Biomedical Waste Management-by Satish Sinha

8/16/2019 Biomedical Waste Management-by Satish Sinha

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Bio-Medical WasteManagement

Satish Sinha


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History of medical waste• Medical Waste Tracking Act in

US

• I Draft Rules in India–1995• Final Rules in 1998,

a!end!ents and 5 guidelines

• "#$luti$n $f Rules and

%ractices t&r$ug& 'ati$nal"()eriences

• 'ati$nal *uidelines $n +MW,*uidelines $n Incinerati$n,

TFs, I!!uni-ati$n Waste andMercur.


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Various networks'*/s

• 0ealt& are Wit&$ut 0ar!

0W02In3ecti$n safet.4

• SI*' Safe In3ecti$n *l$al'et6$rk2

Anti7incinerati$n4 • *AIA *l$al Anti Incinerat$r

Alliance2

Mercur.

• er$ Mercur.


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Stockholm Convention onPersistent OrganicPollutants

• an internati$nal

en#ir$n!ental treat. • ai!s t$ eli!inate $r restrict

t&e )r$ducti$n and use $f)ersistent $rganic )$llutants

%/%s2• entered int$ f$rce $n 1: Ma.

;;< 6it& rati=cati$n . 18and 1>8 signat$ries

http://en.wikipedia.org/wiki/Environmental_lawhttp://en.wikipedia.org/wiki/Treatyhttp://en.wikipedia.org/wiki/Persistent_Organic_Pollutanthttp://en.wikipedia.org/wiki/Ratificationhttp://en.wikipedia.org/wiki/Ratificationhttp://en.wikipedia.org/wiki/Persistent_Organic_Pollutanthttp://en.wikipedia.org/wiki/Treatyhttp://en.wikipedia.org/wiki/Environmental_law


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Basel Convention

• $ntr$l $f Tran $undar.M$#e!ent $f 0a-ard$us

Wastes and T&eir Dis)$sal

• Mini!i-e &a-ard$us 6aste

generati$n and dis)$se itnearest t$ t&e )$int $fgenerati$n


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nvironmental!egulations

• "n#ir$n!ent %r$tecti$n Act, 198>

• +MW Rules 1998

• Munici)al Waste Manage!ent and 0andling2

Rules, ;;;• At$!ic "nerg. Act

• 0a-ard$us Wastes Manage!ent ? 0andling2Rules, 1989

• "7Waste Rules

• +atteries M?02 Rules ;;1

• Manufacture, St$rage and I!)$rt $f0a-ard$us &e!icals rules, 1989


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Patient safety and Bio-medical waste

management

• In ;; W$rld 0ealt& asse!l., )asseda res$luti$n calling !e!er states t$

6$rk f$r safet. $f %atients

• In /ct ;;


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Priority areas for Patient safety

• Safe clinical )ractices and &and&.giene

• Safe Surgical )ractices

• +l$$d Safet.• Safe In3ecti$ns %ractices

• 0ealt& are Waste Manage!entRules and guidelines are a#ailale ut

i!)le!entati$n is #er. )$$r Back $ftraining $r )$$r training is als$ a fact$r It&as n$t een gi#en t&e due )ri$rit. . !$st$f t&e states and dedicated udget isreCuired All states s&$uld f$cus $n t&is


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Health care associated infections

• $!)licate et6een 571; $f ad!issi$ns inacute care &$s)itals in

industriali-ed c$untries

• It is esti!ated t&at t&isrisk is u) t$ ; ti!es

&ig&er in de#el$)ing 6$rld

• At an. gi#en ti!e, 1< !illi$n)e$)le 6$rld6ide suEer fr$! 0AI,and at least 5; $f 0AI are


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"nsafe in#ections

• India c$ntriutes t$ 57; $f t&egl$al in3ecti$ns W0/, 19992

• Annual in3ecti$n usage G – >illi$n, $f t&is nearl. t6$7t&irds>9in3ecti$ns2 unsafe India B"' Stud.;;7;<


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Why $ollow "niversal

Precautions• T&e )re#alence rate $f l$$d $rn

disease7 0e)atitis + 8H1;;;, 0I:H1;;; 'A/ 1992

• DiEicult t$ test eac& )atient

• 'SI and $t&er s&ar) in3uries aret&e ke. anadian &ealt& issue,aEecting :;;;; )e$)le )er .earand c$sting ar$und d$llar 1


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What is this concernfor%

• Infecti$us 6aste s$lid and liCuid2

• S&ar)s 6aste

• .t$t$(ic 6aste

• %&ar!aceutical 6aste

• Radi$acti#e 6aste

• &e!icals and disinfectants

• %ressurised c$ntainers


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BMW !ules and &ey'ctors

• '$ti=ed in 1998

• $nce)t $f %%% !$del

•

Identi=ed tec&n$l$gies andstandards

• %+

•

S%+• De)art!ent $f 0ealt&

Headline of presentation to come here (on slide master)


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&now your waste


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Waste (reatment ) *is+osal System

Category Waste category (reatment

Category 1 Human anatomicalwaste

Inc/burial

Category 2 Animal waste Inc/burial

Category 3 icrobiology !biotechnology waste

Inc/alternate

Category " #aste sharps $isinfection !autocla%ing/microwa%ing/shredding ! mutilation

