BIOMEDICAL WASTE MANAGEMENT SLIDE.pptx

I YR B BSC NURSING

1. BIOMEDICAL WASTE MANAGEMENT PRESENTED BY : MRS BEMINA JA ASSISTANT PROFESSOR ESIC COLLEGE OF NURSING KALABURAGI NURSING FOUNDATION

2. INTRODUCTION Medical care is vital for our life, health and well being. But the waste generated from medical activities can be hazardous, toxic and even lethal because of their high potential for diseases transmission. The hazardous and toxic parts of waste from health care establishments comprising infectious, bio-medical and radio-active material as well as sharps (hypodermic needles, knives, scalpels etc.) constitute a grave risk, If these are not properly treated/disposed or is allowed to get mixed with other municipal waste. Its propensity to encourage growth of various pathogen and vectors and its ability to contaminate other Nonhazardous/non-toxic municipal waste jeopardises the efforts undertaken for overall municipal waste management.

3. The rag pickers and waste workers are often worst affected, because unknowingly or unwittingly, they rummage through all kinds of poisonous material while trying to salvage items which they can sell for reuse. At the same time, this kind of illegal and unethical reuse can be extremely dangerous and even fatal. Diseases like cholera, plague, tuberculosis, hepatitis (especially HBV), AIDS (HIV), diphtheria etc. in either epidemic or even endemic form, pose grave public health risks. Unfortunately, in the absence of reliable and extensive data, it is difficult to quantify the dimension of the problem or even the extent and variety of the risk involved.

4. With a judicious planning and management, however, the risk can be considerably reduced. Studies have shown that about three fourth of the total waste generated in health care establishments is non-hazardous and non-toxic. Some estimates put the infectious waste at 15% and other hazardous waste at 5%. Therefore with a rigorous regime of segregation at source, the problem can be reduced proportionately. Similarly, with better planning and management, not only the waste generation is reduced, but overall expenditure on waste management can be controlled. Institutional/ Organisational set up, training and motivation are given great importance these days. Proper training of health care establishment personnel at all levels coupled with sustained motivation can improve the situation considerably.

5. The rules framed by the Ministry of Environment and Forests ( MoEF ), Govt. of India, known as ‘Bio-medical Waste (Management and Handling) Rules, 1998,’ notified on 20th July 1998, provides uniform guidelines and code of practice for the whole nation. It is clearly mentioned in this rule that the ‘occupier’ (a person who has control over the concerned institution / premises) of an institution generating bio-medical waste (e.g., hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank etc.) shall be responsible for taking necessary steps to ensure that such waste is handled without any adverse effect to human health and the environment.

6. TERMINOLOGIES Hospital waste: refers to all waste, biological or non biological that is discarded and is not intended for future use. Medical waste: refers to material generated as a result of patient diagnosis, treatment, immunization of human being or animals. Infectious waste: are the portion of medical waste that could transmit an infectious disease. Pathological waste: waste removed during surgery, autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimen along their container.

7. DEFINITION: Bio hazardous waste is that waste that is capable of producing an infectious disease in humans and includes at a minimum blood, body fluids, discarded sharps, inoculated culture media, tissues and slides. “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 BMW rules 2016” -World Health Organization Bio-Medical Waste, means any waste, which generated during the diagnosis, treatment or immunization of human being or animals or in research activities and is governed by the Bio-Medical Waste (Management and Handling) Rules, 1998.

8. Components of Bio-medical waste Human anatomical waste (tissues, organs, body parts etc.), Animal waste (as above, generated during research/experimentation, from veterinary hospitals etc.), Microbiology and biotechnology waste, such as, laboratory cultures, micro-organisms, human and animal cell cultures, toxins etc., Waste sharps, such as, hypodermic needles, syringes, scalpels, broken glass etc., Discarded medicines and cyto -toxic drugs Soiled waste, such as dressing, bandages, plaster casts, material contaminated with blood etc., Solid waste (disposable items like tubes, catheters etc. Excluding sharps), Liquid waste generated from any of the infected areas, Incineration ash, Chemical waste.

