BMW biomedical waste management powerpoint.pptx

biomedical waste management

1. BIOMEDICAL WASTE MANAGEMENT (Amendment) RULES, 2018

2. Bio-Medical Waste – 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 . The Bio- medical Waste Management rules are applicable to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form.

3. BMW Rules – HISTORY Ministry of Environment, Forest and Climate change. The BMW 1998 rules were modified in the years – 2000, 2003, and 2011,2016,2018,2019.

4. BMW Rules apply to All who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste :- Hospitals, Nursing homes Clinics Dispensaries, Veterinary institutions Animal houses, Pathological laboratories (irrespective of the size) Blood banks, Clinical establishments Research or educational institution Health camps, Medical or surgical camps, Vaccination camps, Blood donation camps, First aid rooms of schools, Forensic and research labs. AYUSH hospitals , BMW Rules – SCOPE

5. 18 Rules, 4 Schedules, and 5 Forms Schedule I - BMW colour coding, collection, treatment and disposal Schedule II - Standards for treatment and disposal Schedule III - Prescribed Authorities and Responsibilities Schedule IV - Labels for BMW containers and Bags Form I - Accident Reporting Form II and III - Application and Authorization document Form IV - Annual Report Form IVA - Annual Report by SPCB or AFMS to CPBB Form V - Appeal BMW Rules – SCHEDULES and ANNEXURES

6. BM WASTE CATEGORISATION WASTE Non Infectious 75- 85% Infectious 10- 15% Hazardous 5- 15% In a large tertiary care hospital in India (AIIMS), the Bio medical waste generated is about 1.5kg/bed/day as against 2.8kg/bed/day from a similar sized hospital in USA.

7. Why BMW is Important ? 80% non- infectious (kitchen waste, paper) 15% is infectious (dressings, anatomical wastes, blood bags) 5% is non-infectious but hazardous (chemicals, drugs and mercury) When this 20% of the hospital infectious material is mixed with 80%. Then all the 100% waste becomes hazardous and infectious, hence segregation should be done at source.

8. Treatment and Disposal technologies for health care waste Incineration High temperature dry oxidation process. Reduces organic and combustible waste to inorganic incombustible matter. For wastes that cannot be recycled, reused and disposed off in a land fill site. No pretreatment required.

9. Incineration Suitable for incineration Not Suitable for incineration Low heating volume – above 2000 kcal/kg for single chamber incinerators Pressurized gas containers, ampules containing heavy metals Combustible matter content > 60% Large amount of reactive chemical waste Non-combustible solid content < 5% Silver salts and photographic or radiographic waste Moisture content < 30% Halogenated plastics such as PVC Content of non-combustible fines < 20% High mercury or cadmium content waste, such as broken thermometer, used batteries

10. Types of Incinerators Double chamber pyrolytic incinerators, designed to burn infectious health care waste. Single chamber furnaces with static grate. Rotary kilns operating at high temperature, decomposes genotoxic substances and heat resistant chemicals.

11. Chemical Disinfection Kills/ inactivates pathogens Disinfection rather than sterilization Most suitable for liquid waste – blood, urine, stools, hospital sewage Solid wastes can be disinfected with certain limitations (microbiological cultures, sharps)

12. Wet and Dry Thermal Treatment Wet Thermal treatment Shredded waste exposed to high temperature, high pressure steam Inappropriate for anatomical waste and animal carcasses Inefficient for chemical and pharmaceutical waste Screw-Feed technology Non- burn, dry thermal disinfection Shredded and heated in a rotating auger Waste reduction by 80% in volume and 20-35% in weight Suitable for treating infectious waste and sharps Inappropriate for pathological, cytotoxic or radioactive

13. Microwave Irradiation Microwave frequency of about 2450 MHz and wavelength of 12.24 nm. Efficiency should be regularly checked through bacteriological and virological tests.

14. Land Disposal Municipal disposal sites : Open dumps and Sanitary landfills Healthcare waste should not be deposited on open dumps. Advantages of Sanitary landfills over open dumps Geological isolation of waste from environment Appropriate engineering preparation On site staff Organized deposit and daily waste coverage

15. Inertization Mixing waste with cement and other substances before disposal to minimize risk of toxic substance to ground or surface water. 65% pharmaceutical waste, 15% lime, 15% cement and 5% water. Homogeneous mass cubes or pellets formed are then transported to storage sites.

