BioBio-medical Waste Management Issues and Challenges

Dr. Selwyn A Colaco

Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore

I. Environmental Legislation
  

 

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

Implementation of BIOBIO-MEDICAL WASTE RULES 1998

BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment.

Implementation of BIOBIO-MEDICAL WASTE RULES 1998

Health care waste includes  Waste generated by the health care facilities  Research facilities  Laboratories Biomedical waste in hospitals  85% are non-infectious non 10% are infectious  5% are hazardous

Basic Principles
 Segregation and safe containment of waste at the health facility level  Processing and storage for terminal disposal

Basic Principles
 Bio-medical waste shall not be mixed with other wastes. Bio Segregation at source both at ward and unit level  Color coding to support segregation at source  Bio-medical waste shall be segregated into containers/ Biobags at the point of generation in accordance with Schedule II (BMW Rules 1998) prior to its storage, transportation, treatment and disposal.

Basic Principles
 The containers shall be labeled according to Schedule III (BMW Rules 1998)  Transport waste safely to pick up site  Identify destination for each type of waste and ensure safe disposal  Keep track of usage

Transportation & Storage of BMW

 Untreated biomedical waste shall be transported only in
vehicles authorized for the purpose by the competent authority as specified by the government.
 Untreated bio-medical waste shall not be kept/stored beyond bioa period of 48 hours.  If for any reason it becomes necessary to store the waste beyond such period, measures must be taken to ensure that the waste does not adversely affect human health and the environment.

Biomedical Waste Management - Issues

Use/Reuse of equipment

Unsafe collection

Unsafe disposal

Biomedical Waste Management - Issues

Not considered important Lack of interest from senior management No ownership of the process Awareness of problems Appreciate the need for constant monitoring

Biomedical Waste Management - Issues

Segregation of waste not taken seriously at user level Non compliance with color coding Monitoring segregation at source low budgets allocated costs are not always known Cost of color coding, staff, transport and disposal Quantification of waste generated is not accurately done

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Biomedical Waste Management - Issues

Protection of healthcare workers not given adequate thought Clinical waste dumped with non infectious waste - Risk for healthcare workers and public Waste disposal not effective, often dumped in open landfills

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Biomedical Waste Management - responsibilities

Responsibility for waste disposal head of facility, but devolved to members of the waste management team Each healthcare worker segregation and appropriate disposal Private companies from collection point in hospital to disposal Medical waste segregation awareness and Information should be available in all areas of hospital

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Challenges: Need for protocol and policies policies

To provide protection for Healthcare workers Patients Community at large - from the risk of infections Compliance with statutory requirements Government of India -1998 biomedical waste management and handling rules under EPA (compels hospitals, clinics, labs to ensure safe and environmentally sound management of waste generated at their establishments)

Challenges
Establishing robust waste management policies within the organization  Organization wide awareness about the health hazards  Sufficient financial and human resources  Monitoring and control of waste disposal  Clear responsibility for appropriate handling and disposal of waste.

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ADRESSING THE ISSUES 1. Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal 2. This is a long-term process, sustained by gradual improvements. 3. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital. 4. Man power needs and other resources for the BMWM of hospital to be addressed. 5. Quality assessment of bio-medical waste management should be done from time to time.

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ADRESSING THE ISSUES 6. Segregated collection and transportation - The use of color coding and labeling of hazardous waste. 7. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages. 8. Safety of handlers. 9. Raising Awareness about risks related to health-care waste; training staff and HCW on safe practices. 10.Selection of safe and environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

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ADRESSING THE ISSUES 11.Issue of all protective clothes such as, gloves, aprons, masks etc. to all HCW. 12.Regular medical check-up (half-yearly) of staff associated with BMWM. 13.Maintenance of Record registers for this purpose. 14.Containers should be robust and leak proof 15.Tracking of Bio Medical Waste upto point of Disposal. 16.Proper treatment and final disposal.

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Thank you Any Questions?

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ScheduleSchedule-I CATEGORIES OF BIO-MEDICAL WASTE BIOOption Category No. 1 Waste Category Human Anatomical Waste (human tissues, organs, body parts) Animal Waste (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses) Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micromicro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures) Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps) Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines) Treatment & Disposal incineration @/deep burial*

Category No. 2

incineration@/deep burial*

Category No. 3

local autoclaving/microautoclaving/microwaving/incineration@

Category No. 4

disinfection (chemical treatment @@@/auto claving/microwaving and mutilation/shredding## incineration@/destruction and drugs disposal in secured 20 landfills

Category No. 5

ScheduleSchedule-I CATEGORIES OF BIO-MEDICAL WASTE (continued) BIOCategory No. 6 Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood) Solid Waste (Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.) Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities) Incineration Ash Ash from incineration of any biobiomedical waste) Chemical Waste (Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in disinfection, as insectricides, etc.) incineration@autoclaving/micro waving

Category No. 7

disinfection by chemical treatment@@ autoclaving/microwaving and mutilation/shredding## disinfection by chemical treatment@@ and discharge into drains

Category No. 8

Category No. 9

disposal in municipal landfill

Category No. 10

chemical treatment@@ and discharge into drains for liquids and secured landfill for solids
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ScheduleSchedule-I CATEGORIES OF BIO-MEDICAL WASTE (continue) BIONote : @ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that chemical treatment ensures disinfection. Multilation/shredding must be such so as to prevent unauthorised reuse.

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##

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ScheduleSchedule-II COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO MEDICAL WASTES
Colour Coding Yellow Red Type of Container Plastic Bag Disinfected container/Plastic bag Waste Category Categories 1, 2, 3 & 6. Categories 3, 6, 7 Cat. 4, Cat. 7 Categories 5, 9, 10 Treatment options Incineration/ deep burial Autoclaving/MicroAutoclaving/Micro-waving/Chemical Treatment Autoclaving/MicroAutoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding Disposal in secured landfill.

Plastic Bag Blue/White /puncture proof Translucent containers Black Plastic Bag

Notes: 1. Colour coding of waste categories with multiple treatment options as defined in schedule 1, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I. 2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics. 3. Categories 8 and 10 (liquid) do not require containers/bags.
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