9. BIOHAZARDOUS WASTE INCLUDES THE FOLLOWING CATEGORIES Blood and body fluids Infectious Sharps waste Laboratory waste Medical sharps Some isolation waste Some animal waste

10. HEALTH HAZARDS ASSOCIATED WITH POOR MANAGEMENT OF BIO-MEDICAL WASTE Injury from sharps to staff and waste handlers associated with the health care establishment. Hospital Acquired Infection(HAI)( Nosocomial ) of patients due to spread of infection. Risk of infection outside the hospital for waste handlers/scavengers and eventually general public. Occupational risk associated with hazardous chemicals, drugs etc. Un authorised repackaging and sale of disposable items and unused / date expired drugs

11. Blood/Blood Products •Serum, •Plasma •Other blood components 2. Body Fluids •Semen •Vaginal secretions •Cerebrospinal fluid •Pleural fluid •Peritoneal fluid •Pericardial fluid •Amniotic fluid •Any other body fluid visibly contaminated with blood 3.Does NOT Include •Urine, unless visible blood is present •Feces, unless visible blood is present •Vomit, unless visible blood is present

12. SOURCES OF HEALTH CARE WASTE: Private hospitals Nursing homes Physician offices, clinics Dental clinics Dispensaries PHC Medical research and training centers Mortuaries Blood banks and collection centers Slaughter houses Vaccine centers Biotechnological and industrial production units

13. GROUP AT RISK Doctors, nurses, health care auxiliary Hospital maintenances personnel Visitors Laundries waste handling Landfills/ incinerators

14. OVERVIEW OF HEALTHCARE WASTE MANAGEMENT SHARPS: Needles, infusions sets, Scalpels, knives, blades WASTE WITH HIGH HEAVY METAL CONTENT: Batteries, broken thermometers, Blood pressure gauges PATHOLOGICAL WASTE: Body parts, blood & other fluids CHEMICAL WASTE: Lab reagents, Disinfectants, solvents INFECTIOUS WASTE: Lab Cultures, waste from isolation wards, tissues, etc. PHARMACEUTICAL WASTE: Expired or no longer needed pharmaceuticals. GENOTOXIC WASTE: Cytotoxic drugs, geno toxic chemical. PRESSURIZED CONTAINERS: Gas cylinders, Cartridges & aerosol cans.

15. HEALTH HAZARDS OF HOSPITAL WASTE PROLIFERATION OF RODENTS BREEDING OF FLIES AND INSECTS AIR POLLUTION LAND POLLUTION WATER POLLUTION TRANSMISSION OF INFECTIONS LIKE HIV, HEPATITIS-B, OTHER MICROBES BAD ODOUR

16. TREATMENT TECHNOLOGIES: 1. INCINERATION High temperature and dry oxidation process that reduces organic and combustible waste to inorganic and incombustible matter and results in significant reduction in waste volume and weights Usually used for the waste that can not be reused, recycled or disposed of in landfill site. The incinerator should be installed and made operational as per specification under the BMW rules 1998 Certificate may be taken from CPCB/State Pollution Control Board Category 1, 2, 3, 5, and 6 can be incinerated.

17. Waste types not to be incinerated are: Pressurized gas containers. Large amount of reactive chemical wastes. Silver salts and photographic or radiographic wastes. Halogenated plastics such as PVC. Waste with high mercury or cadmium content such as broken thermometers, used batteries. Sealed ampoules or ampoules containing heavy metals.

18. Double chamber pyrolytic incinerators Single‐chamber furnaces Rotary kilns Double-chamber pyro lytic incinerators specially designed to burn infectious health-care waste Single-chamber furnaces with static grate, used only if pyro lytic incinerators are not affordable Rotary kilns operating at high temperature, capable of causing decomposition of geno toxic substances and heat-resistant chemicals.

19. 2. DISINFECTION CHEMICAL DISINFECTION Destruction of most of pathogens from liquids. By using chemical disinfectants such as bleaching powder, glutaraldehyde , alcohols or quaternary ammonium compounds. Best for treating liquid wastes such as blood,urine,stools or hospital sewage.  

