or
animals, or in research activities , or in the production of
biological

> Ministryof'Environment , Forest and Climate change - 2016

6. Burden of Biomedical waste in India

203 tons per day -!!!

DISPROPORTIONATE INCREASE

While new cases increased by 234 per cent, COVID-19 biomedical waste
generation went up by 11 percent between the peak months of the two waves
© NewCOVIO-19 cases @ Averoge COVID-19 biomedical wostegenerationin tonnes per day (TPD)

E
E
E
ES
E

2

= En]
om May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Moy
2020 2021 dl
* Woste generation dota only til May 10,2021; Source: Cental Pollution Control Boord

ayalakshmi , KMCH-IHSR Central Pollution control board, Mays2021

7. By the end of the vaccination drive, which the Centre hopes to reach by the
end of this year, the country would have generated over 1.3 billion used
syringes, needles and more than 100 million discarded glass vials,

8. Classification of Hospital waste

Waste generated In Indian Hospitals — 1-2 Kgs / bed / day

80% General Waste 20% Biomedical Waste

Kitchen waste (Food, peels, tea cups, foil,
plastic, fruit, vegetable leftovers)

General office waste (Wrapping paper,
office papers, cartoons, packing materials)

9/8/2021 Dr JJayalakshmi , KMCH-IHSR

10. 9/8/2021 Dr JJayalakshmi , KMCH-IHSR

11. Unsafe Segregation Reuse of Equipment Unsafe Disposal

Injuries Infections Toxic Effects

12. BMW Management Rule -2016.
(Amended — 2018 & 2019)

A Guidelines for Management of

2 Healthcare Waste as per

stra Biomedical Waste
The Gazette of India Management Rules, 2016

9/8/2021 Dr1JayaMinistry-ofEnvironment & Forest and Climate change-2016

13. BMW management - 3Rs Concept

El € O

REDUCE REUSE

a
ue

RECYCLE

14. Uniform guidelines and Code of practice for managing BMW

Hospitals, nursing homes, clinics, dispensaries,

Veterinary institutions, animal houses, |

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

9/8/2021 DrJ.Jayalakshmi, KMCH-IHSR 1

15. BMW - 2016 ( 2018 & 2019 amended)
Color Coding

+ Standardizing the practices

+ Identifying the contents, without opening the bags

+ Improving compliance

9/8/2021 DryeMinistry-ofEnvironment , Forest and Climate change -2016

16. Human Anatomical Waste

Animal Anatomical Waste

Blood Bags
Microbiology, Cli

ical

& Laboratory Waste

go

=
E

I
se

Non-Chlorinated Yellow

Bag of 50 micro!
El

CONTAINERS rosana

9/8/2021

J

zatment with Autoclave

a |

Jayalakshmi

Discarded Medicines Liquid Waste from OT/Lab

Cytotoxic drugs Floor Washing
Items Contaminated Infected Secretions
with Cytotoxic drugs. Discarded disinfectants

| y
J J
a

Pre-treatment With 1%
Sodium Hypochlorite Solution

ETP/STP

CH-IHSR 1

17. RED CATEGORY

Recyclable Waste (Plastic)
Tubings Urine bags
Bottles Syringes.
Gloves even soiled Vaccutainers

y
Cutting/Mutilation

q

Non-Chlorinated Red Bag of 50 micron

BLUE CATEGORY

Recyclable Waste (Glass)
Broken Glass
Medicine vials Ampoules
Metallic Body Implants

Contaminated Glass}

WHITE CATEGORY

Metal Sharp Waste
Needles Blades

Scalpels Burnt Needles
Syringes with fixed needles

I _
> —

L

Needle shredder/Cutter

White translucent Puncture Proof
Disposable Container

18. #

BIO MEDICAL WASTE MANAGEMENT RULES, 2016 <:

D
CONTAMINATED DISPOSABLE PLASTIC BROKEN / DISCARDED EXPIRED MEDICINES /
RECYCLABLE WASTE SHARPS CONTAINER GLASSWARE & CYTOTOXIC DRUGS &

see METAL IMPLANTS PPE USED FOR

sourowasre MB | uses. sacs Ba NEEDLES & METAL HANDLING THEM
e IV CANRULA SHARPS ONLY

mass, car

Shot cover, oisposaste

oisrosance ramos

Y |

NEEDLE .

Disposante [il

PLASTIC APRON

AUTOCLAVING à

Poster Courtesy — CMC vello;
SEGREGATE WASTE AT SOURCE TO MAKE HAZARD FREE HEALTH CARE * HICC Ah

19. BIOMEDICAL WASTE (AMENDMENT) - 2018

INFECTED WASTE | CYTOTOXICWASTE | ‘SHARPS
Kitchen Waste, Syringes, Gloves & Soiled, Anatomical, — Expired or Discarded | Antiblotic Vials, Needies
Paper & Tissues & Plastic Waste Chemical Liquid, Medicines & Tablets Metallic Implants,
Water Bottles & Cans Laboratory Waste Glassware
Material
Except Cytotoxic

$ ©

9/8/2021

20. BMW Label & Documentation

Day. Month. ‘Year. Format for Bio Medical Waste Reaister/Record

Date of generation ‘Waste category Number... Waste quantity.

