Bio-Medical Waste Management

WASTES Wastes Solid waste Liquid Waste Gaseous Waste   Household waste Industrial waste Biomedical waste or hospital waste

What is Bio-medical waste ?? Definition Waste generated during the diagnosis, testing, treatment, research or production of biological products for humans or animals (WHO) Adequate medical supplies are already a problem for many developing countries like India, but disposal of biomedical waste is another, more serious matter

WHO estimates 85% of hospital waste is non-hazardous 10% is infectious 5% is non-infectious.

WHO has estimated that In year 2014 injections with contaminated syringes caused: • 21 million hepatitis B virus (HBV) infections (32% of all new infections); • Two million hepatitis C virus (HCV) infections (40% of all new infections); • 260 000 HIV infections (5% of all new)

Biomedical Waste (BMW) Management WHO IS AT RISK?? Sanitation workers Medical & Paramedical staff Patients & attenders Public 9/16/2018 Biomedical Waste (BMW) Management

Need of BMW Management in Hospitals???

Let the waste of the “sick” not contaminate the lives of“The Healthy”

Hazardous health care waste can result in 1. Infection 2. Genotoxicity and Cytotoxicity   3. Chemical toxicity   4. Radioactivity hazards.  5. Physical injuries   6. Public sensitivity. Inadequate waste management thus will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles contaminated with human. Although there are no exhaustive documented studies on health hazards associated with poor hospital waste management, some indicators like progressive increase in hospital infection rate, increasing resistance to wide variety of antibiotics are the pointers to the way in which poor hospital waste management can contribute to the ill health plaguing the health care institutions.   In addition to health risks associated with the poor management of bio-medical waste, due consideration must be given to the impact on environment, especially to the risks of pollution of water, air and soil. Hence, collection and disposal of waste in the proper manner is of great importance as it can decrease directly and indirectly health risk to people, and damage to flora, fauna and the environment 

Infection The infectious agents enter into the body through Puncture Abrasion Cut in the skin Through mucous membranes By inhalation and ingestion. Commonest infections, which can result from mishandling of hospital/health care waste, are gastro enteric through faeces and/or vomit (Salmonella, Shigella spp., Vibrio Cholera, Helminthes; Hepatitis A), Respiratory through inhaled secretions; saliva (Mycobacterium tuberculosis; measles virus; streptococcus pneumonae), Ocular infections through eye secretions (Herpes virus), Genital infections (Neisseria gonnorrhoeae; herpes virus), Skin infection through pus (Streptococcus spp.), meningitis through Cerebrospinal fluid (neisseria meningitides), AIDS through blood and sexual secretions (HIV), Haemorrhagic fevers through body fluids (Junin, Lassa, Ebola and Marburg viruses), Septicaemia and  bacteraemia through blood (staphylococcus aureus, Enterococcus, enterobacter, klebsiella and streptococcus) and Viral Hepatitis B & C through blood and body fluids (hepatitis B and C viruses).

Most Common Infections 1. Gastro enteric through faeces and/or vomit e.g. Salmonella, Vibrio Cholera, Helminthes Hepatitis A 2. Respiratory through inhaled secretions e.g. Mycobacterium tuberculosis; Measles virus; Streptococcus pneumoniae 3.Ocular infections through eye secretions e.g. Herpes virus, 4. Skin infection through pus e.g. Streptococcus spp , 5. Meningitis through Cerebrospinal fluid e.g. Neisseria meningitides

Most Common Infection Cont. 6. Blood borne diseases AIDS Septicaemia and  bacteraemia Viral Hepatitis B & C 7. Hemorrhagic fevers through body fluids Lassa, Ebola and Marburg viruses

Genotoxicity and Cytotoxicity Irritant to skin and eyes E.g. alkylating agent, intercalating agent Carcinogenic and Mutagenic e.g. Secondary neoplasia due to chemotherapy

Chemical Toxicity Many drugs are hazardous May cause intoxication , burns, poisoning on exposure

Radioactivity Hazards Radioactive waste exposure may cause headache, dizziness, vomiting, genotoxicity and tissue damage Visual impact of the anatomical waste, recognizable body parts

Physical injuries Sharps Chemicals Explosive agents

Waste with high content of heavy metals Blood pressure guages

PRESSURISED CONTAINERS Aerosol PRESSURISED CONTAINERS Gas cartridges Gas cylinders

Discarded medicines Waste Sharps eg: Needles Human anatomical waste Solid waste eg: cotton swabs

PENALTIES FOR IMPROPER WASTE MANAGEMENT AS PER RULES The PENALTIES are as specified in Environment (Protection) Act 1986. Imprisonment for upto five years with fine upto one lakh rupees, or both. In case the failure additional fine upto five thousand rupees for every day.

