Bio-Medical Waste Management in Indian Hospitals: WELCOME Workshop Bio-Medical Waste Management in Indian Hospitals: Trends, Technology & Challenges CDK - BMW

The problem Health - Care Settings generates Bio-hazardous waste, which is managed casually Bio-medical waste gets mixed with Municipal Solid Waste Improper management & handling of waste Dumping of waste Adverse impact to Public Health & Environment Occupational risk Lack of will and lack of awareness Misplaced priorities CDK - BMW

Who is at Risk ? • Doctors and nurses • Patients • Hospital support staff • Waste collection and disposal staff • General public Environment CDK - BMW

Evolution of Bio-medical Waste legislation • 1860: The Indian Penal Code 269 – Negligent act likely to spread infection of disease dangerous to life 270 – Malignant act likely to spread infection of disease dangerous to life Whoever unlawfully/malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment for a term which may extend to six months or with fine, or with both CDK - BMW

Evolution of Bio-medical Waste legislation • 1974: The Water Act Restriction on discharge of effluents from Health care establishments (HSEs)‏ • 1981: The Air Act Restriction imposed on emission of air pollutants into atmosphere by HSEs • 1986: The Environment (Protection) Act The Central Govt. to make rules in respect of handling of hazardous substances No person shall handle hazardous substance except in accordance with procedures prescribed by law CDK - BMW

Evolution of Bio-medical Waste legislation • 1989: BIS – 12625:1989 Solid Wastes – Hospitals – Guidelines for Management 1995:Delhi HC Case by B.L.Wadhera • 1995: Draft Bio-medical Waste Rules 1997: Second Draft • 1998: Bio-medical Waste Rules Govt. of India Gazette notification on 20.07.1998 2000: First Amendment to schedule VI 2000: Second Amendment 2003: Third Amendment CDK - BMW

Enforcement - Issues Definitions Segregation - containers Packing – plastic covers Transportation Authorization – along with consents Records & Reports – annual & accident Common disposal facility - incinerators Role of Municipal body Applicability of Cess Act Liquid waste Radioactive waste CDK - BMW

Bio-Medical waste (Management & Handling) Rules,1998 Bio-Medical Waste (BMW)‏ Means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I Occupier In relation to any institution generating bio-medical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called, means a person who has control over that institution and/or its premises CDK - BMW

Bio-Medical waste(Management&Handling) Rules,1998 Applicable to all persons who Generate Collect Receive Store Transport Treat Dispose Handle - Bio-Medical Waste in any form Prescribed Authority for Enforcement Karnataka State Pollution Control Board CDK - BMW

Duty of Occupier It shall be the duty of every occupier of an institution generating bio-medical waste to: Take all steps to ensure that waste is handled without any adverse effect to human health & the environment To install an appropriate facility to ensure requisite treatment of waste in accordance with Schedule - I & in compliance with standards prescribed in Schedule - V Ensure proper segregation of waste into containers/ bags at the point of generation in accordance with Schedule - II Ensure proper labeling of containers/bags according to Schedule - III & IV CDK - BMW

Duty of Occupier Make an application in Form - I to the KSPCB for grant of Authorisation Submit an Annual Report to KSPCB in Form - II by 31st January every year Maintain Records about generation, collection, storage, treatment & disposal of wastes Report Accidents occurred while handling waste in Form - III to KSPCB CDK - BMW

Schedule I – Category, Treatment & Disposal Local autoclaving/ Micro waving/ incineration Microbiology & Biotechnology Wastes (wastes from laboratory cultures,stocks or specimens of micro-organisms live or attenuated vaccines,human and animal cell culture used in research and infectious agents from research and industrial laboratories,waste from production of biologicals, toxins, dishes and devices used for transfer of cultures)‏ 3 Incineration/ deep burial Animal Waste 2 Human Anatomical Waste (Human tissues,organs,body parts)‏ 1 Treatment & Disposal Waste Category Waste Category CDK - BMW

Schedule I – Category, Treatment & Disposal Incineration/autoclaving/ micro waving Soiled waste (item contaminated with blood and body fluids including cotton dressings, soiled plaster casts,lines beddings,other material contaminated with blood) 6 Incineration/destruction and drugs disposal in secured landfills Discarded Medicines and Cytotoxic drugs (wastes comprising of outdated, contaminated and discarded medicines) 5 Disinfection (chemical treatment/autoclaving/ micro waving and mutilation/shredding Waste sharps (Needles, syringes, scalpels, blades, glass etc. that may cause puncture and cuts. This include both used and unused sharps) 4 CDK - BMW

