BMW[1].pptx community health nursing-2..

Bio medical waste management

1. COMMUNITY HEALTH NURSING- II BIOMEDICAL WASTE MANAGEMENT Submitted To: RESP. PRAVEEN MA’AM Faculty of CON, VMMC & SJH Submitted By: Mamta 02450306619 B. Sc(hons) Nursing 4 th Year CON ,VMMC & SJH

2. INTRODUCTION In July 1998,first BMW rules were notified by govt of India and ministry of environment and forest {MOFF}. The BMW 1998 rules were modified in the following years- 2000, 2011, 2016, 2018 and 2019. This rule Applies to those who generate , collect ,receive , store , treat Biomedical waste in any manner.

3. DEFINITION Any waste, which is generated during the diagnosis, treatment, or immunization of human beings or animals , research activities or in the production or testing of biological products or in health camps, is referred to as bio-medical waste.

4. IMPORTANCE OF BMW It is crucial to protect the environment and public health. Direct health risk to the general population, health care professionals.

5. Category Type of waste Type of bag or container to be used Treatment and disposal option Yellow a.) Human anatomical waste: Human tissues, organs, body parts and foetus below the viability period . Yellow coloured non-chlorinated plastic bag. Incineration, deep burial. b.) Animal anatomical waste: Experimental animal carcasses , body parts, organs, waste generated from animal testing in veterinary hospitals. Yellow coloured non-chlorinated plastic bag. Incineration, deep burial. c.) Soiled waste: Items contaminated with blood ,body fluids like dressings, plaster caste, cotton swabs. Yellow coloured non-chlorinated plastic bag. Incineration, deep burial, autoclaving, microwaving.

6. Category Type of waste Type of bag or container to be used Treatment and disposal option Yellow d.) 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 . Return back to the manufacturer for incineration . e.) Chemical waste: Chemicals used in production of biological and used or discarded disinfectants. Yellow coloured non-chlorinated plastic bags or containers. Incineration, plasma pyrolysis.

7. Category Type of waste Type of bag or container to be used Treatment and disposal option Yellow f.) Chemical liquid waste: Discarded formalin , infected secretions, aspirated body fluids, liquid from disinfecting activities. Separate collection system. The chemical liquid waste shall be pre-treated before mixing with other waste water. g.) Discarded linen, mattresses, beddings contaminated with blood or body fluids. Non-chlorinated yellow plastic bag. Chemical disinfection, shredding, incineration. h.) Microbiology, biotechnology and other clinical laboratory waste: Blood bags ,laboratory cultures, specimens of micro-organisms, live or attenuated vaccines. Autoclave safe plastic bag or containers. Pre-treat to sterilize with non-chlorinated chemicals on site and thereafter for incineration.

8. Category Type of waste Type of bag or container to be used Treatment an disposal option Red Contaminated waste (Recyclable): Tubings , bottles, catheters, urine bags, syringes ,gloves. Red coloured non-chlorinated plastic bag or container. Autoclaving, microwaving, followed by shredding .Treated waste to be sent to registered or authorized recyclers. White (Translucent) Waste sharps including: metals Needles, scalpels, blades, contaminated metal sharp. Puncture proof, leak proof, tamper proof containers. Autoclaving ,followed by shredding and send for final disposal to iron foundries.

9. Category Type of waste Type of bag or container to be used Treatment an disposal option Blue a.) Glassware: Broken or discarded and contaminated glass including vials and ampoules except those contaminated with cytotoxic waste. b.) Metallic body implants. Cardboard boxes with blue coloured marking. Disinfection, autoclaving, microwaving and then sent for recycling.

10. SOURCES OF WASTE MAJOR SOURCES * Hospitals/ dispensaries. * Medical colleges, research centers. * Blood banks, mortuaries. * Nursing homes. MINOR SOURCES * Dental clinics * vaccination centers. * psychiatric clinics /wards. * Cosmetic clinics.

11. HEALTH HAZARDS OF BIOMEDICAL WASTE Proliferation of rodents. Breeding of flies and insects. Air pollution. Land pollution. Water pollution. Transmission of infections like HIV, Hepatitis-B and other microbes. Bad odour .

12. THE MAIN GROUPS AT RISK ARE Doctors, nurses, hospital maintenance personnel. Patients. Visitors Workers in laundries, waste handling, transportation Workers in waste disposal facilities such as land –fills or incinerators .

13. CATEGORY OF WASTE 1. YELLOW- yellow colored non- chlorinated plastic bags are used. * human anatomical waste, animal anatomical waste, expired medicines, mask and gown, PVC Blood bags, laboratory waste. * Cytotoxic drugs and waste with cytotoxic symbol on bag. * Discarded linen and bedding. * Soiled waste [ dressing , bandage and cotton swabs] TREATMENT- Incineration , Deep burial, Autoclaving, chemical disinfection.

14. . 2. RED – Includes contaminated waste { Recyclable} Red colored non- chlorinated plastic bag container. * Tubings – IV sets, NG tube *Catheters * Used gloves * Urine bags and specimen container * syringe * IV plastic bottles TREATMENT- Autoclaving, microwaving , chemical treatment and send to reclycling .