Bio-Medical Waste Flow Chart Generator (HOSPITALS) In House Segregation (Collection, Segregation Packing in Color Coded Poly Bags) Common Storage Point At Hospitals Transportation (Approved Special Vehicle) Waste Water to ETP Unloading and Temp Storage at CBWTF Re Use Treatment (Incineration, Autoclaving and Shredding) Disposal ( Recycling & Landfill)

Categories of Biomedical Waste Schedule as per WHO Standard WASTE CATEGORY TYPE OF WASTE TREATMENT AND DISPOSAL OPTION Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep burial* Category No. 2 Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts,) Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines,) Local autoclaving/ microwaving / incineration@

Categories of Biomedical Waste Schedule as per WHO standards Cont…. Category No. 4 Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts) Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding Category No. 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Incineration@ / destruction and drugs disposal in secured landfills Category No. 6 Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.) Incineration@ / autoclaving / microwaving Category No. 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# #

Categories of Biomedical Waste Schedule as per WHO standards cont…. Category No. 8 Liquid Waste (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities) Disinfecting by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Category No.10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfecting, as insecticides, etc.) Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids.

HOW TO Manage BMW?? Survey of waste generated reduction at source . Segregation of hospital waste. Collection & Categorization of waste. Storage of waste. Transportation of waste. Treatment of waste.

1) Survey of waste generated -frequent survey 1) Survey of waste generated -frequent survey..atleast during every 6 months

2) Source Reduction Source Reduction - ways to lessen the amount of material Segregation - keeping noninfectious waste out of the infectious waste stream Minimization - reduce or eliminate waste at the source Engineering controls - methods to reduce quantity of waste(smaller containers)

LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

3) Segregation of waste At the point of generation In a color coded leak-proof container Container should bear 'Biohazard' symbol and appropriate wording Container should never be completely filled

Color Coding For Segregation of BMW 1998 WASTE Yellow Human & Animal anatomical waste / Micro-biology waste and soiled cotton/dressings/linen/beddings etc. Red Tubings, Catheters, IV sets. Blue / White Waste sharps ( Needles, Syringes, Scalpels, blades etc. ) Black Discarded medicines/cytotoxic drugs, Incineration ash, Chemical waste.

PACKAGING & LABELING: Bags 3/4th filled should be tied, Name of the ward Date of Packaging, Destination (Treatment Site) Bio Hazard/Cytotoxic Symbol Weighing & Recording Separate Register and Weighing Machine Daily recording is mandatory

LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS/BAGS Date of generation ................... Waste category No ........ Waste class…………… Waste description…………. Sender's Name & Address……….. Contact Person………….. Receiver's Name & Address……… In case of emergency please contact, Name & address………. Label shall be non-washable and prominently visible.

5) Transportation, storage (within the hospital) The waste in bags or containers should be stored in a separate area, room, or building of a size appropriate to the quantities of waste produced and the frequency of collection. Health care waste should be transported within the hospital or other facility by means of hand cart wheeled trolley .

TRANSPORTATION Transportation of BMW can be divided into internal and external transportation. INTERNAL: it is for yellow ,red ,blue and white bags. EXTERNAL: it is for the general waste collected in the black coloured plastic bags.

Safe Transportation REGISTERED, AUTHORIZED, BMW TRANSPORTERS G.J multiclave

DISPOSAL METHODS OF BIO-MEDICAL WASTES Incineration Chemical disinfection Autoclave Microwave Shredder Deep burial

ANNUAL REPORT To be submitted to the prescribed authority by 31 January every year Name of the occupier with Address Categories of waste generated and Quantity [monthly average] basis: Name of treatment facility with Address Category-wise quantity of waste treated Mode of treatment with details: Any other information

STAFF SAFETY Proper training Personal protective clothing and equipment Immunization Post-exposure prophylaxis Medical surveillance Personal hygiene

Responsibility Infection control is everyone's business. You are not only protecting yourself, but also those around you

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