16. OCCUPIER means a person having administrative control over the institution and the premises generating bio- medical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank, health care facility and clinical establishment, irrespective of their system of medicine and by whatever name they are; OPERATOR of a common bio- medical waste treatment facility means a person who owns or controls a Common Bio- medical Waste Treatment Facility (CBMWTF) for the collection, reception, storage, transport, treatment, disposal or any other form of handling of bio- medical waste;

17. PROCESS FLOW OF BMW Generation Segregation Storage Collection Transportation Treatment & Disposal

18. Human anatomical waste, Chemo drugs, Soiled waste Expired or Discarded Medicines, soiled linen Contaminated Plastic Waste (Recyclable) Waste sharps including Metals Glassware: Broken or discarded and contaminated glass including medicine vials and ampoules General waste

19. YELLOW CATEGORY Human Anatomical Waste: Human tissues, organs, body parts and fetus Animal Anatomical Waste : Soiled Waste: Items contaminated with blood, body fluids like dressings, plaster casts, cotton swabs and bags containing residual or discarded blood Incineration or Plasma Pyrolysis or deep burial SOILED WASTE

20. DRUGS (d) Expired or Discarded Medicines including antibiotics Common bio- medical waste treatment facility: Incineration (d) CYTOTOXICDRUGS: Including all items Contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc. YELLOW CATEGORY

21. Microbiology, Biotechnology and other clinical laboratory waste: Laboratory cultures, stocks or specimens of microorganisms Pre- treat to sterilize with nonchlorinated chemicals on- site as per NACO or World Health Organization LINEN: linen , mattresses, contaminated with blood or body fluid. LABORATORY WASTES AND LINEN

22. CHEMICAL & LIQUID WASTES (g) Chemical Waste: Discarded disinfectants Yellow coloured containers or non- chlorinated plastic bags Disposed of by incineration or Plasma Pyrolysis or Encapsulation in hazardous waste treatment, storage and disposal facility. (h) Chemical Liquid Waste : discarded Formalin, liquid from laboratories and floor washings, cleaning, etc. Separate Collection system leading to effluent treatment system YELLOW CATEGORY

23. Pre-Treatment Chemical treatment using at least 1% Sodium Hypochlorite having 30% residual chlorine for twenty minutes Final Treatment Effluent treatment system Chemical waste

24. AUTOMATED LIQUID WASTE TREATMENT SYSTEM FOR PRE- TREATMENT

25. RED CATEGORY – PLASTICS RECYCLABLE WASTE (a) Wastes generated from tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles and fixed needle syringes ) and gloves Autoclaving or micro- waving/hydroclaving followed by shredding or mutilation catheters, urine bags, syringes (without needles and fixed needle syringes ) and gloves

26. SHARPS - WHITE CONTAINER Puncture Proof, Leak Proof, Tamper Proof, Translucent Container Waste sharps Including Metals: Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, This includes both used, discarded and contaminated metal sharps Autoclaving or Dry Heat Sterilization followed by shredding or mutilation Handed over to Waste Agency… when 2/3 full.

27. BLUE CARDBOARD BOXES WITH BLUE COLORED MARKING Glassware: Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes & Metallic Body Implants Disinfection (by soaking the washed glass waste after cleaning with detergent and Sodium Hypochlorite treatment) or through autoclaving or microwaving or hydro claving and then sent for recycling.

28. GENERAL WASTE IN BLACK

29. General Waste All the waste other than bio-medical waste and which has not been in contact with any hazardous or infectious, chemical or biological secretions and does not include any waste sharps. This waste consists of mainly: Newspaper , paper and card boxes (dry waste) Plastic water bottles (dry waste) Aluminum cans of soft drinks (dry waste) Packaging materials (dry waste) Food Containers after emptying residual food (dry waste) Organic / Bio- degradable waste - mostly food waste (wet waste) Construction and Demolition wastes

30. General waste is further classified as : Dry Wastes Wet Wastes collected separately Such waste is required to be handled as per Solid Waste Management Rules, 2016 and Construction & Demolition Waste Management Rules, 2016, as applicable ** Other Wastes : used electronic wastes (E- Waste), used batteries, and radio- active wastes which are not covered under biomedical wastes but have to be disposed as and when such wastes are generated as per the provisions laid down under E- Waste (Management) Rules, 2016, Batteries (Management & Handling) Rules, 2001, and Rules/guidelines under Atomic Energy Act, 1962 respectively. General Waste

31. Biomedical Waste - Accidents and Management Accident: Any Spill of BMW whether liquid or solid and incidents of needle stick injury (NSI) Reported to prescribed authority i.e. CPCC in Form I with the annual report, Management Prevention of their recurrence.

32. Liquid Spill Management PPE : Wear Personal Protection Equipment (PPE) - gloves and mask . If there is risk of splash , protective eye- shield and gown should also be worn. Limit : Put some absorbent material over the spilled liquid like tissue paper or old newspaper or gauze piece so that excess of the spilled liquid gets absorbed onto the absorbent material. Disinfect/neutralize : If spilled liquid is potentially infectious like blood etc., pour a disinfectant solution like 1% sodium hypochlorite solution over the spilled liquid and absorbent material and leave for 30 minutes . For acid spills , sodium bicarbonate and for alkaline spills, citric acid powder may be used for neutralization .