Schedule I – Category, Treatment & Disposal Chemical treatment and discharge into drains for liquids and secured landfill for solids Chemical waste (chemicals used in production of biologicals, chemicals used in disinfection, as insecticides etc)‏ 10 Disposal in municipal landfill Incineration Ash (ash from incineration of any bio-medical waste)‏ 9 Disinfection by chemical treatment and discharge into drain Liquid Waste (waste generated from laboratory and washing, cleaning, house-keeping and disinfecting activities)‏ 8 Disinfection by chemical treatment/ autoclaving/ micro waving and mutilation/shredding Solid Waste (waste Generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc)‏ 7 Act CDK - BMW

Segregation, Packing, Transportation & Storage BMW shall not be mixed with other wastes BMW shall be segregated into containers/bags at the point of generation accordance with Schedule II prior to its storage, transportation, treatment & disposal Containers shall be labelled according to Schedule If containers transported outside the premises also carry information prescribed in Schedule IV BMW shall be transported only by the authorised vehicle Untreated BMW shall not be stored beyond 48 hours Municipal body shall continue to pick up and transport segregated Bio-medical solid waste and treated BMW from hospitals & nursing homes for disposal at municipal dump site CDK - BMW

Colour coding & Type of container for disposal of BMW Disposal in secured landfill 5,9,10 Plastic bag Black Autoclaving/Micro waving/Chemical treatment and Destruction/Shredding Autoclaving/Micro waving/Chemical treatment Incineration/Deep burial Treatment options as per Schedule I 4,7 Plastic bag/Puncture proof container Blue/ White translucent 3,6,7 Disinfected container/ plastic bag Red 1,2,3, 6 Yellow Waste Category Type of Container Colour coding CDK - BMW

Prescribed Authority and Authorisation Karnataka State Pollution Control Board (KSPCB) is the prescribed authority in the State to enforce the provisions of the Rules Every occupier of an institution generating, collecting, receiving, storing, transporting, treating, disposing & handling BMW in any other manner form except occupier of clinics, dispensaries, pathological labs, blood banks provide treatment/service to less than 1000 patients per month shall apply to KSPCB for grant of authorisation in Form I KSPCB shall make enquiry and after satisfied that the applicant possesses the necessary capacity to handle BMW, grant or renew authorisation within 90 days KSPCB will give reasonable opportunity of being heard before refusing, canceling or suspension of authorisation CDK - BMW

Annual Report, Records, Accident Reporting, Appeal Every occupier shall submit Annual Report to KSPCB in Form II by 31st January every year to include information about the categories & quantities of BMW handled during the previous year Occupier shall maintain records related the generation, collection, storage, transportation, treatment & disposal of BMW All records are subject to inspection & verification by KSPCB at any time When any accident occurs while handling BMW the occupier shall report the accident in Form III to KSPCB Any person aggrieved by an order made by KSPCB under these Rules may prefer an appeal in Form V within 30 days to the Appellate Authority CDK - BMW

Common Disposal / Incineration Sites Without prejudice to Rule 5, the Municipal Corporations, Municipal Boards or Urban Local Bodies shall be responsible for providing suitable common disposal/incineration sites for the BMW generated in their area In areas outside the Municipal area it shall be the responsibility of the occupier to arrange for suitable sites individually or in association CDK - BMW

Other issues Liquid waste management Sharps management Plastics waste management Location of color coded bins Common BMW treatment facility Training BMW from home patients Waste audit CDK - BMW

Waste Origin and Disposal Scenario in Bangalore : Total Bedded hospitals : 417 Total non- bedded HCEs : 595 Total bed strength of bedded hospitals : 19769 Total Solid Biomedical Waste in Bangalore : 10 T/d Source: As per records of KSPCB 92% of waste is disposed off at two Common Biomedical Waste Disposal Facilities Semb Ramkey Maridi Ecoservices Rest of the Bio-medical waste (mostly from house and clinics)‏ finds its way to Municipal Solid Waste

The Biomedical Waste (Management and Handling) Rules 1998 Scenario in Karnataka : Total Biomedical Waste generating units (Human Hosp + Vet Hosp + Blood Banks + Diagnostic Centers + Hospitals) : 10537 Waste generated : 52 t/d Total Common Biomedical Waste Treatment and Disposal Facility (CBMWTF): 13 Total districts covered : 23 Districts not covered : 6 (Kolar, Chikballapur, Bagalkot, Koppal, Uttra Kannada and Kodagu)‏ Waste Collected from CBMWTF : 60% Rest of the Biomedical Waste is disposed by captive facility

Disinfection Facility provided at General Hospital, Yelahanka, Bangalore

Thank you, C.D.Kumar KSPCB Bangalore Call 98453 80070 CDK - BMW