Sender's Name and Address Receiver Name NAME & ADDRESS OF HEALTH CARE FACILITY

ar BIO MEDICAL WASTE REGISTER’ RECORD FORMAT

‘Quantity of DUW Generated in KG) | Date of | Tine | Name | Name &

conection | ‘an | Sanatere | Sgratre
Econ | By | eur | ut

Phone Number Phone Number Agency

Fax Number Fax Number

Contact Person Contact Person.

In case of emergency please contact
Name and Address

Phone No,
Label shall be non-washable and prominently visible.

Not

Barcoding.

9/8/2021 Dr JJayalakshmi , KMCH-IHSR 20

22. Movement of BMW
Across Lifecycle

¡Common BMW Storage]
Area @ Hospital

as + Temstonge a
+ Record Maintenance a
* Disinfection / Sterilization + Record Maintenance
+ Temp Storage
+ Record Maintenance

9/8/2021 Dr JJayalakshmi , KMCH-IHSR 2

23. Storage of BMW in the Healthcare facility (HCF)

be stored in a HCF for more
than 48hrs

9/8/2021

24. _Common BMW treatment Facil \CBMAVTR)

ES

25. Workflow - CBMWTF

26. Treatment & Disposal of Biomedical waste

Deep burial pit Sharp pit

Kayakalp - 2018
2

9/8/2021 DrJ.Jayal

27. Safety of Health Care Personnel
PPE & Vaccination

9/8/2021

28. Training — atleast once a year

29. BMW - Forms to be submitted

+ The hospital should submit - I-V forms:
|. Accident reporting - r : = News tvs a

Il. Application for authorization/renewal

Ill. Authorization
IV. Annual report — 30' June

V. Application for filing appeal

9/8/2021 Dr JJayalakshmi , KMCH-IHSR 29

30. Mismanagement Of Medical Waste Can
Lead To 5 Years Of Jail Or Penalty Of 1 Lakh:
Delhi Government

As per the new guidelines under Biomedical Waste Management Rules, 2016, all healthcare units
handling medical waste in any form must pre-treat it onsite through disinfection or sterilization process,
failure to which can lead to imprisonment of five years or fine of ? 1 lakh or both

Delhi, News | IANS | September 04, 2017 5:26 PM | 1

Lo Lt [5] in Ba Ff

Dr JJayalakshmi , KMCH-IHSR

9/8/2021

31. Monitoring BMW Management

+» Audit - Direct observation / CCTV
camera

+ Onsite inspection - BMWCTF

* Reviewing BMW generated

+ Barcoding

32. Hospital Waste Management Committee
>30 beds - Bey 6 months

“OK, next on the age waste management.”

33. Bio-Medical Waste Management
(Amendment) Rules, 2019 ( 195 Feb 2019 )

. The occupier of all bedded health care units, shall maintain and update on a day to day
basis the bio-medical waste management register.

. All bedded healthcare units shall display the monthly record of waste disposal
management on its website.

. Such health care facilities (irrespective of any number of beds), shall make the Annual
Report available on its web-site before 19 March 2021.

. Health Care Facilities having less than ten beds shall have to comply with the output
discharge standard for liquid waste by 31st December, 2019

34. Implementation of BMW standards

+» Practices as per the updated rule + Report accidents

+ CBMWTF - 75kms radius + Daily Documentation of the BMW
+ Deep burial pit — if beyond 75kms + Uploading the website

+ Pre-treat the BMW + Annual report — 30' June

« Non chlorinated bags + BMW committee — Every 6 months

« Labelling & Barcoding

36. TOO MUCH TO HANDLE

As many os 22 staes/Uls have generated more biomecical waste
than thar featment copociy during he pandeme's second wave

00 fox tomes mass gerer n toros per doy (FO) 8 ok amet capacty (F0)

wa Ka

EE

9/8/2021

Rising to the challenge
India has been proactive in issuing guidelines for the
management of COVID-19 biomedical waste

Central Pollution Control Board
(CPCB) releases its guidelines
on COVID-19 biomedical waste

handling which spells out the woste
management system that needs to be
instituted for hospital isolation words

June 6
Third review issued to address the

ores and cers io in he

Dr JJayalakshmi , KMCH-IHSR

March 25
Fe ease of ba ame on
‘waste handling

ond healthcare facilities

CPCB releases the COVID-19 BMW
pplication for treatment facilities and
waste generators fo update their output,
‘Supreme Court makes reporting through
the application mandatory on July 30

July 14
A td fl brace! aptos

37. PCB Guidance for Safe disposal of BMW

38. Safe disposal of COVID waste
(Hospitals)

Temporary Waste
Storage Area of Healthcare Facility

Guidelines for handling , treatment and disposal of waste generated during treatment / diagnosis / quarantine of COVID -19 patients .
Version -4, 21* July 2020

9/8/2021 Dr JJayalakshmi , KMCH-IHSR 38

39. Household

Central Pollution Control Board has updated its guidelines on disposal of COVID-19 waste adding that
general households in the country are now required to cut the gloves and mask and store in paper bags for
at least 72 hours before disposing of

9/8/2021 Dr JJayalakshmi , KMCH-IHSR 39

40. To Summarize.............

+ CPCB / SPCB - CBMWTF
+ Color coded - Bags / PPC

* Compliance to be ensured

OVID waste disposal.

9/8/2021

41. Proper BMWM - Not just a legal necessity
but also a social responsibility...... 11111!

9/8/2021