15. . 3. BLUE [ box]- puncture proof and leak proof boxes. * Glassware { vials ,Ampoules, glass bottles} * Used slides * Metallic body implant. TREATMENT- Autoclaving, Microwaving, Disinfection and then send for recycling.

16. . 4. WHITE [ Translucent]- puncture proof ,leak proof, temper proof container with the cutting device on it’s top. * Waste sharps * blades * sutures * Needles TREATMENT- Shredding, disinfection , autoclaving and then send to iron foundries .

17. 5. GENERAL WASTE BLUE BIN Dry waste Paper Cardboard GREEN BIN Wet waste Vegetables Fruits

18. STEPS FOR EFFECTIVE MANAGEMENT OF BMW Survey of waste generated. Segregation of hospital waste. Collection and categorization of waste Storage of waste Transportation of waste . Treatment of waste

19. WASTE SURVEY Differentiate the types of waste Quantity the waste generated . Determine the points of generation and types of waste generated at each point . Determine the level of generation and disinfection within the hospital.

20. SEGREGATION It refers to the basic separation of different category 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 BMW management. Effective segregation alone can ensure effective BMW management.

21. LABELING OF CONTAINERS The bins and bags should carry the biohazard symbol indicating the nature of waste to the patient and public. Labels shall be non washable and prominently visible. Cytotoxic waste should be labelled with appropriate symbol .

22. COLLECTION The collection of BMW involves of different types of container s :- All the bags used for waste collection need to be sealed once they are filled to ¾ th of their capacity. Sharps box should be puncture proof , leak proof, tamper proof to avoid injuries and infection to the waste handlers. BMW should be handled properly by using universal precautions to prevent from any kind of infection .

23. STORAGE OF BMW Once collection occurs then biomedical waste is stored in proper place. Segregated waste of different categories need to be collected in identifiable containers. This is a short term storage location inside a hospital where various waste kinds should be delivered for secure holding until they are treated or collected for shipment to CBMWTF. [ COMMON BIOMEDICAL WASTE TREATMENT FACILITY]

24. TRANSPORTATION OF WASTE The waste should be transported within 24 hours to the central BMW storage facility of the hospital. The containers should be tied before transportation. Container should be accompanied with a signed document by nurse/doctors mentioning date , shift ,quantity and destination.

25. TREATMENT TECHNOLOGIES INCINERATION – The volume and weight of waste are significantly reduced through the high temperature dry oxidation process known as incineration. Incineration is usually done for those wastes that cannot be reused , recycled,or disposed off in a landfill act site.

26. . CHEMICAL DISINFECTION- 1-2% Hypochlorite is mixed to waste which result in disinfection. More suitable for liquid waste such as discarded blood and body fluid and also for hospital sewage . AUTOCLAVING- It is a thermal process where steam is brought into direct contact with waste in a controlled manner and for sufficient duration to sterilize the wastes. It is mainly used for the treatment of infectious plastic and sharp waste.

27. . MICROWAVING- Radio-frequency waves used at a frequency of 2450 MHz. They produce friction of water molecules which generates heat . Large size microwaves are used for disposal of BMW- mainly infectious plastic and sharp wastes . SHREDDER- Shredding is a process by which wastes are de-shaped or cut into smaller pieces so as to make the wastes unrecognizable. - It helps in prevention of reuse of BMW and also helps to reduce the waste volume.

28. . INERTIZATION- The process of inertization involves mixing waste with cement and other substances before disposal to minimize the risk of toxic substances contained in the waste migrating to surface or groundwater. - 65% pharmaceutical waste. - 15% lime. - 15% cement. - 5% water. LANDFILL OR LAND DISPOSAL 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.

29. ROLE OF NURSE IN BIOMEDICAL WASTE MANAGEMENT   Avoid needle stick injuries. Avoid spilling and clean them with disinfectant. Proper labeling should be done of the bags. Make the provision of safe segregation, handling and transport of BMW. Use universal precautions to avoid infection. Immunize self and others time to time and maintain the records. Report major accidents.

30. CONTINUED.. Regular visits of all the wards and high risk units. Ensuring that samples [ Blood ,Stool, Urine etc..] are collected and dispose safely . Supervising whether the staff are doing safe disposal of waste as per color coding. Prevention of hospital acquired infections by following universal precautions.

31. SUMMARY This Presentation includes the definition of the BIOMEDICAL WASTE MANAGEMENT – IMPORTANCE , CLASSIFICATION OF WASTE , SOURCES OF WASTE, CATEGORIES OF WASTE , HEALTH HAZARDS OF BIOMEDICAL WASTE, TREATMENT TECHNOLOGIES , EFFECTIVE MANAGEMENT OF BIOMEDICAL WASTE MANAGEMENT, WASTE SURVEY,COLLECTION ,SEGREGATION , LABELING OF WASTE ,STORAGE, TRANSPORTATION, ROLE OF NURSE IN BIOMEDICAL WASTE MANAGEMENT.