20. 3. STERILIZATION Steam sterilization: autoclave used to disinfect waste. Microwave irradiation: (2450 MH3 wave length 12.24 m ) water is heated with waste and then infectious component is destroyed by heat conduction. MICROWAVING •Heat is generated inside equipment during bombardment of EM waves into the retaining molecules of waste. •Waste should have some water content to enhance molecular mobility. •Highly efficient •30-40% weight reduction. •Minimal environmental pollution and occupational risk. •Cost effective. WET THERMAL TREATING(AUTOCLAVE) The infectious wastes are steam heated at specified temperature and pressure for specific period of time. Decontamination occurs when steam penetrates the waste. Autoclaves which functions within specified range of temperature, pressure etc is used. DRY THERMAL TREATMENT (SCREW FEED TECHNOLOGY) Waste is treated in a rotating auger. Waste is reduced by 80% in volume and 20- 30% in weight. Suitable for treating infectious wastes and sharps. Not used to process pathological, cytotoxic , or radioactive waste. 

21. PLASMA TORCH TECHNOLOGY It consists of a flame at about 2,200 to 13,900 °C It takes various types of garbage and vaporizes into 4th state of matter ,plasma (plasma pyrolysis ). It reduces thrash that otherwise would fill up landfills. It can dispose bio hazardous wastes safely. It is extremely costly and needs a complex set up. HYDROCLAVE An advanced autoclave method for treating infectious waste, utilizing steam, but much faster and with much heat penetration. It is a double walled cylindrical vessel mounted horizontally. The vessel is fitted with a mixing arm that rotates slowly inside vessel. It totally sterilizes the waste. complete dehydration of waste ,reduces volume by 70%. Very low operating cost. 

22. LAND DISPOSAL Compacting: reducing size and volume of waste (useful for general non hazardous waste) Shredding: breaking the material into smaller pieces by grinding /cutting/granulation Landfill: oldest method of waste disposal Encapsulation :filling containers with waste adding an immobilizing material (plastic foam/ bituminous sand/cement mortar/clay material) and sealing containers

23. 4. LANDFILL OR LAND DISPOSAL Land filling means disposal of residual solid wastes on land in a facility designed with protective measures against pollution of ground water, surface water, air and ground. Open dumps: not recommended. Sanitary landfills: Disposing of certain types of health-care waste (infectious waste and small quantities of pharmaceutical waste) in sanitary landfills is acceptable. Sanitary landfills are specially constructed for disposal of non biodegradable infectious hospital wastes. It should have an impermeable clay and pebble base. Stored earth for covering at the end of each disposal operation. Frequent spray of insecticide is done.

24. WORM COMPOSTING Biodegradable general waste from areas like kitchen, dining places, cafeteria which mostly contain organic wastes, peelings of vegetables etc collected in white containers with black stripes are disposed off. Rectangular pit of 1 m deep bound by brick wall is built. A few 100 earthworms are introduced to earth bed on which waste is dumped and some water sprinkled daily.

25. DEEP BURIAL Wastes belonging to category 1,3,6 collected in yellow containers are disposed by this method.  

26. 5. INERTIZATION: Mixing waste with cement and other substances before disposal. 65% pharmaceutical work 15% lime 15% cement 5% waters

27. HANDLING OF BIOHAZARDOUS WASTE 1.GENERATION, 2.WASTE SEGREGATION, 3.COLLECTION 4.TRANSPORTATION, 5.STORAGE, 6.END TREATMENT OR DISPOSAL

28. Segregation of waste Segregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms, treatment rooms etc. The responsibility of segregation should be with the generator of biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical personnel).

29. Transportation Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it’s mixing with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment .

30. RATIONALE OF HOSPITAL WASTE MANAGEMENT Injuries from sharps leading to infection to all categories of hospital personnel and waste handler. Nosocomial infections in patients from poor infection control practices and poor waste management. Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels. "Disposable" being repacked and sold by unscrupulous elements without even being washed. Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers. Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash

31. PRECUTIONS TAKEN DURING BIO MEDICAL WASTE MANAGEMENT 1)Never overload bins used for storing Bio Medical Waste 2)General waste to be put in black container. 3)Display the Bio-Hazardous Symbol and the types of waste to be put in each container as per Schedule 4)Never transfer sharps directly from person to person 5)Do not inhale chemicals directly. Use always mask

32. ROLE OF NURSE IN BIOMEDICAL WASTE MANAGEMENT REGULAR VISIT TO ALL WARDS AND HIGH RISK UNITS. ENSURING THAT SAMPLES (BLOOD, STOOL, URINE ETC) ARE COLLECTED AND DISPOSE SAFELY. MONITORING AND SUPERVISING THE STAFF WEATHER THEY ARE DOING SAFE DISPOSAL OF WASTE AS COLOUR CODED. PREVENTION OF HOSPITAL ACQUIRED INFECTIONS BY FOLLOWING UNIVERSAL PRECAUTIONS. • USE PERSONAL PROTECTIVE EQUIPMENT WHILE HANDLING WASTE. • Avoid needle stick injuries. • Collect waste when the bin is 3/4th full. • Avoid using common lift to move waste. • Avoid spillage. • Clean spills with disinfectant.