33. Liquid Spill Management Collect : Thereafter, disinfectant/neutralizing the spilled liquid along with the agent may be mopped up/wiped . The absorbent material should never be turned during this process, because this will spread the contamination. The mopping should be carried out by working from the least to the most contaminated part. Mopping cloth should not be reused , but should be put into appropriate waste container for final disposal. After mopping, cleaning may be done with detergent and water.

34. BMW Management at Healthcare Facilities No HCF shall establish on-site BMW treatment and disposal facility if the provision of CBMWTF is present at a distance of 75 Km . If no CBMWTF is available, the occupier shall set up requisite BMW treatment facility such as incinerator, autoclave or microwave, shredder after taking prior authorization from the prescribed authority After confirming treatment of plastics and glassware by autoclaving or microwaving followed by mutilation/shredding, these recyclables should be given to authorized recyclers .

35. Non Compliance of Rules The occupier is liable for penalty for contravention of the provisions of the Act and the Rules, orders and directions as specified in Rule 15 . of the E(P)Act,1986 which states that “whosoever fails to comply or contravenes any of the provisions of the Act and the Rules, orders and directions be punishable with imprisonment for a term which may extend to five years or with fine which may extend to one lakhs rupees or both ”

36. Newer Innovations in BMW Management Barcoding and GPS (global positioning system) to be established for handling of BMW within 1 year.

37. Bad vs Good Practices

38. GOOD WASTE HANDLING PRACTICES

39. Labelling of BMW bags The label should be non- washable and prominently visible

40. NEEDLE STICK INJURIES Infectious Disease/Agent Risk of Transmission HBV up to 30% (if the source patient is HBs Ag as well as H b e Ag + ve ) 1 to 6% (if the source patient is only HBs Ag +ve) HCV to 7% HIV 0.2 to 0.5% An injection needle used on a HBV or HCV positive patient may retain live virus for approximately 7 days. Survival of HIV in a hypodermic needle is for approximately 3 days.

41. NEEDLE STICK INJURIES All HCWs and waste handlers must get complete course of vaccination against HBV and tetanus. For prophylactic purposes, 3 doses of HBV vaccine are given at 0, 1 and 6 months interval. After 2 months of the 3rd dose, anti HBs titre is estimated. The protective level of anti- HBS Titre is ≥ 10 m IU/ml. If the titre is less, the course of vaccination should be repeated. There is no need for booster dose. 4 doses of Tetanus Toxoid are given, 1 dose each at 0, 2, 12 months and 5 years.

42. Immediate For Injury : Wash with soap and running water. For Non intact Skin Exposure : Wash with soap and water. For Mucosal Exposure : Wash thoroughly. Reporting All sharps injury and mucosal exposure MUST be reported to the immediate supervisor, and to the Casualty Medical Officer to evaluate the injury. Details of the needle- stick injury should be filled by the supervisor and handed over to the HIC nurse for further follow- up. Management Management is on a case to case basis. Follow- Up Follow- up and statistics of needle- stick injury are done by the HIC nurse on a weekly basis. This information is presented at the HICC meeting and preventive actions to avoid needle- stick injuries, if any, are recorded. NEEDLE STICK INJURIES MANAGEMENT

43. POST-HIV EXPOSURE MANAGEMENT / PROPHYLAXIS (PEP) Occupational exposure : Occupational exposure refers to exposure to potential blood- borne infections (HIV, HBV and HCV) that occurs during the performance of job duties. “Exposure” which may place an HCP at risk of blood- borne infection is defined as: a percutaneous injury (e.g. needle-stick or cut with a sharp instrument), contact with the mucous membranes of the eye or mouth, contact with non- intact skin (particularly when the exposed skin is chapped, abraded, or afflicted with dermatitis), or contact with intact skin when the duration of contact is prolonged (e.g. several minutes or more) with blood or other potentially infectious body fluids. NEEDLE STICK INJURIES MANAGEMENT

44. HIV - Infection Risk

45. It is necessary to determine the status of the exposure and the HIV status of the exposure source before starting post-exposure prophylaxis (PEP). For skin - if the skin is broken after a needle- stick or sharp instrument: Immediately wash the wound and surrounding skin with water and soap, and rinse. Do not scrub. Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine). After a splash of blood or body fluids on unbroken skin: Wash the area immediately Do not use antiseptics NEEDLE STICK INJURIES MANAGEMENT

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