Planning & Management of Bio Medical Waste H O P E S Planning & Management of Bio Medical Waste MS. JAGRUTI BHATIA 1

The History Awareness campaign by Dr Paul Connett’s visit. NGO and public pressure on the govt. & Policy makers. Involvement of the medical fraternity. Pilot project to understand the implications. Change in law. 2

The Waste Plan Setting up a team Create Awareness/Sensitization Conducting a waste audit - Identify quantum of waste category wise Decision on end treatment options Drawing up a facility wise detail plan Allocating resources Training of Trainers Extend the program to all staff from CEO to sanitary attendants Monitor - Implementation of plan Record / Report Monitoring, Review & Refresher training 21

The Team A responsible person designated as ‘Waste Manager’ . Housekeeping manager / Attendant In Charge (Mukadam). Nursing Director/Superintendent. Infection Control Nurse, Key members from the Infection Control Team. A representative from the management. A representative from the Doctors / Consultants. Sister In Charges. 22

Awareness Bio Medical Waste Management and Why Nots’??? The Whys???

Hospital Waste Disposal Awareness Hospital Waste Disposal Health Hazard Environmental Hazard Aesthetic Issue

Awareness Environmental Hazard : Hospital waste contains a higher amount of chlorinated plastics. Dumped in dumping grounds where rag pickers burn it leading to high levels of pollution Burning chlorinated plastics under incomplete combustion releases many harmful pollutants key among them being Dioxins & Furans 10

Awareness Dioxin : A Unique Killer Two aspects of Dioxin toxicity from the public health perspective: - wide variety of harmful health effects - low levels of exposure - EPA’s acceptable daily exposure 0.01 picograms/kg/day. Gets transferred through the food chain causing various health effects Humans routinely consume 300 to 600 times this amounts 19

Classification Of Hospital Waste The Waste Plan Classification Of Hospital Waste 23

Color Coding System - Segregation Incinerator ash (sec landfill), chemical waste (neutralise), Household / kitchen waste, Non-infectious bio degradable Plastic Bag Bio degrad Black Waste Sharps Puncture Proof cont Blue / White Microbiology & Biotechnology, toxins, Soiled waste(contaminated with bld & body fluids, plaster, cotton, dress), Solid Wastes (disposables) (Cat.3, 6,7) Disinfected Container / Plastic bag Red Human Anatomical Waste, Discarded medicines, cytotoxic drugs (Cat. 1,2 &5) Yellow Waste Category Type of Container Color Coding 8

Color Coding System - Treatment Disposal In secured landfill - Bio degradable – vermi-composting / composting Black Autoclaving / Micro-waving / Chemical treatment and destruction & shredding Blue / White Autoclaving / Micro-waving / Chemical treatment Red Incineration / Deep Burial Yellow Treatment Options Color Coding 9

Color Coding System - Segregation 11

Conducting a waste audit Based on the facility plan, areas for sample audit are selected for hospitals > 100 beds, for smaller hospitals all areas are covered Is conducted in 2 phases Before starting the training program After waste management planning & training The waste management team is trained to instruct, segregate & quantify waste as is the current hospital practice Time frame one to two weeks based on the hospital size 12

Conducting a waste audit 13

End treatment facility After waste audit decision on the end facility to be developed Should be based on type of waste generated, quantity & statutory requirement Will also depend on available options from central facility. Population etc. 14

Central Treatment Facility - Mumbai 12

Waste Collection Hopper -Central Treatment Facility - Mumbai 13

Implementing Waste Plan Allocating color coded bags and bins in accordance with facility plan ensuring segregation as per the rules TOT – explaining the plan, to also include worker safety measures Scheduling the collection timings within the hospital Transportation system within hospital Developing Storage facilities in-house 15

Sharps Management Plan Institute a sharps management plan Available option: Needle burners (are a better option) Needle cutters after which you disinfect & discard Disinfect in puncture proof jerry cans with disinfecting solution (like 1% Na Hypochorite) if tranporter takes authorisation from PCB for responsibility of pilferage, the better option is still to mutilate and disinfect before discard. 16

Color Coding System - Segregation 17

Sharps Management Plan 18

Transportation: Points to be remembered: The containers to be puncture proof and bags to be sturdy, leak proof for high risk waste The bags to be tied by the neck while transportation Transportation trolleys and specific lifts or timings to be designated Staff handling this to wear protective clothing, gloves, mask, aprons etc. If bags tear or get contaminated they be placed in a new clean bags ( double bagging ) Never allow any person to put hands inside the bag Stringent Infection Control Policies to be formed & implemented 19

Monitor & Review Training Evaluation Training Tools: Conducting pre and post training tests Monitoring of model sessions by Trainers Post training exams conducted for trained staff by trainers 1

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Records & Reports: Waste Audit & record keeping Ward reporting format checklist Nurse Station Sanitation Supervisor Program In Charge As per the MOEF Rules, Annual Report format (Form II, Rule 10) Accident Reporting (Form III, Rule 12) 2

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Recycling & Waste Minimization: 7

Recycling & Waste Minimization: 8

Worker Safety: Teach employees’ responsibility Issuance of protective equipment like gloves, mask Establishment of an occupational health program that includes immunization, post-exposure prophylaxis, and medical surveillance 10

THINK TODAY TO ENSURE A BETTER TOMMOROW THANK YOU 11

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