33. NURSE’S ROLE AND RESPONCIBILITY IN BMW MANAGEMENT Nurses are responsible and accountable for professional behavior. This involves the application of the nursing process and cooperation with other concerned authorities within the legislation affecting the practice of nursing. The accountability of nurse should be in accordance with the profession’s code of ethics and practice and within the context of the policies of the employing agency. It should also comply with the customs and values of the society in which the nursing care rendered. The following guidelines should be followed for effective BMW management. Disinfectant the waste so that it is no longer a source of pathogenic organisms. Reduce the bulk in order to reduce requirement for storage and transportation.

34. Make the waste un recognizable for aesthetic reasons Make recyclable items unusable, for example, cutting up syringes and damage the needles. Recycling infectious plastic waste can be considered only after adequate disinfection/sterilization. Disposal items, such as gloves, syringes, and the like, should be mutilated after use to prevent illegal packing and reuse. Code coding of bags should be done as per regulation. Needles, syringes and other sharp instruments and objects should be placed in a puncture–resistant plastic/ metal container at the workstation. Alternatively, sharp waste may be transported to a central site for treatment and container may be reused, but after cleaning and disinfecting. 50% of needle stick injuries are as a result of reheating. Therefore, do not recap the waste.

35. Chemical disinfectant prior to disposal is required for sharp, disposal infectious plastic/rubber, and infectious glassware and blood fluids by 1% hypochlorite or equivalent disinfectant. Always ensure that the right concentration of the disinfectant is used. Ensure that all surfaces come in contact with the chemical. Contact time should be at least 30 minutes Change the chemical solution frequently, or at least once a day. Always handle the waste with gloves and masks, apron and boots must be used if splashing is expected. Use sharp decontaminating units made up of solid plastic puncture-proof material on the outside and inner perforated container with handles filled with one third hypochlorite solution.

36. HOW TO MINIMIZE HOSPITAL WASTE? As far as possible purchase reusable Items made of glass and metal Select non-PVC plastics Strengthen sterilization procedures Adopt procedures & policy for BMW segregation Establish effective & sound recycling policy (authorized manufacturer) Special effort to recycle chemical waste Be good as gold--buy green

37. COORDINATION BETWEEN, HOSPITAL AND OUTSIDE AGENCIES Municipal authority Co-ordination with Pollution Control Boards: To search for cost effective and environmental friendly technology for treatment of bio-medical and hazardous waste Development of non-PVC plastics as a substitute for plastic which is used in the manufacture of disposable items.

38. KEY MESSAGES 1. Adhere strictly to Bio-Medical Waste (BMW) Management guidelines 2. Always use protective gears 3. Immunize yourself (HBV and TT) 4. Never take short cuts in segregation, collection, transportation or disposal of waste

39. Training Every hospital must have well planned awareness and training programme for all category of personnel. Training should be conducted in appropriate language/medium and in an acceptable manner. All the medical professionals must be made aware of Bio‐medical Waste (Management and Handling) Rules 1998.

40. CONCLUSION Safe and effective management of waste is not only a legal necessity but also a social responsibility. Proper collection and segregation of biomedical waste. Try to reduce the waste generation. Individual awareness and participation. Use recycle products. Label with agent, concentration and hazard warnings. Communicate about workplace hazards.

41. References: The Environment (Protection) Act, 1986 The Biomedical Waste (Management & Handling) Rules, 1998 The Municipal Solid Waste (Management & Handling) Rules, 2000 The Hazardous Waste (Management & Handling) Rules, 1989 The National Environmental Tribunal Act, 1995 The Air (Prevention and Control of Pollution) Act, 1981