1. Bio-Medical Waste Management

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

3. 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

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

6. 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);
• HIV infections (5% of all new)

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

9. Need of BMW Management in Hospitals???

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

11. 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 

12. 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).

13. 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

14. 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

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

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

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

18. Physical injuries
Sharps
Chemicals
Explosive agents

19. Waste with high content of heavy metals
Blood pressure guages

20. PRESSURISED CONTAINERS
Aerosol
PRESSURISED CONTAINERS
Gas cartridges
Gas cylinders

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

22. 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.

23. 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)

24. 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)
/ 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 /

25. 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 / autoclaving / microwaving and mutilation / shredding
Category No. 5
Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines)
/ 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.)
/ 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 / autoclaving / microwaving and mutilation / shredding# #

26. 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 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.

27. 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.

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

29. 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)

30. LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

31. 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

32. 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.

34. 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

35. 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.

36. 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 .

37. 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.

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

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

41. 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

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

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

45. Our’s is a Beautiful Planet…Let us save together…
Lets Make This World A Better Place to Live in.

46. THANK YOU