Category & $iscarded medicines'

cytotoic drugs

Inc/landll

Category * !+

,olid waste Autocla%ing'microwa%ing !mutilation for category +

Category - .iuid waste $isinfection

Category 0 Incineration ash .andll


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Schedule ,,

Colourcoding

(y+e ofContainer ,

WasteCategory

(reatmento+tions as

+er Schedule,

ellow lastic bag Human' animal'microbiology'soiled waste

Incineration/deepburial

4ed $isinfectedcontainer/ plasticbag

icrobiology'solid ! soiledwaste

Autocla%ing/icrowa%ing/Chemical 5reatment

6lue/#hitetranslucent

lasticbag/punctureproofcontainer/,harps6laster

#aste sharps !solid waste

Autocla%ing/icrowa%ing/Chemical 5reatment !destruction/shredding

6lac7 lastic bag $iscardedmedicine' $isposal insecured landll


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Bio-medical waste andtechnology

• Tec&n$l$g. is $nl. a fracti$n $f t&e

s$luti$n• Ma3$r c$!)$nents $f 6aste

!anage!ent are4

o Segregation of waste

o

Waste minimisationo Reducing use of hazardous substances

or processes

o Waste Audit


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'++roved treatment

methods

• Aut$cla#e

• &e!ical disinfecti$n

• 0.dr$cla#e

• Micr$6a#e

• Incinerati$n

• An. $t&er tec&n$l$g. after %+ a))r$#al


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,n house management of

waste• 1Sur#e.

Meeting 6it& t&e &eads $f all t&e de)art!ents

F$r!ing a 6aste !anage!ent c$!!ittee

Suggest eCui)!ent )r$cure!ent

:F$r!al training f$r all t&e nursing staE

8I!)le!enting t&e s.ste! t&r$ug&$ut t&e


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Of site management of

waste-Centralied $acilitiesDraft Guidelines on Common facilities-

• Treatment facilities- 90% non-burn, 10% waste- burn

• Limits incineration to Categories 1&2• tleast 1 !m from residential areas" cce#table in

industrial area

• $ne o#erator allowed to cater u#to 10,000 beds,situated witin 10 'm radius

• (egregation is te role of generator) o#erator can re#ortmi*ing of waste to te #rescribed autorit+


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2006 2008 2009

HCF Total Number of Healthcare facilities 73975 129511

Number of HCFs linke to CTFs ! o"n facilit# 3$001 11*-

Number of facilities "here "aste is not bein%treate

3997$ 13$31

&ercenta%e of total facilities "ith no t#'e oftreatment mechanism

5$( 10(

)aste *io+meical "aste %enerate !a# 319$53 k%s $13500, "1"0&*8

*io+meical "aste treate !a# 1$3952 k%s 295270 291983

*io+meical "aste not treate !a#+ 175501 k%s 113719

Percentage of Bio-medical waste untreated/day

55% 28%

-ncinerator Total incinerators in the countr# $36 5$7

-ncinerators "ith .&C/s 207 250

-ncinerators "ithout .&C/s 229 297

Total Number of Violations 244!2 !"#"$

&' issued ()ow cause notices !48*8

Medical 6aste in India4 ;;>7;;9


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Hurdles in

,m+lementation Issues $f a)acit.

B$6 )ri$rit.

Res$urce All$cati$n Fi(ed Mindset

In3ecti$n safet., c&e!ical safet. and 6aste !anage!ent issues .et t$ =nds)ace in de#el$)!ent )lanning


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At t&e S%+ le#el

a)acit. and res$urce

M$nit$ring and c$ntr$l

Trans)arenc. $f )r$cesses 0ierarc&. $f c$ntr$l

Inde)endent audits

A6areness $f c$!!unit. Increasing $utreac& $f centrali-ed

facilit. t$ rural areas


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't the Hos+ital level

Mindset issues

In#$l#e!ent $f seni$r!anage!ent

Res$urce a#ailailit. and)ri$ritising

*$#ern!ent 0$s)itals iggest

defaulters a)acit. +uilding

I!)le!entati$n $ttlenecks

Res)$nsiilit. =(ing


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Way $orward

Res$urce all$cati$n f$r 6aste!anage!ent

Maintaining a )$$l $f trainers at l$ckHdistrict le#els Stake&$lders in#$l#e!ent Inc$r)$rati$n int$ curricula $f !edical,

nursing and )ara!edical c$lleges U) gradati$n t$ latest de#el$)!ents in+MW !anage!ent

Waste !ini!i-ati$ns )$lic.

A))r$)riate tec&n$l$g. selecti$n 7


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merging ,ssues

Mercur. First !ercur. d$cu!entati$n in

&ealt&care in ;;


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merging ,ssues

In3ecti$n Safet. Increased attenti$n . &$s)itals

Fines $n unattended needles '$ t$ reca))ing

Re)$rting $f needle stick in3ur. and

f$ll$6 u)

&e!ical Safet.

M$nit$red use $f *lutaralde&.de,f$r!alde& de en-ene c t$t$(ic


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(hank .ou

Toxics Link-2, ung#ura .*t"

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011-22003, 220411

[email protected]

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Biomedical Waste Management-by Satish Sinha